Jackson Ruth, Hailemariam Assefa
Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Australia.
Center for Population Studies, Addis Ababa University.
Ethiop J Health Sci. 2016 Sep;26(5):471-478. doi: 10.4314/ejhs.v26i5.9.
Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth.
A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes.
Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women.
HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.
埃塞俄比亚文化中深深根植着女性在家分娩的偏好。许多女性只有在分娩时出现并发症才会前往医疗机构。已部署卫生推广工作者（HEW），通过弥合社区与医疗机构之间的差距来提高孕产妇保健服务的利用率。本研究调查了卫生推广工作者在将女性转诊至中级卫生机构分娩时所面临的障碍和促进因素。
2014年3月至12月间，在阿法尔州、南方各族州和提格雷州三个地区开展了一项定性研究。对45名卫生推广工作者、14名女性推广工作者（受雇于阿法尔州阿法尔牧民发展协会）以及来自健康中心、医院或卫生办公室的11名其他卫生工作者进行了访谈和焦点小组讨论。基于整理数据和确定关键主题进行数据分析。
前往医疗机构的障碍包括距离、缺乏交通工具、社会文化因素以及护理态度不佳。基于医疗机构分娩的促进因素包括与健康发展军（HDA）领导人联络，在预产期前或家中开始分娩时转诊女性；引入救护车服务；以及提供在文化上更易为女性接受的卫生服务。
当健康发展军成熟、卫生工作人员提供尊重的护理且随时有救护车可用时，卫生推广工作者能够有效地将更多女性转诊至医疗机构分娩。
