This is an individual project showing strategies of addressing pregnant women labor delays in St. Paul's Hospital Millennium Medical College , Addis Ababa, Ethiopia

1. Project title :- Strategies to address labor delays among mothers giving
birth at S.t Paul’s Hospital Millennium Medical College
Project holder:- Saint paulos hospital millennium medical college liaison
staffs In collaboration with Saint paulos hospital millennium medical
college & federal minister of health
Project duration-April 2016- August 2016
By
Yared Lasebew Asres, MPH in HE
To be submitted to Measho G/slassie

2. Project Summary
Maternal delay is one of the contributing factors for high maternal mortality in
developing countries. High maternal mortality is associated with lack of
effective measures to prevent the “three delays” as defined by WHO.
Ethiopia has a high MMR which constitutes 442 per 100,000 maternal deaths
and one of the six countries which have contributed to more than 50% of all
maternal deaths across the world. Delay in referral systems and poor access to
appropriate health care are among the causes for this high mortality rates.

3. This project is going to assess the cause for delays and complications leading
to maternal deaths in mothers giving birth at saint paulos hospital
millennium medical college.
The objective of the study is to identify Strategies that address labor delays
among mothers giving birth in the hospital( by the strategies listed in
design criteria).
The project budget will be covered by federal minster of health and the
hospital and there are different stake holders to participate for the
success of the project.

4. Back ground
Every year eight million women suffer pregnancy related complications and,
almost the entire half million maternal deaths globally are in low- and middle-
income countries. A woman in Sub-Saharan Africa (SSA) has a 1-in-22 chance of
dying over her lifetime as a result of pregnancy. According to the United Nations
(2005) more than half a million women in developing countries die each year
during pregnancy or childbirth and twenty times that number suffer serious
injury or disability.
Maternal delay is one of the contributing factors for high maternal mortality in
developing countries . Staff shortage, insufficiently trained staff, lack of proper
drugs, supplies and equipment are among the causes for the delay.

5. The Three Delay Models
1. Delay in decision to seek care( First delay
2. Delay in reaching care(Second delay)
3. Delay in receiving care( Third delay)
Ethiopia has a high MMR which constitutes 442 per 100,000 maternal deaths
and one of the six countries which have contributed to more than 50% of all
maternal deaths across the world (World bank report 2015 ).

6. Maternal deaths can be minimized by using known effective interventions, such
as timely referrals, skilled birth attendance and provision of comprehensive
emergency obstetrical care . Mothers in developing countries had lower chance
for accessing emergency obstetric care due to socio-economic, cultural, female
decision making power, ignorance, distance, transportation and political
constraints. Ethiopia has made progress in lowering maternal mortality rates, but
due to a weak health system many women are still succumbing to preventable
complications before, during and after childbirth.
The Ethiopian government has formulated strategies to reduce MMR in the fifth
year growth and transformation plan to achieve the MDG goals of reducing
maternal death by ¾.

7. Saint paulos millennium medical college is one of the government federal
hospitals which give delivery service for mothers referred from regions and Addis
Ababa. There are deaths registered in the hospital at different times due to labor
complications and delays during referral. This project is going to assess the cause
for delays and complications leading to maternal deaths . It has been given due
attention to identify those factors and formulate strategies to alleviate the
problem.

8. Situational analysis
Policies and programs
 Detailed needs assessment to identify which of these delays are affecting women
accessing safe maternal healthcare.
 Empowering and educating women and their families.
 Strengthening outreach and community-based care
 Developing community supported transport and emergency finances
 Building infrastructure closer to homes of women with limited resources (rural and
underserved areas)
 Developing effective referral systems
 Promoting commitment to affordable high quality maternal health services for all
women
 Strengthening monitoring and evaluation information for
continual improvement of health care services and workers

9. Socio economic and cultural factors
Evidences and researches have consistently shown that maternal processes in
Africa are prone to crises as a result of multiple socio-cultural and economic
factors. For instance, male domination, low status of women, poverty, and
cultural beliefs affect pregnancy outcomes in most societies in the continent,
particularly in Sub-Saharan Africa ,and the same is true in Ethiopia.

