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Ethiopia – Bushulo Catholic Health Centre

The health centre has been serving the community since 1979. It is situated at 6 km south of Awassa in southern Ethiopia. As a health institution of the Vicariate of Awassa, it provides a multitude of health care services. The Centre is run by the Franciscan Missionaries of Mary (FMM) Sisters.

Health is a major challenge to Ethiopia’s development. Key health indicators are among the lowest in the world. Neonatal, infant and under-five child mortality rates are 38, 78 and 116 per 1,000 live births, respectively. Ethiopia is in fact one of six countries that account for 50 percent of all under-five child deaths worldwide, mainly from preventable and treatable infectious diseases complicated by malnutrition. This means 1 in 10 children do not reach their fifth birthday. On the side of the mothers, the picture is equally grim. Only 6 percent of babies are delivered at some type of institution assisted by a trained birth attendant or health professional. The vast majority of Ethiopian women deliver at home in less than ideal circumstances and because of this 20,000 mothers die giving birth each year. The Maternal Mortality Rate (MMR) is 673 per 100,000 live births. Given this backdrop, two of the ten UN Millennium Development Goals (MDG), numbers 4 and 5, relate to reducing child mortality and improving maternal health – noble and critical goals towards which to work in Ethiopia.

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Bushulo Safe Motherhood Program
Seven years ago, the Catholic Church decided to concentrate the services of Bushulo towards mother and child health (MCH) through the initiation of the Safe Motherhood Program. The multifaceted program included enhanced ante-natal care (ANC), post-natal care (PNC), community outreach to educate and animate mothers, an expanded infant/child immunization program, natural family planning, infant growth monitoring and nutrition services, and the pinnacle of the program – 24hr obstetric/gynaecological services at international quality standards by specialist doctors, midwives and nurses. The goal was clear and the plan ambitious: to reduce mother and under-five child deaths.

From April-August 2013, a thorough evaluation of Bushulo’s Safe Motherhood Program was completed, with the objective of assessing its impact and helping guide the future strategic direction of Bushulo. Conducting this type of professional evaluation in itself promotes an evidence-based development approach. As part of the evaluation, a detailed household level survey was conducted on the women in the reproductive age group (15-49 years) in the catchment area of Bushulo who gave birth in the past 2 years. The results of the study demonstrate the tangible impact.
When compared to the regional state, the achievement is impressive. The results are clear: if women have access to high quality ante-natal care (99% of all pregnant women received ante-natal care in the Bushulo catchment area!) through community level outreach, the risk of complications can be detected and these women can be advised to deliver at the institution.

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Last year 1,818 deliveries were performed at Bushulo of which half were by caesarean section due to complications. This high number of complicated deliveries is attributed to the increased reputation of Bushulo whereby other institutions refer their high risk women for management. Another surprising result is this: of the women who delivered at Bushulo, 100% returned for post natal checkups (compared to 57% of women who delivered at home) and these mothers would then continue with regular immunizations, growth monitoring and health care for their children.

Conquering Mother and Infant Deaths
Ethiopian women prefer to deliver at home due to a complex set of cultural and traditional reasons. For example, the tradition of the Sidama people, the dominant ethnic group around Bushulo, is to bury the placenta immediately after birth in the soil floor of the family’s house, definitively marking one’s family roots. With institutional delivery, this tradition is broken. That is why changing the place of delivery has been so difficult. Both the government and NGO’s have poured millions of dollars into changing behavior but with little results.

So what is the reason for Bushulo’s success? Top notch Ethiopian obstetricians, experienced personnel, the community based outreach education, the sincere care and love that the FMM Sisters pour into their service ñ all these are factors. But we would suggest that outcome is the key. Last year at Bushulo there was only one maternal death, and this year up until today with over 2000 births, not one mother has died despite the fact that the majority were high risk. It is only such positive outcomes that will truly change the behavior of more women towards institutional delivery. If they see with their own eyes that they are more likely to survive by delivering at the institution, then most of them choose it, despite the cultural yearning to deliver in their home and village.

The Future of Bushulo
Building on these encouraging results, the Diocese of Awassa is moving forward to forge a collaborative partnership with the government to upgrade Bushulo into a fully specialized ‘Mother and Child Health Centre (MCH)’. It would be the first and only specialized MCH centre in the whole south of Ethiopia (30 million people). It would be a ‘Centre of Excellence’ in obstetrics and paediatrics offering the best care, along with opportunities for research and training of doctors, midwives and nurses. There is a lot of work ahead to realize the noble vision of this specialty MCH centre, but one thing is certain: if ever the term ‘evidence-based development’ could be aptly applied to a project, it is for the future of Bushulo, where need and opportunity meet at the service of the poor.

Mark Banga

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