Globally, 295,000 women died during and following pregnancy and childbirth in 2017. Most of these deaths occurred in low-resource settings . The World Health Organization (WHO) had estimated a total death of 2.5 million children within the first month of their life, in 2018 . Furthermore, 2.6 million babies are stillborn, with half of these deaths occurring at home .
Ethiopia is a low-income country with high incidences of maternal and neonatal mortalities. Over the past couple of decades, the Government of Ethiopia, its citizens, and development partners have successfully implemented most global and national commitments. During the implementation of health sector development programs spanning 20 years, the country has heavily invested its resources into improving maternal, neonatal and child health outcomes . Despite this, the country has gained minimal results in the reduction of maternal and neonatal mortalities . Although maternal mortality has declined from 708 per 100,000 live births in 1990 to 497 per 100,000 live births in 2013, the country has failed to achieve the millennium development goals (MDG) . Similarly, the decline in neonatal mortality has been slow, from 63 per 1,000 live births in 1990 to 28 per 1,000 live births in 2015 . Furthermore, the latest Ethiopian mini-demographic and health survey report documented a high neonatal mortality rate of 33 per 1,000 live births .
The WHO aims for a world where every pregnant woman and newborn receives quality care throughout pregnancy, childbirth, and postnatal periods . To meet the sustainable development goals (SDGs), Ethiopia has developed its second five-year health sector transformation plan (HSTP), from 2020/21 to 2024/25. One of the strategic objectives of the HSTP is reducing maternal mortality from 401 per 100,000 live births to 279 per 100,000 live births, and neonatal mortality from 33 per 1,000 live births to 21 per 1,000 live births .
Most maternal and perinatal deaths are preventable with the institution of high impact and cost-effective interventions during pregnancy, labor, delivery, and postpartum periods. One of these interventions is the delivery of quality antenatal care (ANC) services. In 2016, the WHO recommended a minimum of eight ANC contact visits for expectant women, with specified evidence-based and beneficial interventions being administered during those contacts. One of the recommendations is mandatory ultrasound (U/S) scanning of all pregnant women at least once before the 24th week of gestation by skilled providers .
The attainment of the Ministry of Health (MoH) of Ethiopia’s vision “to see productive and prosperous citizens” is challenged with extreme shortage of human resources [3, 11]. During the year 2020, there were 95 radiologists and 462 obstetricians and gynecologists available to provide obstetric ultrasound services in the country, which has population of over 110 million. Optimizing the capacity of existing human resources, and distribution of tasks and responsibilities among various health professionals will improve access to, and quality and equity of health services .
The United States Agency for International Development (USAID) funds the USAID Transform: Primary Health Care project (2017- 2022) to support the MoH in line with its long-term goal of preventing maternal and child deaths (PCMD) .
To improve access to, and quality and equity of basic maternal and neonatal health services, the project, in collaboration with its technology partner General Electric Co. introduced Vscan access—a small portable ultrasound devise, for obstetric scanning by trained mid-level providers in 100 health centers . The project strategizes to increase skilled birth attendance (SBA), introduce point of care ultrasound scanning services during ANC, and improve the proper management of complications of pregnancies in referral health facilities all of which will contribute to improvements in maternal, fetal, and neonatal positive health outcomes [13, 15].
Studies have documented improvements in maternal and neonatal health service utilization and favorable pregnancy outcomes for both mother and baby, as a result of availing obstetric point of care ultrasound services and improved quality of services in remote places around the world [16–27]. In addition, during the second HSTP, the MoH of Ethiopia has a plan to introduce ultrasound services in about one thousand health centers. This study aims to assess the effects of institutionalizing Vscan access limited obstetric ultrasound services on ANC, skilled delivery, and postnatal care (PNC) service utilization in Ethiopia. To the authors’ knowledge, this study is of the first of its kind in the country and will be used to guide policy on the area.