Evaluation of an Intervention to Improve Essential Obstetric and Newborn Care Access and Quality in Cotopaxi, Ecuador
Despite improvements in health-care utilization, disadvantages persist among rural, less educated, and indigenous populations in Ecuador. The United States Agency for International Development-funded Cotopaxi Project created a provincial-level network of health services, including community agents to improve access, quality, and coordination of essential obstetric and newborn care.
From 2010 to 2013, the 21 poorest parishes (third-level administrative unit) in Cotopaxi were targeted for a collaborative health system performance improvement. The intervention included service reorganization, integration of traditional birth attendants with formal supervision, community outreach and education, and health worker technical training.
Extensive data was collected to evaluate improvements in participating facilities compared to non-participating comparison facilities. In the participating facilities, we observed an increase in the percentage of women receiving a postnatal visit within the first 2 days of delivery and the percentage of women receiving postpartum counseling. The project increased community and facility care quality and improved mothers’ health knowledge. Intervention parishes experienced a nearly continual reduction in newborn mortality between 2009 and 2012 compared with an increase in control parishes. All results were statistically significant.
The project established a comprehensive coordinated provincial-level network of health services and strengthened links between community, primary, and hospital health care. This improved access to, quality, use, and provision of essential obstetric and neonatal care and survival. Based on these findings, Ecuador’s Ministry of Health is scaling up the model nationally.