araya-thesis

Chapter 8
are visible complications during birth [8,9]. Other determinants like women’s age,
education, income, number of children and health‐seeking behaviour could also
influence their preference on health facility delivery and birth assistance by skilled birth
attendants [10]. Thus, focused birth preparedness by pregnant women is necessary to
encourage every woman to have birth at a health facility or to be assisted by health
professionals. It is advisable for HEWs and other community health workers to have
effective discussions on birth preparedness with every pregnant woman when they do
home‐based ANC visits. Third, health posts are not well‐equipped for providing delivery
service, which is a disincentive for women to use these facilities. Almost all health posts
are a single room only, with no waiting room area, water source, or electricity. Hence a
strong referral system should be established between health posts and health centers
(which are better equipped for birth deliveries) until health posts meet the necessary
standards for delivery service. Fourth, HEWs’ low performance in assisting birth also
relates to how HEWs are perceived by the community. The community may regard
HEWs as less competent to assist birth. Given these reasons and considering HEWs’
present workload, it may be unrealistic to expect a greater involvement in birth
assistance by HEWs at short notice [6‐8,11,12].
Knowledge and performance of HEWs in maternal health care
provision
With the interest of determining whether HEWs do have the required knowledge for
rendering quality maternal health care to pregnant women, we did an assessment of
HEWs’ knowledge and performance on antenatal care and delivery care among a total
of 50 HEWs working in 39 health posts [13]. We analysed a composite score of
knowledge of HEWs and interpreted the scores based on the Ethiopian education
scoring system. On average, a HEW assisted approximately six births per 6 months.
Most deliveries took place at home without the necessary professional help or the
necessary facilities. The HEWs knowledge on danger symptoms, danger signs, and
complications in pregnancy was poor. In this regard, it was indicated that HEWs rarely
referred a pregnant woman to a health center. Very few HEWs received professional
support on obstetric care from a midwife.
Findings of this assessment among HEWs strengthened the findings of our community
based survey on utilisation of maternal health services by rural women (Chapter 2) [1] .
This showed that one possible reason for the low performance of HEWs in stimulating
behavioural change among the community and facilitation of referrals could be due to
their poor knowledge on contents of antenatal care, danger signs, danger symptoms,
and complications in pregnancy. Because of their poor knowledge, HEWs may not be
able to convince pregnant women to give birth at health facilities assisted by skilled
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