Ensuring Equitable Access to Life-Saving Cesarean Delivery: Improving operative delivery access in rural Ethiopian primary healthcare settings
The Ministry of Health has invested in constructing over 400 operative blocks to expand surgical access at the primary care level. However, many of these operating rooms remain non-functional due to logistical barriers, equipment gaps and shortages of specialized personnel. To translate infrastructure into life-saving services, ACSIS supports MoH and partners with government and local stakeholders to operationalize these rooms and to build local clinical capacity so that emergency surgical care reaches rural communities.
Scale-up & sustainability
The program was implemented in coordination with the Ministry of Health and regional and woreda administrations, emphasizing local ownership, leadership, and system-level accountability. The model is designed for national scale-up to reduce surgical inequities across rural Ethiopia.
ACSIS welcomes partnership inquiries for scaling and sustaining operative delivery services. For more information, program data, or partnership requests, contact: info@acsisethiopia.org
Program Objective
To expand access to life-saving cesarean delivery by supporting non-functional operating rooms in rural health centers and by building the capacity of general practitioners (GPs) and local systems to initiate and sustain operative delivery services at primary care level.
Key interventions
Competency-based training: A four-month structured program delivered to 70 GPs from 10 regions in the first round, combining classroom instruction, simulation and supervised in-hospital practice under obstetricians. Each trainee completed a supervised minimum of 40 cesarean sections before independent practice.
Clinical quality systems: Recurrent quality improvement (QI) sessions, clinical audit and mentorship to monitor outcomes and reinforce safe practice.
Key output
• 67 of 70 trainees (95.7%) achieved Level-3 competency.
• 96% of trainees completed ≥40 independent cesarean sections and gained ultrasound proficiency.
• US$639,000 worth of essential equipment was mobilized to operationalize ORs.
• 52 of 67 (77%) health centers initiated operative delivery services within five months of the program demonstrating rapid capacity improvement and system readiness.
Lessons learned
Training and empowering mid-level providers to perform emergency surgical procedures has proven to be an effective and rapid strategy for expanding surgical coverage in rural areas, particularly when supported by structured supervision and continuous quality improvement systems. The success of this approach is further strengthened through collaborative resource mobilization, where partnerships with government bodies, regional administrations and local leaders ensure that facilities receive the essential equipment, supplies and infrastructure needed to initiate and sustain services. Long-term impact, however, relies on sustained mentorship, predictable financing for consumables and equipment maintenance, and strong integration of these services within existing local health system governance structures ensuring that gains in access and quality are both scalable and enduring.