Leveraging Informatics to Enhance the Obstetrics Emergency Supply Chain in Amhara, Ethiopia

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Maternal mortality remains a critical public health concern, especially in Sub-Saharan Africa where the majority of maternal mortality cases occur. To improve maternal outcomes, facilities must have the clinical capacity to manage obstetric emergencies. This capacity begins with having the necessary medications and equipment to identify, treat, and modify care. Currently, there is no system in place in Amhara, Ethiopia to monitor readiness and deploying supplies in real time. The aims of this study are to investigate the barriers and bottlenecks within Amhara’s obstetric emergency supply chain and produce a dashboard prototype and design specification document that will track the movement of emergency supplies and monitor obstetric emergency readiness. The study aligns with the National Institute of Nursing Research priority areas of identifying interventions to remove barriers to health equity and promoting population health. This study will provide an electronic dashboard for monitoring facility readiness to manage obstetric emergencies in Amhara, Ethiopia which will assist in ensuring regional facilities are able to provide adequate obstetric care. This will ultimately improve outcomes and decrease maternal mortality rates in the region. The Socio-technical Framework will be used to guide this mixed-methods study. This framework supports exploration of the impact of new technology in a healthcare system. A preliminary quantitative analysis using the Signal Functions Tracer Items and the Clinical Cascade assessed the region’s current clinical capacity to manage obstetric emergencies. To contextualize these findings, we will conduct 20 semi-structured interviews with individuals in the regional and the federal ministries of health along with local health facility workers who interact with the current obstetric supply chain. The findings from the preliminary study and Aim 1 will inform the creation of the electronic dashboard for visualizing supply chain status. We will apply user-centered design strategies, including think-aloud protocol, to enhance dashboard usability. End-user evaluations using the Health Information Technology Usability Scale and heuristic evaluations with human-computer interaction experts will ensure ease of use and usefulness of the dashboard. This study will culminate in the creation of a prototype dashboard and design specification document that can be incorporated into Amhara’s current Integrated Pharmaceutic Logistics System to improve readiness surveillance. This study will be supported by a diverse mentorship team and will benefit from the vast resources available at Columbia University School of Nursing and through the Emory-Ethiopia Partnership, which has over a decade of experience conducting research and working in Amhara. This established relationship will aid the applicant by connecting her to potential interviewees and in-country support. Results of this study will not only improve Amhara’s capacity to monitor obstetric emergency clinical capacity, but it will also provide the region with the tools to enact targeted interventions to both improve and maintain a high standard of care for mothers.