Since its independence in 1991, Eritrea has made remarkable progress in maternal health improvement, reducing its maternal mortality ratio from 1590 deaths per 100 000 live births in 1993 to 804 deaths per 100 000 live births by 2015.[1] However, an unfinished maternal and child health agenda has left the country with substantial inequalities in maternal health services, which kept the maternal mortality ratio high. Skilled birth attendance remained low in hard to reach rural areas where available health facilities often cannot deliver essential maternal services.

Since 2007, in collaboration with the Ministry of Health and other stakeholders, WHO have supported the roll-out of Maternal Waiting Homes (MWH) as a vital element of a low-cost strategy to bridge the obstetric gap care between rural and urban areas. MWH are residential facilities near a qualified medical facility, where women coming from hard to reach areas can await their delivery and be transferred to a nearby medical facility shortly before delivery or earlier should complications arise. WHO has directly supported 43 MWH located in hard to reach areas in five of the six regions (Zobas) of Eritrea. The support includes the supply of twenty equipment sets of Solar Suitcases and Lithium Ferrous Phosphate (LFP), including 12-volt replacement batteries for reliable electricity to support essential lighting, communication, and medical services in MWH, located primarily in rural settings in need of simple, reliable, accessible and affordable electricity.The solar suitcases are also climate change friendly and replacing fossil fuel sources of lighting and electricity, thereby freeing much needed time for health workers to efficiently provide timely and effective emergency obstetric health care for pregnant women, mothers and babies to prevent maternal deaths.In addition to ensuring stable electricity, WHO also supported service delivery in MWH by providing 20fetal Doppler machines, 40 rechargeable headlamps with a micro USB cable, 20 multi-tip phones chargers, maternal pyjamas, baby cover and baby kits.

WHO's efforts to sustain MWH operations have contributed to increasing skilled attendance at birth and increased health facility delivery among women living in remote and hard to reach rural areas. Skilled birth attendance among women living in Eritrea increased from 26.7% in 2009 to 51.6% in 2019. National administrative data also show progressive increases in health-facility deliveries, mostly accounted for by Zobas and health facilities linked to MWH. Consequently, maternal mortality in Eritrea has reduced significantly from 804 deaths per 100 000 live births in 2005 to 480 deaths per 100 000 live births by 2017.

WHO's roles in delivering essential maternal health services to underserved communities help Eritrea consolidate the significant achievement recorded in maternal mortality reduction.

[1]. WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. Trends in Maternal Mortality: 2000 to 2017. Geneva, World Health Organization, 2019. Available online Maternal mortality ratio (modeled estimate, per 100 000 live births) -Eritrea | Data (worldbank.org)

Photo caption: Community built MWHs in Beilubuy, Eritrea to compliment and upscale WHO’s ongoing support to strengthen access to quality maternal and new born heath care.

Photo credit: WHO