From Distant Hospitals to Local Health Centres: Ultrasound Service Task Shifting to Mid-Level Health Professionals

Too many pregnant women in the developing regions travel far for basic maternal health services. In places like the Afar Region, the topography and climate present significant barriers and health risks to pregnant women seeking care. 

Traditionally, basic maternal health services such as antenatal care and ultrasound services were only available in tertiary level health facilities, usually located in major cities in Ethiopia. This arrangement often neglects a large segment of Ethiopian women who live outside of major cities, who are left without access to essential services.

Through the A’ago project, the provision of basic maternal health services is no longer exclusive to specialized health professionals within hospitals. Community health workers are being trained and equipped to offer services at the community level, meeting women where they are. They are being given the resources to deliver essential services to pregnant women within their homes and in health posts. At the health centre level, midwives are being trained and equipped to offer services within regional health centres.

A’ago supports health facilities in the Afar region by providing technical assistance and medical equipment to improve access and the quality of sexual and reproductive health services.  The project supplied select health centres with ultrasound technology and training for midwives, and community health workers with backpacks equipped with portable ultrasounds from Philips Health to support their outreach efforts. 

By ensuring more pregnant women are provided with basic maternal health services, the outcomes of their pregnancies and potential complications can be identified and addressed early on. Women, like 22-year-old Tigist Molla, are at the front line of improving maternal and child health at the community-level.   

Tigist is a BSC Midwife Nurse at Saburie Health Center in the Awash Fentalie district of Afar Region, Ethiopia. She has spent nearly the last two years providing community-level care, following ultrasound user and clinical training through the A’ago project. Tigist is both confident in and proud of the work she does.

She shared, “I was trained theoretically on maternal health abnormalities in my pre-service trainings, but not practically to identify abnormalities. After I got the opportunity to be a part of ultrasound trainings and frequent clinical mentorship supported by Amref, I am now confident and able to identify abnormalities like Intra uterine fatal death (IUFD), placenta previa, triplets, anencephaly, and more, which gives me the chance to identify and give referrals for high risk mothers to higher level health facilities early on. This is lifesaving work and has not ever been a midwife’s duty as a mid-level professional before the project. I am happy to be part of this experience.” 

Since being supported and trained in ultrasound services, Tigist has referred over 10 pregnancy abnormalities to the nearest hospitals of Mehamed Akle (50kms away) and Adama (180kms away). She added “just in the last seven months, I have identified anencephaly, triplets, twins, mal presentations (face, breach), and referred those cases to hospitals. I am really satisfied, motivated, and confident and hope all of my colleagues also have this chance for training and support.

Saburie Health Center has experienced significant demand and high service volume since expanding ultrasound services to be offered within their facility. 

The addition of ultrasound services in lower level health facilities was not only a helpful strategy to detect high risk mothers early, but also in increasing the satisfaction and trust of mothers. Tigist added, “It is not only the community who is satisfied with the service. I, as a professional, am also very satisfied and motivated by the service. I used to think ultrasounds couldn’t be delivered by a mid-level professional like myself, but we can! It has also been helpful to have periodic mentoring and coaching provided by senior health professionals to strengthen our skills and confidence”

Implementing Partners

Amref Health Africa in Ethiopia; Engender Health; Triggerise and Philips Healthcare Africa

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