Prioritizing Research for Maternal and Child Wellbeing
Ethiopia is making strides in improving maternal, newborn, and child health (MNCH), yet significant challenges remain. With over 14,000 maternal deaths annually and high rates of neonatal and under-5 mortality, Ethiopia’s MNCH landscape calls for focused, evidence-based action. The HaSET Maternal and Child Health Research Program (MCHRP) is leading the way, leveraging a rigorous prioritization process to guide future MNCH research investments.
Through a mixed-methods formative assessment, HaSET engaged over 100 diverse stakeholders – including policymakers, program implementers, researchers, and community members – to identify the most pressing MNCH research needs in Ethiopia. Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, the team generated 56 priority research questions across the continuum of care, from women’s health to newborn and child health to health system strengthening.
The top research priorities reveal critical gaps that, if addressed, could drive meaningful improvements in MNCH outcomes. Topping the list are studies to:
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Increase coverage of high-impact interventions: Examine barriers and enablers to scaling up proven interventions like integrated community case management (ICCM), family-centered newborn care, and kangaroo mother care.
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Understand determinants of care-seeking: Identify factors shaping uptake of antenatal care, facility-based deliveries, immunization, and postnatal care.
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Strengthen health system capabilities: Investigate health worker skills, health facility documentation practices, and resilience of MNCH service delivery during shocks.
Notably, the expert consensus discussions and community workshops further validated these priorities, underscoring their relevance to the Ethiopian context. Community members emphasized the need for research to improve awareness and quality of postnatal, antenatal, and delivery services, as well as to understand harmful traditional practices.
“This research agenda truly reflects the voices of those closest to the issues – the program leaders, frontline workers, and community members who see the daily realities,” said Dr. Grace Chan, HaSET’s principal investigator. “By aligning research to these priority needs, we can generate evidence to drive more effective and equitable MNCH programs.”
Leveraging Lessons from the HIV Response
The HaSET team drew inspiration from the global HIV response when designing their MNCH research prioritization process. Like HIV, MNCH encompasses a continuum of care with diverse stakeholders, complex social determinants, and an urgent need to translate research into policy and practice.
“The HIV response has shown us the power of community engagement, the importance of addressing social and structural barriers, and the value of using rigorous methods to set research agendas,” noted Dr. Linda-Gail Bekker, a HaSET collaborator and member of the UNAIDS-Lancet Commission. “We aimed to apply those lessons to strengthen MNCH research in Ethiopia.”
Indeed, the HaSET prioritization process mirrored key attributes of the HIV response, including:
Multistakeholder engagement: Involving policymakers, implementers, researchers, funders, and community members ensured the priorities reflected diverse perspectives and needs.
Focus on equity and rights: Emphasizing the importance of research to improve access and outcomes for underserved populations, such as newborns, adolescent girls, and marginalized groups.
Commitment to translation: Designing the process to generate actionable, context-specific evidence that can directly inform MNCH programs and policies.
Transparent, systematic methodology: Adapting the rigorous CHNRI approach to produce a ranked, quantitative list of priorities, enhancing credibility and replicability.
Validation through consensus-building: Incorporating expert discussions and community workshops to contextualize and validate the prioritized research questions.
These elements helped position the HaSET research agenda as a collaborative, inclusive, and impactful roadmap for strengthening Ethiopia’s MNCH ecosystem. By aligning research to the most pressing needs, HaSET aims to catalyze progress and ultimately improve the health and wellbeing of women, newborns, and children nationwide.
Addressing Gaps Across the MNCH Continuum
The prioritized research questions span critical gaps across the MNCH continuum, offering insights to guide investments and action.
Women’s Health
Maternal mortality remains unacceptably high in Ethiopia, with 401 deaths per 100,000 live births as of 2017. The top women’s health priorities focus on understanding barriers to accessing essential services, including:
- Identifying factors associated with the location of delivery (home vs. facility) and antenatal care (ANC) adherence.
- Examining the role of maternal diet and nutrition during pregnancy on birth outcomes.
- Exploring the prevalence and determinants of gestational diabetes.
- Investigating the effect of water, sanitation, and hygiene (WASH) availability in health facilities on maternal and newborn outcomes.
Addressing these knowledge gaps can inform strategies to improve care-seeking behaviors and ensure high-quality, responsive maternal health services.