10. Study setting
The study project will be carried out at SPHMMC, one of the federal
hospitals in Ethiopia, where there are many referrals from all corners of
the country , especially from the near by oromiya region.
Target population
Laboring mothers who come to Saint paulos millennium medical college from
different areas

11. Statement of the problem
Nearly 4.7 million mothers, new-born, and children die each year in sub-Saharan
Africa: 265,000 mothers die due to complications of pregnancy and childbirth.
High maternal mortality is associated with lack of effective measures to
prevent the “three delays” as defined by WHO. In Ethiopia, more than 25,000
mothers die related to pregnancy each year and up to 500,000 may have short
term and/or long term disabilities.( USAID).
Timely referrals and access to appropriate health care has a great impact on
reduction to maternal deaths and disabilities. Delay during labor causes
pregnancy complications

12. Women experienced delays both before and after arriving at a health facility.
Decisions on where to seek care are most often taken by husbands and
mothers-in-law . Access to health facilities providing emergency obstetric
care is inadequate and transport is also a major obstacle. Many of the
mothers come to the hospital from rural areas after two or more days of
labor at home. After arrival at a health facility women experienced lack of
supportive care, neglect, poor assessment of labor and lack of supervision.
This project tries to show the strategies for delay of labor and give insight
on how to address it, among mothers giving birth at saint paulos hospital.

13. Problem tree
Long waiting
Time(Delay)
Lack of
transportation
Long distance
from the
hospital
Lack of
awareness
Requirement
of referral
paper
Pregnancy Complications
Maternal deaths Neonatal
deaths
Lack of
money
Lack of
Ambulance
service
Traditional
home delivery
Longer time
to have the
referral paper
Core problem
Causes/
Starter
problem
Effects
Shortage of
Ambulances

14. Objective
Over all Goal
• The over all goal of the project is to identify Strategies that address
labor delays among mothers giving birth at SPHMMC.
Specific objectives
• To reduce pregnancy complications
• To reduce maternal and neonatal death
• To Minimize wastage of resources
• To have healthy mothers and neonate

15. Objective tree
No maternal
death
No pregnancy
Complications
No Neonatal
death
Short waiting
time( no delay)
Availability of
transportation
services
Short distance
from the
hospital
Knowledge of
complications
Easily Getting
the referral
paper
No financial
problem
Ambulance
availability
Institutional
delivery
Shorter time to
get referral paper
Project purpose/
immediate
objective
Ends
Means

16. Design Strategy
Design criteria
- Making available transportation services
- Health education of the mothers and the community on
pregnancy complications.
-Teaching the mothers on advantage institutional delivery.
Strategy components
Government commitment in implementation of BPR and BSC in health
facilities to make the referral system easy and timely .

17. Project budget
Time phrase 5 months period
Sources of funding SPHMMC and FMOH
Item Birr
Capital budget No capital budget
Recurrent budget Birr
1. Project manager=1 400 Birr / day) for 5 months=60,000
2. Supervisors=5 300Birr/day =225,000=225,000
3. Data collectors= 10 37,500 Birr(250Birr/day for 5 months=375,000
4.Car drivers= 5 200Birr/day =150,000
5. Stationary materials covered by the hospital
Contingencies 5%(40,500)
Total 850,500 Birr

18. Work break down structure( WBS)(work plan)
Activities Responsible body
Logistics preparation Supervisor
Visiting health facilities
Project team
Communicating with heads of health facilities Supervisor
Data collection Data collectors
Reporting data Supervisors
Compiling and analyzing data Project manager

19. Gantt chart
Strategy/tasks Responsible body Apr May Jun Jul Aug
Communication with
SPHMMC provost office
about the project
Liaison staffs x
Communication with
budget &finance
department
Project team x
Selecting key staffs from
the Liaison department
Project manager x x
Identifying the role of
each members
x
Communicating with health
center heads in A.A & near
by Oromiya health centers
x
Pilot t visit of health
center’s referral systems
&laboring process
X

20. Required resources
- transportation vehicles are required when we visit the health centers in
Addis Ababa and the near by Oromiya regions, the hospital will give us
service cars and drivers.
- Part time payment for food and house expenses, which are going to be
covered by SPHMMC.

