Reducing harmful traditional practices in Adjibar, Ethiopia : lessons learned from the Adjibar safe motherhood project

This paper assesses the impact of the Adjibar Safe Motherhood Project and derives lessons of value to future interventions. Amongst the participatory qualitative methods used were 15 group discussions, eight semi-structured interviews, a number of opportunistic informal discussions and observation. The information gathering was complemented by a detailed review of project documents. Field visits for data collection took place over a six day period in March 2005. The project was effective in raising awareness about maternal health, and the social, economic and health consequences of various harmful traditional practices (HTPs). It has also mobilised the community to monitor and report HTPs and has strengthened referral systems for counselling, support and treatment. A number of effective strategies were identified as having contributed to project success. These are presented using the framework offered by the Ottawa Charter for Health Promotion which presents five areas of public health action: developing personal skills; strengthening community action; building healthy public policy; re-orienting health services; and, creating supportive environments. This evaluation contributes to and strengthens the expanding body of literature about effective development practices to reduce HTPs. It demonstrates that addressing HTPs takes time and long term investment; both are necessary to enable better understanding of the social and cultural reasons for HTPs before attempting to address them, and to build the community trust necessary to overcome the natural resistance to challenging such deeply entrenched practices. The project also highlighted the importance of developing a multi pronged strategy based on engagement with a broad range of stakeholders and supportive legislation.

The three delays as a framework for examining safe motherhood in Kafa zone, SNNPR, Ethiopia

The study examines delay as a crucial factor contributing to maternal mortality, using the conceptual framework of the Three Phases of Delay to explore factors that hinder the provision and utilisation of high quality, timely obstetric care in Kafa Zone, SNNPR, in Ethiopia. The Three Delays constitute the delay in deciding to seek medical care during an obstetric emergency, in reaching a medical facility, and in receiving suitable treatment in a health facility. Various aspects of the Three Delays are evaluated to examine problems of delay, transportation, and the referral system that is considered a vital element of the Ethiopian 'National Reproductive Health Strategy'.

(Un)safe routes : maternal mortality and Ethiopia's development agenda

This study juxtaposed women's experiences of birth at home in rural Ethiopia where it is 'safe' with that in a modern health care setting where it is 'unsafe' because the distance from international maternal health policy to its implementation is vast and the 'pathway to maternal survival' can be circuitous.

Researching maternal, neonatal and child health service use in rural and pastoralist Ethiopia: A key informant research approach

Like many nations in sub-Saharan Africa, Ethiopia has both a high neonatal mortality rate and maternal mortality ratio and is unlikely to meet Millennium Development Goals 4 and 5 by 2015. This working paper examines how Key Informant Research (KIR) in rural and pastoralist Ethiopia will identify facilitators and barriers to the use of maternal, neonatal and child health services. The methodology is informed by Participative Ethnographic Evaluation Research (PEER) and Key Informant Monitoring (KIM). Key Informant Research (KIR) training will provide research skills to Health Extension Workers (HEWs) and Non-government organisation (NGO) staff to enable them to develop research questions, collect data and participate in preliminary data analysis. This will enable the identification of strategies that improve the identification of risk, enhance early referral, increase access, affordability and acceptability of skilled birthing services in rural and pastoralist Ethiopia.

‘Waiting-to-see’ if the baby will come : findings from a qualitative study in Kafa Zone, Ethiopia

Background: Much of the quantitative research on maternal mortality in developing countries focuses on the need for health service interventions such as skilled attendants at birth and emergency obstetric and newborn care. A growing number of studies document the need for a more comprehensive perspective and include the macrostructural, that is, the social, cultural, economic and political determinants of health.
Objectives: To examine the salient aspects of birth at home and variables that influence decision making around transfer to a health facility during prolonged/obstructed labor.
Methods: Ethnography using participant observation and semi-structured interviews was conducted in 2007. A total of 56 mothers in Kafa Zone were selected: 20 in-depth interviews with women who gave birth at home; four who gave birth in a health facility; and 32 during antenatal care. Interviews were also conducted with health staff from Bonga Hospital and 15 health centers or health posts. Analysis followed a process of data reduction, data display and conclusion drawing/verification with the data organized around key themes.
Results: Most women gave birth at home assisted by their neighbor, mother, mother-in-law, or husband. It is likely women who gave birth at home feel ‘safe’ because that is where birth normally takes place and where they feel supported by close relatives and neighbors. Prolonged labor or ‘waiting-to-see’ if the baby would come was somewhat normalized and resulted in considerable delays to seeking assistance. Women felt it was ‘unsafe’ to go to a health facility because of the very real possibility that they would die on the way.
Conclusion: The findings highlight the importance of educating the local communities to recognize pregnancy related risks and to develop and implement appropriate responses, especially early referral, as communities play an important mobilizing role to health services.

