Abstract:
Postnatal care is among the major recommended interventions to reduce maternal
deaths globally. During this period, health professionals can diagnose postpartum
problems and potential complications to ensure prompt treatment or interventions.
The purpose of this study was to assess, adapt, and contextualise Chelagat’s
framework for improving postnatal care that was developed within the Kenyan
context, for implementation in Ethiopia.
Sequential mixed-methods research, that involved a quantitative and qualitative
cross-sectional study design, was conducted over three phases. In the first phase of
the study, the applicability of Chelagat’s framework for implementation in Ethiopia, as
well as the challenges and opportunities for the implementation of the framework,
was assessed and described. The second phase of the study concentrated on the
adaptation and contextualisation of Chelagat’s framework as well as the
development of an action plan for the implementation of the adapted and
contextualised framework within Ethiopia. The third phase was the validation of both
the contextualised framework and an action plan for the implementation of the
contextualised framework within the Ethiopian context.
The findings revealed that the framework from Chelagat is applicable for the
improvement of postnatal care in the Ethiopian context. It was indicated that a lack of
physical resources, infrastructure problems, cultural concerns, inadequate capacity
v
building, inaccessibility of health services, unavailability of guidelines, lack of
communication with healthcare users, and poor monitoring and evaluation were
challenges that can impact the implementation of the contextualised framework.
These identified aspects were addressed and incorporated in the contextualised
framework and action plan. The health sector transformation plan, good health
system governance, as well as good political will by the Ethiopian government, were
opportunities identified which could contribute to the implementation of the
contextualised framework.
A validated contextualised framework and action plan to facilitate the implementation
thereof were developed using the inputs from respondents during Phase 1, a
thorough literature review, as well as the three-round Delphi technique.
Actions/methods to address the abovementioned challenges were included in the
action plan for the facilitation of the implementation of the contextualised framework.
The contextualised framework, accompanied by the action plan to facilitate
implementation, will be shared with the Ethiopian Federal Ministry of Health and
other concerned organisations working on postnatal care services to enhance
implementation in the Ethiopian context.
Follow-up studies to assess the limitations of the framework and action plan can be
conducted to adapt and improve the framework. Further studies on possible
challenges associated with the implementation can enhance the success of the
framework. Studies that assess the impact (the Systems Model), such as the
possible reduction in maternal and neonatal morbidity and mortality after the
implementation of the contextualised framework, are also recommended.
