Challenges

In Djibouti, maternal and neonatal health are considered public health issues. In its “National Action Plan to Fight Maternal Mortality”, the country has set ambitious key targets for reducing maternal mortality rate and neonatal mortality rate. Towards that, the Mother and Child Health Center of the Ministry of Health in Djibouti is cooperating with various partners to enhance access to maternal healthcare facilities and sensitize the population on the importance of maternal and children healthcare.

One of the main challenges facing the country is the weak electronic monitoring and surveillance of high-risk pregnancies and childbirth. This is due to many reasons, including a shortage of the required equipment within the maternal and healthcare centres in the country; and the non-systematic follow up of protocols and standard operating procedures to properly manage high-risk pregnancies. In addition, health staff involved in the public reproductive health needs capacity uplifting to better manage such situations

Toward a Solution

The Reproductive Health Centre of the Hospital Ibn Sina is a national health centre in Morocco with over 25 years of experience in the management of obstetric and neonatal activities. Annually, this centre is dealing with about 20,000 pregnancy cases, and has been applying electronic monitoring of the high-risk pregnancies and childbirth in Morocco for a long time. The centre has developed a training toolkit for electronic monitoring customized to the Moroccan context and in line with the World Health Organization standards.

The Centre is recognized at the national and regional level as a resource center in maternal health. It provides training, including support for maternal health centres in sub-Saharan Africa through knowledge exchange. It has offered more than 300 training sessions and workshops related to women and infant health. More than 1,500 health specialists from 22 countries, including representatives from Djibouti, benefited from these training.

The Islamic Development Bank (IsDB) is in continuous dialogue with the Government of Djibouti and has supported the country’s health sector. The Bank is, therefore, familiar with the country’s challenges and the capacity gaps in maternal health.

The IsDB has also collaborated with the Reproductive Health Centre for a long time. The Bank funded various training workshops in partnership with the Centre, as it was identified as a provider of expertise in the Member Country Partnership Strategy for Morocco. In addition, a Memorandum of Understanding between the Moroccan Agency for International Cooperation and the IsDB was signed to facilitate the transfer of Morocco’s experience. Thus, the Bank was able to match the needs of Djibouti with the expertise of Morocco and put the skills share into action.

To achieve the overall goal of the programme, the intervention consisted of:

• developing a specific customised set of Training of Trainers (TOT) modules adapted to the local context and providing TOT for Djiboutian maternal health specialists;
• developing the capacity of Djiboutian nurses, midwives and medical doctors in monitoring high-risk pregnancies and childbirth through series of training workshops;
• formulating and implementing protocols and standard operating procedures for monitoring high-risk pregnancies and childbirth in the Maternal and Healthcare Centers in Djibouti,
• equipping selected maternal and healthcare centres in the country with cardiotocography machines and upgrading the technician’s skills in the maintenance of these equipment; and
• sensitizing decisionmakers and the public in general on the importance of electronic monitoring of high-risk pregnancies.

In term of replicability of the approach, the model has been implemented in Djibouti. A phase II of the project is under discussions and the model would be implemented in other IsDB member countries in Sub-Saharan Africa based on the same approach and modus operandi, while taking into account the needed customization to the local context.

In term of approach, as per the design of the Reverse Linkage intervention, the project was developed based on a peer-to-peer approach, which consists of a consultation process between stakeholders from Morocco and Djibouti facilitated by the IsDB. More importantly, the core team of the provider institution, which is a collaborating centre of the World Health Organization, is very familiar with Djibouti context since it had already been engaged into cooperation with the country’s Ministry of Health on previous projects.

The success of the programme depends on the built-in efficient and effective tripartite collaboration between IsDB (facilitator), The Reproductive Health Center of the Hospital Ibn Sina(expertise provider) and beneficiary country. Cross-country lessons from beneficiary countries in the region also contributed towards the overall success of the programme.

The programme has achieved multiple wins, including directly contributing to SDGs 3 and 17. The programme also harnesses the numerous benefits of South-South and Triangular Cooperation to concurrently address beneficiaries’ development needs, promotes knowledge transfer and fosters cross-country partnership and collaboration for development through South-South cooperation.

Key Development Results of the Programme

• Support the target maternal health institution to properly manage and maintain healthcare system surveillance of high-risk pregnancies and childbirth, in Djibouti;
• Main maternal and healthcare centres in Djibouti implementing the newly developed Protocols/Standard Operating Procedures (SOPs) for the surveillance of high-risk pregnancy and childbirth;
• High-risk pregnancies and childbirth monitored by qualified medical and technical staff in targeted maternal and healthcare centres;
• Main maternal and healthcare centres in Djibouti equipped with functional CTG tools.