Integrated Periodic Outreach Strategy to Improve Maternal and Child health Service Access Among Hard- to-Reach Areas in Ethiopia

Abstract Background The inequities that exist in healthcare for hard-to-reach areas have serious implications on the prevention and control of diseases. Rural populations who are pastoralists, seasonally mobile, or simply live far from facilities within the national infrastructure are among the hard-to-reach population groups. The USAID Transform: Primary Health Care Activity initiated the integrated periodic outreach service (IPOS) strategy to address inequities in healthcare. The aim of this assessment was to identify the contributions of the IPOS strategy on facilitating access to healthcare for hard-to-reach areas. Methods A managerial and health facility level cross-sectional study employing both qualitative and quantitative data collections were carried out. Results The average number of hard-to-reach kebeles among IPOS implementing higher tier health facilities (HFs) was found to be 6, and from these 87% were targeted for the IPOS strategy. Having no HFs nearby, shortage of transport services, security issues, and the nature of pastoralist communities are some of the potential reasons for the requirement of IPOS. Preparatory activities like training, microplanning, and community mobilization were conducted before the actual implementation of the sessions. Integrated reproductive, maternal, newborn, child and adolescent health-nutrition (RMNCAH-N) services were then provided for women and children. There was community acceptance for all services provided and service utilization was high. There has been a progressive improvement of coverage of maternal and child health services between 2017 and 2020 among IPOS implementing districts (woredas) and HFs. Lack of adequate transport and logistical constraints are among the major challenges of IPOS implementation. Forty percent of districts and 20% of health centers (HCs) have since conducted IPOS using their own budgets. Conclusion IPOS has contributed to the improvement of maternal and child health services in hard-to-teach communities and scale up of the strategy is recommended. Lack of transport is a major barrier to IOPS implementation and support for districts is necessary. Ensuring the sustainability and ownership of IPOS implementation by making it part of annual district-based planning exercises is recommended. Community engagement is also critical for the effective implementation of IPOS.