In an effort to generate evidence aligned with national priorities and to facilitate evidence-based policy making, a National Advisory Committee (NAC) was assembled for our Safe Motherhood trial in Ethiopia. The NAC consists of representatives from the Federal Ministry of Health, the Zonal Health Office, national ethical review boards, among others. This year we held our second NAC meeting at the Directorate of Maternal and Child Health in Addis Ababa. It was a pleasure to have Benoit join us for the meeting this year before heading to Jimma with me to assist with preparations for the endline survey.

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Members of the research team presented preliminary findings from the baseline quantitative and qualitative datasets at the NAC. One of my research components focuses on maternity waiting home (MWH) use in Jimma Zone, Ethiopia. Our cluster-randomized controlled trial is being conducted in three primarily rural districts in Jimma Zone where the majority of the population depends on agriculture for their livelihood. In our survey, about half of the women of reproductive age enrolled in the study had not completed any level of schooling and almost 90% were housewives.

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As part of our annual research findings update to the NAC, I presented the results of my analysis on the baseline household survey conducted between 2016-2017. It was interesting, but not surprising, to discover that women who are part of wealthier households, have social support during pregnancy and who live more than 30 minutes from a health facility offering obstetric care tended to report having used MWHs more. Housewives also had a higher odds of MWH use compared to employed women. These findings have important implications for policy makers who need to ensure equitable access to maternal health services. Our findings suggest that women from vulnerable sub-groups – poorer households and those that do not have access to social support- may struggle in accessing MWH services.

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I also presented the findings from a rapid needs assessment carried out prior to intervention roll-out in 2017. Accompanied by our counterparts from Jimma University, I visited several MWHs to gauge the status of services. We also spoke to midwives and health extension workers to get a sense of the services offered and how women are linked to them. What we discovered was large variability in the availability and quality of services across sites and over time.

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This corroborated Zonal Health Department data on MWH functionality that suggested district-level variation in functionality.

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This information was also of interest to the NAC as it highlighted the need for additional resource and management support. The MWH model that operates in our study area is one where the community takes the lead on providing resources to support MWHs. Contributions in the form of cash or crops as well as construction materials and labour are expected from the communities. Other resource generation initiatives include the One Women One Birr system where families are expected to contribute 1 Birr (~5 cents) annually towards the MWH.

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Finally, as Mariame Ouedraogo was not able to attend the NAC this year, I presented her findings on the quality of maternal health data in the national Health Management Information System (HMIS). Mariame found that there was district-level variability in completeness and timeliness of reporting as well as internal consistency issues with some of the tracer indicators she chose to focus on. For more details, check out her paper published in PLOS (https://doi.org/10.1371/journal.pone.0213600)