ESOG-ACOG Collaboration Program Report

In Ethiopia the maternal mortality ratio (MMR) decreased dramatically to meet the challenge of the Millennium Development Goals (MDG) that ended in 2015, in part by using innovative delivery services and a community health approach. While many gains were achieved in maternal and child health during the MDG era, the current MMR in Ethiopia remains at 353 for every 100,000 live births. The challenges to further reduce this ratio and improve results are naturally complex. While the achievements to date in access to care and education for women and their families has come through the robust community health worker program, the government and civil society organizations in Ethiopia are now looking at deeper structural change. The next phase of improvement needs to be based on solutions that address infrastructure, education, and preparedness.

The Ethiopian Federal Ministry of Health (FMoH) Sector Transformation Plan (HSTP) for the years 2015/16-2019/20 was created to expand the equity and quality of care across the country, in all disciplines. Doing its part in realizing this goal, the Ethiopian Society of Obstetrics and Gynecology (ESOG) is supporting the HSTP implementation and striving to ensure the improvement in the standard of maternal health services.

To align these efforts, the FMoH, the Center for International Reproductive Health Training at the University of Michigan (UM-CIRHT), ESOG, and ACOG came together to create an innovative and unique collaboration. UM-CIRHT had already been working in Ethiopia for years, which laid significant groundwork to support this collaboration. The intention of the collaboration was to support ESOG in its aspirational and important goals, which were both broad in scope and simultaneously deep in expertise. Focusing on medical education before and after schooling, pursuing accountability and professionalism of its cadre, and addressing clinical training deficits was an ambitious set of goals to attain for one project.

The opportunity to jointly define a broad set of initiatives that were implemented simultaneously and offering extensive support and guidance turned out to realize significant achievements in a short period of time. Additionally, a strong collegial bond was formed between many of the American and Ethiopian medical professionals that will add to the sustainable advancements beyond this program period.

The ESOG-ACOG Collaborative Project was launched in June 2016, with four thematic areas, later expanded to eight. The objectives were to:

1. Standardize Ob-Gyn Residency Programs and training with minimum competencies and educational objectives for all graduating residents, including strengthening faculty development

2. Produce a Certification Examination for all graduates of Ethiopian ob-gyn residency programs

3. Deliver high-quality, up-to-date Continuing Medical Education

4. Revitalize the Ethiopian Journal of Reproductive Health (EJRH), and enhance capacity of faculty and residents in research in all Ob-Gyn residency programs in Ethiopia

5. Create a Code of Medical Ethics for obstetrics and gynecology practice in Ethiopia

6. Provide Leadership Development programs for ESOG members, with emphasis on young and female members, to generate the Ob-Gyns of the 21st century

7. Strengthen ESOG’s Program Communications to educate public and private stakeholders on ways of advancing women’s health on the valuable work ESOG is doing

8. Support membership management and educational initiatives with robust I.T. systems and infrastructure

ACOG acted as a consultant to ESOG, providing the necessary tools, educational materials, expertise and technical assistance to help ESOG identify its own priorities and generate appropriate strategies. The program was therefore country-led, with ESOG identifying challenges and developing solutions. A key partner in this capacity building program was the FMoH, which guides all health care delivery facilities, and partners with the Federal Ministry of Education (FMoE) in guiding health care related training institutions. The FMoH was involved in the planning and execution of the activities of the thematic areas of the program. The FMoH’s involvement from the outset insured alignment, ownership, and close follow up. These were critical factors in reporting results during the implementation and in the resolving communication challenges.

The biannual joint leadership meetings, attended by leaders of ESOG, ACOG and UM-CIRHT, were sessions in which progress and challenges at every level were critically reviewed and corrective guidance was given. The team members were very active in their follow up and participation. That guidance, and the leadership team process, was another important factor to the program’s progress navigating complex issues.

This collaboration of the two committed associations offers insights into how to replicate this effort in other countries to benefit the goals of health ministries, improve care for women and their families, and achieve sustainable change in the quality of education for students and practitioners in Ob-Gyn. ACOG Fellows, physician vice presidents, and staff provided specific support as requested and defined by ESOG, including ACOG continuing medical education materials, publications, practice guidelines and committee opinions. UM-CIRHT, ESOG and ACOG developed aligned annual work plans to meet key objectives in each of the thematic area. The work plans outlined training engagements, milestones, and project deliverables for each 12-month period.

An enhanced medical society can help improve the quality of care for all Ethiopians by raising the skills, awareness, and standardized practice of all its members. The ESOG-ACOG Collaborative Project took major steps to create the dynamic, proactive, and competent society that will help the FMoH realize its goal of expanding health care equity to all citizens.

The report looks at each thematic area and the key objectives, activities, and accomplishments, as well as the sharing the challenges and plans for the future.