The Power of Partnership: Addressing the 3 Delays in Ethiopia

During my last visit to Ethiopia, I watched as tourists poured into the town of Lalibela in Northern Ethiopia, to visit the renowned rock hewn churches and to celebrate the festival of Timket (Epiphany). I couldn’t help but grapple with the stark contrast of traveling via direct flights and charter buses, as our partners and I analyzed the challenges that local women face to reach a health center to deliver their baby. Some of the women that I met with described how it took up to four hours to traverse the rough terrain and reach the health center, either on foot or lying on a stretcher, being carried by family members and neighbors.

The difficulty of reaching a health center is one of three delays that are often described as the most pressing barriers that women face in order to prevent death during pregnancy and childbirth. Equally important to consider, is the delay in deciding to seek care and the delay in receiving adequate care upon arrival at a facility.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) is working with the Ethiopian Society of Obstetricians and Gynaecologists (ESOG) on the Women and Their Children’s Health (WATCH) Project, a project that is implemented in collaboration with Plan Canada, to help address the three delays that contribute to high maternal mortality rates in Ethiopia. While Plan Canada is well placed to work at the community level to reduce the delay for patients to seek care, the SOGC and ESOG bring their expertise to improve the quality of care offered at health facilities, through training of health professionals and health administrators, as well as supportive supervision visits to ensure that the training is integrated into daily practice.

During my visit in January, I participated in the first round of supportive supervision visits at the health centers around Lalibela and was able to observe how beneficial these visits were to everyone involved. The ESOG members, who act as Emergency Obstetric and Neonatal Care focal people, were able to learn about how health centers function out in the districts and better understand the challenges that the mid-level care providers face when dealing with complications during pregnancy and childbirth. The ESOG members offered recommendations to improve the services provided at the health centers and reinforced the importance of evidence-based practices.

The health care providers at the health centers were equally pleased to have had representatives from the referral hospital visit their center, noting that these types of visits rarely occurred in the past. The visits helped to reinforce the training that had been provided to them previously and also to strengthen the relationship between the hospital and health centers. The ESOG members encouraged the health center staff to call them in times of emergencies or when clinical questions arise. The two groups also had an opportunity to discuss improved communication between the two levels of health care facilities and explore ways in which to strengthen referral mechanisms.

The integrated approach to community- and facility- based maternal and newborn health programming that is used within the WATCH project is a comprehensive strategy to strengthen health systems at the district, sub-district and health-post level in order to improve health care services along the continuum of care.

The childhood game of ‘connecting the dots’ seems simple enough, but in the world of development we sometimes forget this very important step. My last visit to Ethiopia made me realize just how beneficial it is to bring together different actors and to look at all points of contact for the pregnant woman as she follows through the continuum of care. Because reducing one delay or barrier is not enough to guarantee the woman’s survival during childbirth; to have a real impact we must work together to simultaneously overcome all three.

Moya Crangle is a Registered Midwife and a Project Manager with the Global Health Program at the Society of Obstetricians and Gynaecologists of Canada (SOGC). She can be reached at [email protected].

For more information about the SOGC’s Global Health Program, please visit


June 10, 2014


Moya Crangle