Scale up of maternal nutrition interventions strengthens antenatal care in Ethiopia

Dec 15 2022

The scale-up of a package of maternal nutrition interventions in five of Ethiopia’s 10 regions is progressing well, stakeholders said during recent interviews. The package was developed with Alive & Thrive technical assistance.

Ethiopia scale up
Beshir Obsa, a healthworker in the Dalocha Health Center in SNNPR's Silte zone, Dalocha Worde, counseling a mother.

“Our work with the health staffs in almost 200 health facilities across multiple regions is helping the Government of Ethiopia strengthen its health care system to achieve optimal nutrition for women and children,” said Dr. Abdulaziz Oumer, Alive & Thrive’s Country Director in Ethiopia. “We’re pleased with the progress scaling up the interventions.”

As part of implementing the package, Tegegn Worku, Nutrition Officer in Banja Woreda Health Office, Awi Zone, Amhara Region, has been providing training to target health facility staff, following up on the progress of training of health workers and providing feedback on the activities.

“A&T’s maternal nutrition intervention package has been very well received by health workers,” Tegegn said. “Those who received the training have cascaded it to their colleagues and all are actively engaged in the scale-up process and practice.”

The intervention package includes counseling on diet diversity, adequate meals, iron-folic acid consumption, appropriate weight gain and early breastfeeding. Alive & Thrive is supporting the Government of Ethiopia to scale up the package by introducing it in selected health facilities in Afar, Amhara, Oromia, SNNP and Somali regions.

Read the brief about the maternal nutrition intervention package and the results of implementation research on the package in Ethiopia

Watch the Alive & Thrive maternal nutrition webinar where our experts discussed the maternal nutrition implementation research and our partners at IFPRI presented the research results

The scale-up support includes training of trainers, conducting cascade trainings for health care providers and managers, and adapting previously developed job aids and materials to Afar, Amhara and Oromia regional contexts. Collectively, the health facilities in the scale-up areas serve more than 800,000 people, including approximately 30,000 pregnant women.

Misgana Feyissa, Nutrition Focal Person in Woliso Woreda Health Office, Southwest Shewa Zone, Oromia Region, participated in the maternal nutrition training.

community meeting Ethiopia
A health worker in Ethiopia's Somali Region providing maternal nutrition information to mothers.

“The intervention has created motivation and determination among the health workers, and they are excited to make the work a success,” Misgana said. “They discuss challenges during mentorship sessions, identify the source of any shortcomings and work towards addressing them.”

The scale-up strategy includes developing a pool of trainers who then cascade the training to health workers in the regions, said Tamirat Walissa, Alive & Thrive’s Nutrition Associate Director in Ethiopia.

“Trainings of trainers were provided for 15 maternal and child health and nutrition officers from the new regions of Afar, Amhara and Oromia regional health bureaus and implementation woredas,” Walissa said. “We also supported cascade trainings to primary health care unit staff.”

There is wide recognition of the importance of integrating maternal nutrition interventions in antenatal care (ANC) to improve maternal and child health. In Ethiopia, despite the availability of national maternal nutrition guidelines and promising maternal nutrition interventions, key maternal nutrition indicators still lag.

According to the Ethiopian Demographic Health Survey (EDHS 2016), 24% of women (15-49 years), 29% of pregnant women, and 29% of lactating women are anemic. Only 5% of women took 90+ iron-folic acid (IFA) tablets during pregnancy. There are interventions available to address maternal nutrition needs, but little is known about how well they are implemented in routine health services.

Alive & Thrive provided technical assistance to the Government of Ethiopia to strengthen maternal nutrition service delivery through the integration of a package of maternal nutrition in ANC services and immediate postnatal care (PNC) services while carrying out implementation research between 2019 and 2021. The research sought to better understand how to effectively integrate proven maternal nutrition interventions into Ethiopia’s public health ANC program.

To strengthen the evidence base for maternal nutrition programs and policies, Alive & Thrive developed and tested the integration of the intensive package of maternal nutrition interventions into existing ANC services delivered through government health facilities that will align with the latest global evidence and the NNPII.

Recent scale-up activities have also included data review meetings with health staff, joint supportive supervision visits conducted with government counterparts and exit interviews involving 117 ANC clients.

At the data review meetings, each primary health care unit, which comprises a health center and five health posts, presented its quarterly performance, Walissa said. The data collected showed improvement in the coverage of maternal nutrition topics among women who attended ANC visits, but also highlighted weaknesses, including inadequate utilization of pregnant women’s conferences and home visits and poor engagement of husbands and other household members in supporting pregnant women.

“Data reviews allow health staff to identify issues in service delivery,” Walissa said. “The data inform their decision making as they seek to improve ANC visits.”

Similarly, interviews with clients of ANC services also provide insight as the interventions are scaled up, he said.

“The supervision teams noted a considerable improvement in the quality of maternal nutrition counselling services in Amhara, Oromia, SNNP and Somali regions as reported by these interviewees and during observations of the service provisions by the teams,” Walissa said. “In addition, the teams have seen improvement in documentation of the maternal nutrition services provided, including tracking the number of IFA tablets provided versus consumed and weight gain tracking – the current measure versus weight gain.”

With the insights from data reviews and interviews, along with observations from joint supportive supervision, the health staff teams “have realized the necessity of innovative approach to improve husbands’ and other family support and enhance the utilization of these contact points,” Walissa said. “The team will brainstorm to come up with novel ways to consider for implementation in 2023.”

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