Ethiopia implements a three-tier healthcare delivery system with primary,secondary, and tertiary levels of care networked through a referral system. Aprimary care unit comprises of primary hospitals, health centers, and theirsatellite health posts. Over the past three decades, the country has achieved asteady expansion of primary care units as well as mobilization of a women-ledhealth development groups to create model households and communities

During the same period, the government and development partners have madesignificant progress in promoting and implementing policies and laws thatcenter on reproductive rights and empowerment of women, legalization ofabortion under certain circumstances, combating gender-based violence andprevention of early marriage and other harmful traditional practices.

The COPMOD (Contain Patients Move Doctors) approach is a rights-basedholistic transformation of primary care aimed at accelerating improvements inthe quality of sexual and reproductive health (SRH) services. In tertiary healthfacilities, there are high number of both health professionals and patients. Toaddress this, COPMOD focuses on moving doctors from tertiary facilities toprimary health centers, effectively containing patients at the primary level. Thisapproach also enables experts to transfer their knowledge to mid and low-level health professionals.

In the realm of sexual, reproductive, and maternal health, timely access to acute care is a matter oflife and death. Tragically, 60% of mortality related to these health conditions is attributed to delaysin receiving adequate care. Despite efforts made to make the health care system morecompassionate and respectful, there remains a lot to be done to insure it recognizes people’sidentity, culture and privacy. In addition to these most care interactions between providers andclients are missed opportunities to transfer knowledge. The COPMOD project aims to tackle thesepressing issues by implementing three strategic pillars that focus on improving timeliness,implementing person-centered care, and empowering women to take ownership of their health. Byrethinking the way healthcare is delivered, COPMOD strives to create a healthier community.

Institutions providing healthcare often witness delays in delivering the right care, leading topreventable deaths and disabilities. The COPMOD project addresses this challenge by enhancingadherence to evidence-based protocols, redesigning task distribution, and improving the skills ofhealthcare professionals. Moreover, a culture of clinical audit will be fostered, allowing forcontinuous learning and improvement within the system. By initiating thematic quality improvementinitiatives and optimizing the efficiency of sexual, reproductive, and maternal emergency careprocesses, COPMOD aims to improve timeliness of maternal care.

• Training on the COPMOD concept and its implementation quality improvement tools wasprovided to 340 health professionals from across 5 coaches, 15 hubs and 85 spokes.
• Operative delivery service was facilitated in 12 out of 15 (80%) of the envisaged hubs, providingcesarean delivery service to 468 pregnant women closer to their homes.
• Obstetrics Emergency Case-based Training Manual, Structured Point of care ObstetricUltrasound (SPOUS) Training Manual and Cesarean Delivery Training Manuals were preparedthrough consultative workshops featuring subject matter experts.
• The Structured Point of care Obstetric Ultrasound (SPOUS) training was administered to 73mid-level professionals across 15 hub and selected spoke facilities.
• Two tools, the Obstetric Emergency Triage Tool and ToR for Referral and Linkage weredeveloped to improve triage and emergency flow processes in addition to Audit Tool forObstetric Emergency Services and Audit Tool for Abortion Services for the optimization of SRHemergency care process

By adopting a person-centered care model, COPMOD aims to meet the unique needs of women,girls, and their families. Ambulatory sexual and reproductive health, antenatal care, family planning,and other outpatient visits will be redesigned based on this model. Additionally, the project willestablish contact centers for decision support, ensuring professionals and patients have access toreliable information and guidance.

• Person-Centered Care Assessment Checklist for SRH Services, Structured Communication andCollaborative Care Management Training and Expert Mothers Training Manuals were preparedthrough consultative workshops.
• Structured communication and collaborative care management training was provided to 63health professionals, including liaison officers and health service managers from coach and hubhealth institutions.
• During the reporting period, decision support contact centers were established within fourcoach centers and one hub institution.
• 91 gynecologic examination couches and 55 mechanical vacuum aspirators were procured anddistributed to 89 facilities as need assessment findings revealed that 60% of the 103 facilitieslacked full equipment to facilitate cervical cancer screening and comprehensive abortionservices.
• Since January, 2023, 4,424 cervical cancer screening services have been provided in theCOPMOD project implementation hubs among which 1209 women were screened duringscreening campaigns supported by ACSIS in five sites.

Women make up half of Ethiopia's population. Recognizing that sexual and reproductive health is afundamental right, COPMOD emphasizes the importance of involving women in the planning,design, implementation, and delivery of SRH services. By promoting co-production and ownership,the project seeks to involve women and girls in the delivery and monitoring of healthcare services.Through literacy and graduation programs, the knowledge base of women and adolescent girls willbe strengthened. Initiatives such as the Coproduction: By Mothers for Mothers (CoMoM) and womanhealth marketing shops will provide platforms for regular audits and economic empowerment.

• Pregnant woman’s portfolio guidebook has been prepared to serve as a reliable resource forexpectant mothers.
• Women Health Equity Boards, each comprising five female members, were established in 15 hubcenters. WHEB Scorecard was developed to assess healthcare facilities regarding sexual andreproductive health services in addition to a comprehensive assessment tool to evaluate WHEBperformance.
• Community shades and shops were established in two hubs, namely Harbu Health Center inAmhara 2 (Dessie) cohort and Dima Health Center in Oromia 2 (Alert) cohort.

Background: The Afar Region, located in the north-eastern part of Ethiopia, isdivided into 5 administrative zones and 30 woredas. This region ispredominantly occupied by the Afar ethnic group (92%), who mostly engagein agro-pastoralist activities. In the Afar culture, clans are important socialand political units. The region has a total population of nearly 2 millionpeople living in an estimated area of 72,052.78 square kilometers. Theestimated population density is 20.7 people per square kilometer

Background: The Amhara region, located in the northern part of Ethiopia,administered under 11 zones and 140 woredas. Its capital is Bahirdar which isthe seat of the Regional Government of Amhara. About 90% of the Amharaare rural and make their living through farming, the remaining 10% beingattributed for manufacturing in its urban centers. Based on the 2007 censusconducted by the Central Statistical Agency of Ethiopia (CSA), the Amhararegion has a population of 17,221,976. With an estimated area of 154,708.96km2 (59,733.46 sq mi), this region has an estimated density of 108.2 peopleper square kilometer. The projected population as of 2022 was 32,134,988.

Ethiopia implements a three-tier healthcare delivery system with primary,secondary, and tertiary levels of care networked through a referral system. Aprimary care unit comprises of primary hospitals, health centers, and theirsatellite health posts. Over the past three decades, the country has achieved asteady expansion of primary care units as well as mobilization of a women-ledhealth development groups to create model households and communities