287. Contextualizing care for women with pre-eclampsia and eclampsia in Ethiopia: Exploring policy and implementation environments

• Published in: Pregnancy hypertension 2018-10, Vol.13, p.S118-S119
• Main Authors: Sripad, Pooja, Dempsey, Amy, Guta, Yonas R., Ismail, Hussein, Warren, Charlotte E.
• Format: Article
• Language: English
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2018.08.350

Effective management of pre-eclampsia and eclampsia (PE/E) depends how policy environments relate to health service delivery interfaces. Less known is how these contextual factors intersect with the lived experience of care provision and use. To explore the policy and health systems environment around PE/E to improve care provision and use in Ethiopia. Institutional ethnography was used to assess viewpoints across multiple primary data sources (n = 95) and a desk review of peer-reviewed publications and maternal health-related textual guidelines and policies (n = 43). In-depth interviews were conducted with women who experienced pre-eclampsia (n = 17), health extension workers (n = 17), health workers (nurses/midwives/doctors) (n = 22), and policymakers and stakeholders at kebele, woreda, zonal, regional and national levels (n = 21). Sixteen focus group discussions engaged men and women of reproductive age in select areas. Despite a progressive maternal health policy environment around task shifting and expanding service access, including to PE/E care, there remains ambiguity of provider roles in PE/E diagnosis and management. No document delineates cadres to administer the loading dose of magnesium sulphate (MgSO4) or antihypertensive drugs nor details pre-referral care and referral processes sufficiently. All respondents describe the visibility of guidelines and protocols in facilities influence care provision. Downstream effects of professional practice norms, supervisory structures, and provider abilities manifest in the lack of confidence among providers at all levels of the health system to administer MgSO4. Supply chain bottlenecks limit the use of essential PE/E drugs and commodities at health centers and health posts, curtailing providers’ ability to manage and refer women in a timely way. A health system’s ability to effectively manage pre-eclampsia and eclampsia depends on various contextual factors, including an amenable policy environment, supportive health worker practice norms, and supply chain functioning. Factor confluence has implications for quality of care and outcomes experienced by women with PE/E.