SUM-Safe: Scaling Up Midwife-led safer birth bundle of care through Quality Improvement in Ethiopia: a stepped wedge cluster randomized controlled trial study

The purpose of this proposal is to increase the level of evidence-based practices and increase the capacity for midwives to lead Quality Improvement (QI) initiatives in maternal and newborn health along the continuum of care.

The proposed project aims to explore if and how the uptake of evidence-based Midwifery-Led Continuity Safer Birth Bundle of Care (MLC-SBBC) practices can increase by capacitating midwives to lead QI initiatives.

The intervention is hypothesized to lead to an increased level of evidence-based MLC-SBBC practices, increased capacity for midwives to lead quality improvements initiatives in along the continuum of care, and improved maternal and newborn outcomes.Previous Safer Births studies testing individual interventions on a smaller scale, have reported improvements in quality of care and saving lives.

Generating evidence-based knowledge on quality of care around birth from large-scale interventions is a key priority to reach SDG targets 3.1 and 3.2 of reducing preventable maternal and perinatal mortality.

However, the results have not been confirmed in larger experimental studies in a low-income context.This project will be implemented in a stratified stepped-wedge cluster (hospitals) randomization approach in ten hospitals of Amhara Regional state in Ethiopia between 2025-2027. Randomization will be done using simple random sampling.

Clusters will receive the intervention at different time points based on randomization.