Community-based delivery of lifesaving maternal and newborn health interventions in vulnerable Ethiopian communities: Lessons from implementation research
5 affiliations
- 1JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
- 2Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia
- 3Fenot: Harvard T. H. Chan School of Public Health, Addis Ababa, Ethiopia
- 4Minstry of Health, Addis Ababa, Ethiopia
- 5Gates Foundation, Addis Ababa, Ethiopia
Abstract
Introduction: In Ethiopia, women in remote agrarian and pastoralist regions face major barriers to accessing timely, quality maternal and newborn health (MNH) services, leading to high rates of home births and preventable mortality. This study assessed the implementation of the Village Health Leader (VHL)-led community-based MNH package in vulnerable agrarian and pastoralist communities in Ethiopia. Methods: Implementation research deploying a mixed-methods process evaluation across seven health centers and 38 vulnerable communities in the Afar, Somali, and Oromia regions was carried out from December 2023 to July 2025. VHLs were trained to deliver community-based MNH interventions that included misoprostol for the prevention of postpartum hemorrhage, chlorhexidine for umbilical cord care, iron-folic acid for the prevention of anemia, and postpartum family planning counseling and services. Quantitative program monitoring data were collected from 3,980 pregnant women and analyzed descriptively. Qualitative data were collected through 90 in-depth interviews and 14 focus group discussions with VHLs, health workers, postpartum women, community members, and supervisors. Qualitative data were coded in ATLAS.ti using both deductive and inductive approaches. Findings from the quantitative and qualitative components were integrated to provide a comprehensive assessment of implementation. Results: The intervention reached about 4,000 pregnant women, with high rates of uptake for lifesaving MNH services. Among women who gave birth, 35% delivered at home, 92% used misoprostol, and almost all applied chlorhexidine to the umbilical cord stump. Qualitative findings indicated generally positive perceptions of the intervention and highlighted its acceptability and feasibility. VHLs demonstrated strong adherence to protocols and timely referrals to health facilities. Challenges included supply shortages, lack of incentives for VHLs, and weak referral feedback systems. Despite these constraints, the intervention improved access, enhanced equity, and did not disincentivize facility-based deliveries. Conclusions: Community-based delivery of lifesaving MNH interventions by VHLs is both feasible and acceptable in most underserved communities. The model strengthens the primary health care system by extending its reach, improving the continuum of care, and addressing persistent access barriers. However, sustainability requires reliable supply chains and tailored approaches for pastoralist populations. The findings support the integration of trained community volunteers into national MNH service delivery strategies to reduce preventable maternal and newborn deaths.
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BibTeX
@article{tiruneh2026communitybased,
title = {{Community-based delivery of lifesaving maternal and newborn health interventions in vulnerable Ethiopian communities: Lessons from implementation research}},
author = {Gizachew Tadele Tiruneh and Agumasie Semahegn and Alemnesh Hailemariam Mirkuzie and Nebreed Fesseha and Addis Girma and Mikiyas Teferi and Hillina Tadesse and Shegaw Mulu and Biruhtesfa Bekele and Abdulhalik Workicho and Mirkuzie Woldie and Temesgen Ayehu and Biruk Bogale and Bezawit Mesfin Hunegnaw and Chala Tesfaye and Zemzem Mohammed and Mariamawit Asfaw and Lidiya Tefera and Frank DelPizzo and Addis Tamire and Misrak Mekonnen and Mesele Damte Argaw and Dessalew Emaway},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0360788},
url = {https://doi.org/10.1371/journal.pone.0360788},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Community-based delivery of lifesaving maternal and newborn health interventions in vulnerable Ethiopian communities: Lessons from implementation research
AU - Gizachew Tadele Tiruneh
AU - Agumasie Semahegn
AU - Alemnesh Hailemariam Mirkuzie
AU - Nebreed Fesseha
AU - Addis Girma
AU - Mikiyas Teferi
AU - Hillina Tadesse
AU - Shegaw Mulu
AU - Biruhtesfa Bekele
AU - Abdulhalik Workicho
AU - Mirkuzie Woldie
AU - Temesgen Ayehu
AU - Biruk Bogale
AU - Bezawit Mesfin Hunegnaw
AU - Chala Tesfaye
AU - Zemzem Mohammed
AU - Mariamawit Asfaw
AU - Lidiya Tefera
AU - Frank DelPizzo
AU - Addis Tamire
AU - Misrak Mekonnen
AU - Mesele Damte Argaw
AU - Dessalew Emaway
PY - 2026
DA - 2026/11/05
JO - PLOS One
DO - 10.1371/journal.pone.0360788
UR - https://doi.org/10.1371/journal.pone.0360788
AB - Introduction: In Ethiopia, women in remote agrarian and pastoralist regions face major barriers to accessing timely, quality maternal and newborn health (MNH) services, leading to high rates of home births and preventable mortality. This study assessed the implementation of the Village Health Leader (VHL)-led community-based MNH package in vulnerable agrarian and pastoralist communities in Ethiopia. Methods: Implementation research deploying a mixed-methods process evaluation across seven health centers and 38 vulnerable communities in the Afar, Somali, and Oromia regions was carried out from December 2023 to July 2025. VHLs were trained to deliver community-based MNH interventions that included misoprostol for the prevention of postpartum hemorrhage, chlorhexidine for umbilical cord care, iron-folic acid for the prevention of anemia, and postpartum family planning counseling and services. Quantitative program monitoring data were collected from 3,980 pregnant women and analyzed descriptively. Qualitative data were collected through 90 in-depth interviews and 14 focus group discussions with VHLs, health workers, postpartum women, community members, and supervisors. Qualitative data were coded in ATLAS.ti using both deductive and inductive approaches. Findings from the quantitative and qualitative components were integrated to provide a comprehensive assessment of implementation. Results: The intervention reached about 4,000 pregnant women, with high rates of uptake for lifesaving MNH services. Among women who gave birth, 35% delivered at home, 92% used misoprostol, and almost all applied chlorhexidine to the umbilical cord stump. Qualitative findings indicated generally positive perceptions of the intervention and highlighted its acceptability and feasibility. VHLs demonstrated strong adherence to protocols and timely referrals to health facilities. Challenges included supply shortages, lack of incentives for VHLs, and weak referral feedback systems. Despite these constraints, the intervention improved access, enhanced equity, and did not disincentivize facility-based deliveries. Conclusions: Community-based delivery of lifesaving MNH interventions by VHLs is both feasible and acceptable in most underserved communities. The model strengthens the primary health care system by extending its reach, improving the continuum of care, and addressing persistent access barriers. However, sustainability requires reliable supply chains and tailored approaches for pastoralist populations. The findings support the integration of trained community volunteers into national MNH service delivery strategies to reduce preventable maternal and newborn deaths.
SN - 1932-6203
ER -