21. Management structure hierarchy
SPHMMC officials
Project manager
Supervisor
Data collectors
Driver
FMOH

22. Stake holder analysis
Project Sponsor Role in the project Input to project Need from project
SPHMMC& FMOH Fund the project Budget It needs summarized
reports about the referral
system and laboring
process .
Project Manager Control & monitor planned
activities ,project team,
resources & over all report
-Monitoring &
controlling,
balances,time,budget
& quality
Project success
Supervisor -Supervise data collectors
closely based on project
guideline & daily report
-Communication&
coordination
supervision&
guidance
Send timely report to the
project coordinator
Data collectors Visit the health institutions
and collect the required
information
Collection of data Appropriate and timely
data & information
Driver transporting the visiting
team to the required areas
Saves time Reaching to the planned
health facilities with the
team

23. Feasibility study
Technical feasibility
It is feasible, it has been planned before this project is proposed and it is
timely critical issue needing intervention soon. The project is in line with
the expectation of workers in the hospital and patients.
Institutional feasibility
The institution is organizing teams to visit the area and bring the necessary
data from health facilities, the budget and the human resource allocated for
it is not beyond the capacity of the institution. The required materials are
available in the hospital. The human resource to be recruited is at hand.

24. Financial feasibility
The hospital has shown its voluntariness to cover the financial expense in
collaboration with FMOH & other donors will fund it observing it’s
successfulness
Sustainability of the project:- The project will continue to assess health
facilities out side of Addis& near by oromiya, strengthening stakeholders.

25. Logical Frame work
Narrative
summary
Objectively
Verifiable indicators(OVI)
Means/sources of
verification(MV)
Important assumptions
Overall goal
To avoid labor
complications
Decreased MMR & IMR HMIS records If there is no delay and
there is timely
management of labor.
Purpose
Timely delivery with out
waiting long.
health status of mothers
& neonates
Observation of waiting
time of delivery( referral
up to delivery)
If strategies to control
delay are fully
implemented.
Results
healthy mothers and
neonates
healthy mothers and
neonates in the hospital
-Observation
-Records
If there is political
support and government
intervention on delay time
of delivery

26. Risk log
Risk Probability Impact Proposed action
Refusal of health facilities to
give the required information
Low High Awareness creation
about the importance
of the data for future
plans
Lack of infrastructure ( Roads) Low High Cooperation with the
local community to
solve problems
Lack of registers and poor data
sources
Medium High Assessing previous
data sources & asking
key informants
Language barrier High High We proposed to use
translators

27. Phase out strategy
Give the project for other stakeholders after dissemination of the result of
this project so that further projects will proceed and other strategies are
investigated. We will also recommend the project holders to go further in
areas where we didn’t assessed.

28. References
1. Socio –cultural factors affecting pregnancy outcome among the Ogu speaking people of
Badgary area of Lagos state, Nigeria.
2. Overview of Safe Motherhood and Global Maternal Morbidity and Mortality Prevention
( USAID ,fistula care)
3. Causes of low skilled – birth attendance coverage in Selected Woredas of Amhara,
Oromia and SNNP Regions
4. Factors Affecting Choice of Place for Childbirth among Women’s in Ahferom Woreda,
Tigray, 2013
5. Factors associated with Institutional delivery service utilization among mothers in Bahir
Dar City administration, Amhara region: a community based cross sectional study