Project Zero to be rolled out in 2024 following a hugely successful pilot

Project Zero, Hamlin Fistula Ethiopia’s most ambitious program in decades, was launched in March 2023. This ground-breaking new program will accelerate the eradication of obstetric fistula in Ethiopia by adopting a woreda (district) by woreda approach.

The hugely successful pilot in Ale Woreda in south-western Ethiopia concluded in October with significant support and encouragement from local and regional health bureau, the Ministry of Health and the United Nations Population Fund (UNFPA).

Ale Woreda will shortly be declared obstetric fistula-free.

House-to-house surveys to identify women with decades-long fistula injuries

In just one woreda, made up of 24 kebeles (municipalities or neighbourhoods) with an estimated population of 85,408 people, teams of Hamlin-trained community volunteers known as Health Development Armies (HDA) and some 343 health extension workers carried out a total of 14,664 house-to-house surveys in 24 weeks. Most household members had not heard about obstetric fistula before and were eager to learn more about it.

The HDA also had little prior knowledge of birth injuries and were keen to learn more about maternal health issues and other ways they can serve their communities. The HDAs are keen to keep the momentum going to further increase awareness of birth injuries and available treatment. They are vital to the success of Project Zero.

In just one woreda, seven women with decades-long fistula injuries and 56 women with advanced stage pelvic organ prolapse (POP) were found and transported to Hamlin’s Metu Fistula Hospital for life-changing surgery.

Many of these women have lived in social isolation and been shunned and humiliated by their communities and even their own families. Every woman found by the Project Zero team can access tailored counselling, literacy and numeracy classes and vocational and life skills training at Desta Mender to rebuild their confidence and restore their dignity and emotional wellbeing. The new skills they acquire enable them to earn an income and live independently when they return home.

Raising awareness of obstetric fistula, its treatment and the benefits of accessing maternal healthcare

The Project Zero team and the HDA conducted many different activities to spread awareness of the advantages of accessing antenatal and midwifery care during pregnancy and having an institutional delivery. Great efforts are being made to remove cultural barriers and encourage women to utilise healthcare services.

Awareness-raising activities included FM radio announcements and spreading the word at markets, schools, community gatherings, conferences for pregnant mothers and through meetings and workshops with religious and community leaders and health care providers. Talks at mosques and churches will be incorporated into the roll out of Project Zero.

These activities were supported through the distribution of leaflets, t-shirts and banners. Loudspeaker announcements in the local language, made from the roofs of vehicles driving around the woreda, were particularly effective – children were heard mimicking the message and music!

Assessments conducted via questionnaire in three kebeles revealed a 68% increase in awareness of obstetric fistula between February and November 2023.

Mentoring and improving healthcare services

The Project Zero team is strengthening maternal healthcare services within Ethiopia to reduce the incidence of birth injuries. The goal is to establish a midwifery clinic in every woreda (district), staffed by Hamlin Midwives. A national education campaign is giving women the tools and knowledge they need to give birth safely.

During the pilot, Hamlin Midwife Mentors provided mentoring to government midwives and the Maternal Healthcare (MHC) team in the main towns of Onga and Gore. The team reviewed existing practices and made many improvements including:

  • Reorganising the clinical areas, including the creation of a ‘newborn corner’
  • Educating staff on the most up-to-date clinical care practices, eg: extending post-partum care hours with increased comprehensive checks on mothers and newborns
  • Introducing improved Infection, Prevention and Control (IPC) procedures
  • Changing to a more woman-centred model of care
  • Improving documentation and establishing robust stock management controls.

The new app, M-HIT (Maternal Health Improvement Tool) is being used by Hamlin Midwives to monitor pregnant women and escalate care for those at risk. The adoption of M-HIT has been a little slower than predicted so different steps have been taken to increase usage including enhanced training and making improvements to the app to make it more user friendly.

Project Zero roll out in 2024

Using learnings around the impact and efficacy of this pilot, Project Zero will be implemented in two more woredas in the first half of 2024 and in further woredas every two months thereafter.

The new Project Zero woredas have been selected based on criteria that included:

  • Likelihood of having a significant number of obstetric fistula cases because of their rural remoteness and poor health coverage
  • Expectation of number of kebeles in the woreda
  • Distance from the centre/town
  • Having a Hamlin-supported midwifery clinic
  • Political stability.

Implementation will commence in February in Didhesa Woreda about 180km from Metu, followed in April by Fedis Woreda near Harar.

Click here to learn more about Project Zero.

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