External policy influence and higher education reform in Ethiopia : understanding symbolic power of the World Bank

Increasingly national policy processes are intersected with and affected by global policy actors and ideas. In aid-recipient countries such as Ethiopia, donors use financial and non-financial means to influence national policy decisions and directions. This paper is about the non-financial influence of the World Bank (WB) in the Ethiopian higher education policy reform. Using Pierre Bourdieu’s concept of symbolic power as a ‘thinking tool’, the paper aims to shed light on forms of symbolic capital that the Bank uses to generate a ‘misrecognisable’ form of power that regulates the HE policy process in Ethiopia. The findings show that the WB transforms its symbolic capital of recognition and legitimacy to establish a ‘shared misrecognition’ and thereby make its policy prescriptions implicit and hence acceptable to local policy agents. The Bank uses knowledge-based regulatory instruments to induce compliance to its neoliberal policy prescriptions. The paper therefore underscores the value of symbol power as an analytical framework to understand elusive but critical role of donors in policy processes of aid recipient countries.

Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the government's health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.

‘Knowledge aid’ as instrument of regulation: World Bank’s non-lending higher education support for Ethiopia

In the context of low-income countries, the role of donors in public policymaking is of great importance. Donors use a combination of lending and non-lending instruments as pathways of influence to shape policy directions in aid-recipient countries. This paper reports some findings from a doctoral study on the role of the World Bank in the recent higher education (HE) policy reform process in Ethiopia. It focuses on the nature and impact of non-lending assistance by the Bank to the Ethiopian HE subsystem. Based on an interpretive policy analysis of sector reviews and advisory activities of the Bank, and selected national HE policy documents, the following findings are highlighted. First, as a ‘knowledge institution’, the World Bank produces, systematises and disseminates knowledge through policy advice, policy reports, analytical sector reviews, and thematic conferences and workshops. Second, knowledge aid from the Bank not only has a profound discursive effect on shaping Ethiopian HE policy reform priorities in accordance with its neoliberal educational agenda but also undermines the knowledge production capacity of the nation. The paper also argues that, for an effective education policy support, the Bank needs to shift its modality of engagement from knowledge aid to research capacity building. 

The `knowledge-intensive development' agenda and equitable access to knowledge: higher education in Ethiopia

In light of the normative assumption of the role of knowledge in economic productivity and in response to strong exogenous policy orientations (mainly from the World Bank), the government of Ethiopia has restructured and expanded the higher education (HE) subsystem since the late 1990s. In critically analysing selected policy documents, this article seeks to understand the seemingly unlinked agendas of strengthening the role of HE in supporting the knowledge-intensive development agenda and the representation of the problem of inequality in access to and success in HE. It has been shown that the economic value of knowledge has been echoed in the reforms of Ethiopia, and that the problem of inequality has been superficially represented just as inequality of access while serious challenges that hinder participation and success of women, non-traditional students and ethnically and regionally disadvantaged groups remain unchallenged. Hence, the analysis indicates that under a situation of unequal opportunity to knowledge, the knowledge-intensive development agenda appears to be empty policy rhetoric.

Widening access to lifelong learning for adults in Ethiopia: opportunities with recognition of prior learning

Socio-economic implication of the lifelong learning for all agenda is enormous. The very idea of lifelong learning frees learning from time and space constraints. It advocates learning to be an activity of a lifetime both within and without the formal education system. The assumption is that lifelong and life-wide learning will promote competitiveness, creativity, employability and social cohesion. Taking it in the context of developing countries such as Ethiopia, lifelong learning as an educational organising principle may play a vital role in supporting efforts to eradicate illiteracy and reduce poverty. Recently, Ethiopia has introduced the third phase of their education sector development programme, which underscores the importance of adult education, and a national strategy for adult education. This paper analyses the two documents to understand the extent to which non-formal and formal education are linked, and thereby to highlight the significance of institutionalising the recognition of prior learning (RPL) to promote lifelong learning for adults and working population.

Multiple informal imperial connections and the transfer of accountancy to Ethiopia (1905 to 2011)

The accounting history literature expounds the role of imperial connection on the transfer of Western accountancy concepts and practices to developing countries. An emerging theme within this literature is the shift in imperial power from Britain to USA over the last century and the ramifications of this shift on accountancy globally. Using a framework developed by prior research for investigating the transfer of accountancy across countries, this study examines historical developments of accounting practice, education and professional training in Ethiopia (from 1905 to 2011) in the light of the country’s interactions with Britain and the USA. These interactions facilitated Ethiopia’s continued importation of British accountancy practice and professional training contemporaneously with importation of accounting education from the USA. Over the past two decades, Ethiopia has been undertaking accounting reforms as part of economic policy reforms in pursuit of neo-liberal economic ideals. In response to shifting priorities of transnational actors, Ethiopia continued trialling policy initiatives that are yet to yield a stable equilibrium with coherent links of accounting education, practice and professional training.