Intrapartum and Newborn Health
Ethiopia has made impressive strides in reducing under-5 mortality, but neonatal mortality remains high at 28 deaths per 1,000 live births. Priority research in this domain includes:
- Identifying the major causes of morbidity and mortality during the intrapartum and neonatal periods.
- Evaluating health worker capabilities to recognize and manage neonatal complications, such as the ability to identify newborns needing resuscitation.
- Investigating the aetiology and antimicrobial resistance patterns of neonatal sepsis.
These insights can guide efforts to strengthen facility-based care, enhance quality of services, and address leading drivers of newborn deaths.
Postpartum and Child Health
While postnatal care remains a persistent challenge, research priorities in this area emphasize testing innovative, high-impact interventions, such as:
- Assessing the effect and coverage of family-centered newborn care and kangaroo mother care.
- Identifying barriers to postpartum care-seeking and strategies to improve uptake.
- Describing the psychosocial and mental health characteristics of postpartum women.
Companion priorities in child health focus on improving coverage of integrated community case management (ICCM) and integrated management of newborn and childhood illness (IMNCI) packages, as well as understanding reasons for immunization dropout.
Health System Strengthening
Underlying many of the MNCH challenges are health system gaps. The prioritized research agenda recognizes the need to:
- Investigate the resilience of MNCH service delivery and utilization during shocks like pandemics.
- Assess the current laboratory and clinical diagnostic capacities of the MNCH health workforce.
- Identify effective strategies to improve health facility documentation of key MNCH outcomes.
Addressing these system-level issues can enhance the overall functionality and responsiveness of Ethiopia’s MNCH services.
Elevating Community Voices
A distinguishing feature of the HaSET prioritization process was the intentional engagement of community members – a critical step often overlooked in research agenda-setting.
Through two workshops held in Angolela and Kewot, HaSET convened women of reproductive age, local health leaders, and other community stakeholders to share their perspectives on pressing MNCH issues. These discussions surfaced priorities that complemented, but also expanded upon, the expert-generated list.
For instance, community members highlighted the need for research to:
- Improve the accuracy of gestational age estimation during pregnancy.
- Understand the health impacts of harmful traditional practices like uvulectomy (cutting of the uvula).
- Address certain community beliefs, such as elongation of the uvula, that can deter care-seeking.
“While the expert-driven priorities focused on system-level gaps, the community workshops revealed important local perspectives and context-specific concerns,” explained Addisalem Fikre, HaSET’s community engagement lead. “Integrating these insights ensures the research agenda is truly responsive to community needs.”
Indeed, the community-identified priorities underscore the value of multistakeholder engagement in shaping research priorities. By elevating the voices of those most directly impacted by MNCH challenges, the HaSET process has generated a holistic, community-centered research agenda.
Catalyzing Action Through Collaboration
The HaSET research prioritization exercise is more than an academic exercise – it is a strategic roadmap to drive measurable improvements in Ethiopia’s MNCH landscape. By aligning investments and efforts around these priority research questions, HaSET aims to catalyze coordinated action and translate evidence into policy and practice.
“This prioritized research agenda is not just for HaSET – it is for the entire MNCH ecosystem in Ethiopia,” emphasized Dr. Getnet Tadele, HaSET’s co-principal investigator. “Our goal is to share these findings widely, engaging stakeholders at all levels to collectively pursue these research opportunities.”
To that end, HaSET is actively disseminating the prioritized research questions to key partners, including the Ministry of Health, regional health bureaus, academic institutions, implementers, and funders. The team is also incorporating the priorities into HaSET’s own research agenda and fellowship program, ensuring the critical gaps are systematically addressed.
Moreover, HaSET is leveraging its extensive partnerships to facilitate research collaborations and knowledge translation. By aligning efforts with the Ministry of Health, Ethiopian Public Health Institute, and other national entities, HaSET aims to ensure the research findings directly inform MNCH policy and programming.
“The true test of this process will be its impact – whether the evidence generated can drive meaningful changes in the lives of women, newborns, and children,” said Dr. Tsion Assefa, HaSET’s country director. “That is our north star as we work to advance newborn and maternal health in Ethiopia.”
Through this inclusive, evidence-based approach, HaSET is positioning Ethiopia’s MNCH research ecosystem for greater impact. By galvanizing stakeholders around a shared agenda, the program is poised to catalyze coordinated, context-responsive action to improve health outcomes for the nation’s most vulnerable populations.
