Delivery Waiting Room
- Community Growth
- Women & Gender
Every year, more than 600 mothers give birth at the local Health Center. The catchment area spans 5 square miles. When expecting mothers go into labor, they are carried on a locally made gurney by family and friends - on foot - to the health center, which could be more than 5 miles away. The health center has one ambulance and one driver that serves 16,000 people, goes out of commission often and is often only used for transfer from the health center to a larger hospital since finding patients within the catchment area is difficult. Once expecting mothers arrive at the health center, they are assessed by health center staff for admittance. If they are not far enough along, they are told to come back later, due to a lack of waiting space at the health center. The current patient waiting spaces are wooden benches in a hallway outside of the delivery room. This hallway is also the common entrance to the family planning, antenatal care and immunization service rooms, and therefore receives high traffic, serves as a waiting area for other patients (sick and/or injured) and is an uncomfortable place to wait while in labor. I am always shocked when I hear that patients have already given birth at home, along the road, or within minutes of arriving, but can easily understand why it happens so frequently anytime I walk to the far stretches of the community or when the waiting benches are filled with sick patients and crying babies – conditions which could make even the most motivated women consider staying at home a little longer. Often, mothers deliver within minutes or a few hours of arriving at the health center, at home or on the road to the health center – scenarios which are all dangerous to the health of mothers and babies.
If a complication arises, many patients are far away from the health center. If the patient has made it to the health center early enough, the nearest referral hospital is over an hour away by ambulance – but again – many patients are already in the late stages of labor when they arrive at the health center. Given the current difficulty of accessing the health center, the far distance to the nearest referral hospital, and the inability of the health center to house mothers who are in early stages of labor, mothers in this catchment area are not in a safe environment to give birth. The community has a maternal mortality rate of 459, and an infant mortality rate of 230 (per 100,000 births), which are some of the worst rates in the world and can be attributed to accessibility (distance and space availability) of the health center as well as knowledge and preparedness of expecting mothers. The health center has recognized this issue and started the process of building a waiting room in 2017 by purchasing construction materials. However, due to funding shortages the project was not completed. With the funds raised by this grant and additional contributions from the community, the Health Center can construct a delivery waiting room. The waiting room will first and foremost provide a safe space for mothers to wait during the labor process. It will also provide doctors the capacity to treat complications early, provide mothers the chance to ask questions and receive educational counseling on pre and post-partum care and services, and strengthen the usage of the health center by providing a more comfortable environment. These benefits will ultimately improve maternal and child health outcomes for the community. Recent community initiatives have resulted in huge improvements in maternal and child health through successful programs to increase antenatal care and immunization service usage. However, the community still has work to do. Delivery service accessibility is still an issue and this project isn't something that the community can fund on its own. Funding this project would therefore be monumental in continuing the community’s momentum to save the lives of their mothers and babies.
The focal objective of this project is improving maternal and child health (MCH) in the community. Due to the importance of family among community members, high birth rates, and poor MCH statistics, the local health community has been active in carrying out interventions to improve MCH conditions. In recent years, they have implemented a strong antenatal care, family planning, and childhood immunization program offered every Wednesday which has seen great attendance and has improved MCH in the community. The dedication of the health center to provide these services exemplifies their commitment to the project objective. Additionally, community participation of the program every Wednesday shows that the non-health staff community is also motivated to make improvements. Additionally, this project was initiated before Peace Corps was heavily involved with the community but was not finished due to budget constraints. After learning this, I investigated ways that I might be able to revive the project as a Peace Corps volunteer. When I brought this up to the health center head, I suggested that if the community wanted to continue the project, I might be able to secure extra funds that the health center could not come up with but emphasized that it is forbidden for Peace Corps grants to contribute the entirety of a project budget.
After that meeting, we involved the community in a discussion of the future of the project, and they seemed hopeful that with support from Peace Corps, with the existing construction materials that have already been purchased, and additional funds from the community and health center budget, this project is feasible. We then had a third meeting to discuss what I would need from the community to contribute Peace Corps grant funds, and the staff put together a preliminary project budget, estimate of beneficiaries, objectives, list of roles and responsibilities, and a sustainability plan. Following receipt of the Peace Corps grant application, health center staff were the primary contributors to the grant application, especially for timeline planning and soliciting budget quotes. Moving forward, the health center staff will be the primary planners of the project. Their planned responsibilities include securing materials and labor, creating waiting room patient care protocol, staffing the waiting room, and creating a plan to keep the facility cleaned and maintained. The health center has already formed a project committee that has been actively planning operations of the project. We have also discussed creating educational videos on the birthing process and post-partum care to be incorporated as part of the admission process; since this is a new concept to most staff and this part of the project is very technology-involved, I will be heavily involved. Outside of this project component, this project will be planned, implemented, and monitored primarily by the community, with oversight and support from me to ensure the project is upholding Peace Corps values.
There are two components of this project which must be sustained for the project to be successful long-term. One is continued proper patient care, monitoring, and counseling while patients are using the delivery waiting room. The other is continuous upkeep of the facility to prevent disrepair and run-down of the building. The health center administration is committed to ensuring that these tasks are kept up to prevent project failure. Before construction of the delivery waiting room, the health center will create a patient care protocol that will detail exactly how patients are to be cared for while they are using the waiting room. This protocol will be printed in the waiting room as well for patient awareness and accountability. The protocol will include providing check-in instructions and proper use of the facility, monitoring intervals for nurses, instructions for transfer to the delivery room, a counseling curriculum timeline for delivery, post-partum care and subsequent health center appointments, and check-out instructions for the family. This protocol will be incorporated into delivery staff’s routine responsibilities and enforced by health center administration.
As part of the delivery waiting room usage protocol, health center cleaning staff will be instructed on how to routinely clean and maintain the facility. However, it has been acknowledged that a facility like this, which will have household items such as bedding and dishes, is an unfair burden for cleaning staff to routinely clean after patient use, assuming it will be used almost daily. Therefore, to maintain the cleanliness of the facility, the project planning staff have proposed charging families a 25-birr deposit, refundable upon completing the delivery waiting room check-out tasks. These tasks will include cleaning kitchen items that were used, washing sheets (only sheets, not the blankets!), and leaving the floor swept and mopped. Cleaning supplies will be provided in the waiting center for users to properly complete these tasks. The staff believe this is a reasonable requirement, since laboring mothers often arrive at the health center with a large group of family and friends, who are likely to use the facility’s cooking supplies to provide coffee and warm food for the new family and would be willing and able to clean-up when they are ready to make the journey home. Upkeep of the actual structure will be done on the same schedule as other health center structures since it is in the same compound. Additionally, to promote use of the facility, pregnant mothers will be informed of the opportunity to use the delivery waiting room during routine antenatal care visits. It is also assumed that once the facility is in operation for a few months, community awareness will be spread by word of mouth.