Scaling Preservice Training in Comprehensive Contraception and Abortion Care and Research across Ethiopia

This retrospective case study examines a five-year project scaling preservice training of comprehensive contraception and abortion care across nine Ethiopian schools of medicine and midwifery beginning in July 2014. It captures lessons learned from implementing the framework and share them with other schools and health ministries planning to strengthen contraception and abortion preservice training and research. The case study is based on semi-structured interviews conducted in July–December 2018 with 19 individuals who held faculty roles in the partner schools or staff roles with the Center for International Reproductive Health Training team in Ethiopia or Michigan. It also draws from document analysis of internal project files from across the full project period and participant observation by the case study authors, who were each involved in various stages of implementation. The case study is also available at http://hdl.handle.net/2027/spo.mpub11627346. This case study is shared under a Creative Commons Attribution Noncommercial No-Derivatives License: http://creativecommons.org/licenses/by-nc-nd/4.0/.https://deepblue.lib.umich.edu/bitstream/2027.42/150691/1/2019-scaling-preservice-training-in-comprehensive-contraception.pdfDescription of 2019-scaling-preservice-training-in-comprehensive-contraception.pdf : Case Stud

Quality Family Planning Counselling

https://deepblue.lib.umich.edu/bitstream/2027.42/152386/1/Quality_FP_Counseling.mp4https://deepblue.lib.umich.edu/bitstream/2027.42/152386/2/Quality_FP_Counseling.ppt

The Ethics and Law of Contraception and Abortion and Reproductive Justice

https://deepblue.lib.umich.edu/bitstream/2027.42/152395/1/FP_CAC_Ethics_Law.ppt

Clinical Policy Guideline for Abortion Care in Michu Clinics

https://deepblue.lib.umich.edu/bitstream/2027.42/152387/1/Abortion_Clinical_Policy_Guideline.doc

Family Planning Counseling

https://deepblue.lib.umich.edu/bitstream/2027.42/152391/1/FP_Counseling_Obermeyer.ppt

Second Trimester Abortion

http://deepblue.lib.umich.edu/bitstream/2027.42/152383/1/Second_Trimester_Abortion.ppt

Common Myths in Abortion

https://deepblue.lib.umich.edu/bitstream/2027.42/152396/1/Abortion_Myths.ppt

Patient Centered-Care

http://deepblue.lib.umich.edu/bitstream/2027.42/152394/4/Patient-Centered_Care.pptxhttp://deepblue.lib.umich.edu/bitstream/2027.42/152394/1/Patient-Centered_Care.ppt

Progress in health among regions of Ethiopia, 1990-2019: a subnational country analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities. METHODS: We gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment. FINDINGS: The SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59-7·20) in 1990 to 4·43 (4·01-4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96-6·86) in Somali to 1·50 (1·26-1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79-22·07), from 46·91 years (45·71-48·11) in 1990 to 68·84 years (67·51-70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91-72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53-66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69-1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities. INTERPRETATION: There were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets. FUNDING: Bill & Melinda Gates Foundation