The Ethiopian Federal Ministry of Health is expanding the use of pre-service training for nursing, midwifery and medical students and residents in contraception and safe abortion care, based on the successful partnership of the Center for International Reproductive Health Training at the University of Michigan and ten Ethiopian universities.
"One woman from the area came in. She was having her 10th baby. The subject of contraception was not raised at all. I asked the local staff and they told me 'Most clients do not accept contraception. So since this is our experience, we should not waste our time counselling.' Then I raised the issue with her. She asked us for bilateral tubal ligation."
That's a testimony from Dr. Abel Teshome, an OB-Gyn at Haramaya University's Hiwot Fana Specialized Hospital in Hara in eastern Ethiopia. He was in the first graduating class of OB-Gyn residents from St. Paul's Hospital Millennium Medical College (SPHMMC) in July 2016. He brought that pre-service training in family planning with him from Addis Ababa to Harar, and is helping to implement changes to the culture of care for girls and women seeking comprehensive and compassionate service.
It's one example of how the pre-service approach to improving family planning education for nursing, midwifery and medical students and residents is affecting services and contributing to reducing the ratios of maternal mortality and morbidity in the country. The Center for International Reproductive Health Training at the University of Michigan (CIRHT) has partnered with 10 medical schools across Ethiopia over the past four years to help implement that pre-service approach.
While individual incidents like that of Dr. Teshome occur every day, the Ethiopian Federal Ministry of Health (FMOH) has recognized the importance of CIRHT's work nationwide. Recently, when he was still in office, former Minister of Health Professor Yifru Berhan Mitke thanked CIRHT for its "profound contributions" in strengthening the health system "to provide all ranges of reproductive health care, particularly that of comprehensive contraception and safe abortion services… This implementation method of CIRHT not only is cost-effective and result-oriented, it also insures country ownership and sustainability."
Dr. Mitke credited CIRHT's successful implementation as forming the basis for bringing in the help the FMOH secure significant additional funding. The program will "give millions of women access to modern, voluntary family planning services across the country."
"We are proud that our partner institutions have seen such great results for their faculty, students and the populations they serve. This recognition from the ministry is very meaningful to us, and affirms the vision of our founder Dr. Senait Fisseha when she established CIRHT and its approach," said Janet Hall, CIRHT Managing Director.
When CIRHT first partnered with SPHMMC, the initial phase of implementation was so successful that nine more university medical schools chose to introduce the pre-service training into their curricula. 18 months later, eight nursing and midwifery schools signed on.
CIRHT uses the principles of pre-service training based on three main capacity-building principles: formal integration of a comprehensive and competency-based curriculum in contraception and safe abortion across all pre-service programs; faculty development targeted at improving clinical, teaching and research skills; and supporting infrastructure so that students can have competency-based hands-on training, in simulation labs and specialized clinical settings.
Dr. Abdu Mengesha, head of OB-Gyn at Addis Ababa University's Black Lion Hospital, has seen great opportunity in the multi-tiered approach – improvements in the simulation labs, better facilities offering more services in the "Michu" family planning clinic, and an increase in faculty research activity, including ten projects in the pipeline, which he says had never happened before. "In many ways we missed opportunities to serve our community in the past. Now we have new competencies and a new attitude, with patients at the center." Medical and midwifery students, as well as post-graduates, are learning skills they will take with them when they are deployed across the country.
Working with partner universities and the FMOH, CIRHT's recommendations for family planning pre-service training were integrated into the national "Competency-Based Integrated Modular Medical" and "National Harmonized Obstetrics and Gynecology Specialty Training" curricula that were unveiled in July 2017.
Research performed by the University of Michigan, SPHMMC and Jhpiego shows that the impact of the integrated, structured pre-service family planning training did indeed increase the competency of medical students in knowledge and the practice of insertion and removal of long-acting reversible contraception (LARC).
Other research projects have looked at aspects of the provision of contraception methods and abortion access – from social barriers and attitudes to training and availability. Recently, 16 abstracts were accepted for presentation at the annual conference of the Consortium of Universities in Global Health.
Michu clinics have been established at most of the partner university hospitals, as have upgraded simulation labs and the integration of the use of those labs in education.
The ministry's recognition is an encouragement to CIRHT and also to the medical professionals serving girls and women across the country.
Dr. Teshome in Harar sums it up: "I believe that nothing makes me happier than providing service for the poor woman in rural part of Ethiopia. What brings satisfaction is providing service and when your service is recognized."
Explore further: Medical school program addresses rural physician shortage