For 30 years, IHI has used improvement science to advance and sustain better outcomes in health and healthcare systems across the globe. 

IHI has worked with the Ministry of Health in Ethiopia since 2013 to reduce maternal and newborn mortality by improving the quality of healthcare. In recent years, IHI and the Ministry’s Public Health Infrastructure Directorate have sought to explore what ideal maternity care looks like from community perspectives and to better understand the effect that the built environment of maternal care facilities has on both quality and experience of care. To advance this work, EPSCF provided funding to IHI to engage mothers, providers and community members in two regions of Ethiopia to discuss how their experiences of maternal healthcare have been shaped by the physical structures of the care facilities. 

As a condition of EPSCF funding, IHI ensured the active participation of the Ministry of Health from the start. IHI partnered with global design firm MASS Design Group, as well as Ethiopia-based architecture firm Fasil Giorghis Consult, to conduct facility assessments and community engagement. During the development phase, IHI received additional funding from the Bill & Melinda Gates Foundation to expand the project to include additional sites, allowing IHI to identify commonalities in women's perceptions of high-quality perinatal care. In addition to conceptual designs of assessed facilities, IHI will use the information to produce "Global Goods," a toolkit that stakeholders around the world can use to replicate the human-centered design process. The Global Goods will be guided by a Steering Committee convened by IHI and comprised of global public health experts who will ensure broad and equitable dissemination of the project's learnings. The Global Goods are expected to be published in 2023.

Findings thus far have been fascinating. While there are some limitations to overall space at the facilities, there is significant opportunity to optimize existing space by reconfiguring which services are delivered where. Services should be organized to align with care journeys to streamline movement, ensuring that the critical adjacencies are taken into account. Accommodating companions - a priority, according to mothers - will require creative use of exterior spaces for waiting and storage areas and paths through which companions can move without crowding internal corridors. Some challenges - such as permanent provision of clean, running water - will require larger investments by the Ministry of Health. 

In late-2022, Fasil Giorghis Consult submitted final construction documents for two facilities and a bill of quantities (materials costing) will follow. The Global Goods SC will review the findings and provide guidance on how to share this information. IHI continues to engage with the Ministry of Health and Regional Health Bureau, important implementation partners. EPSCF is thrilled to be a part of the creation of a set of global guidelines for model facility design to improve maternal and neonatal outcomes.