International Projects

Essential Obstetric and Newborn Care Networks Project in Cotopaxi, Ecuador

CHS Project
Midwives and community health workers use this flipchart and other materials during prenatal and birth counseling sessions for women and their families in Ecuador.



A mother provides kangaroo mother care (KMC) for her newborn at the Latacunga Hospital. CHS is helping hospitals provide KMC-related services to improve care for low birth weight and premature infants. Photo by the EONC Networks Project Team.

CHS worked with Ecuador’s Ministry of Health (MOH) to meet the goals of the National Plan for Reduction of Maternal Newborn Mortality. The Essential Obstetric and Newborn Care (EONC) Networks Project focused on Cotopaxi, a province in the Andes Mountains largely populated by indigenous people and where maternal, neonatal and infant mortality rates are significantly higher than national rates.

The project 1) developed an integrated health care network to improve the continuum of care from community to provincial hospitals by creating referral mechanisms, 2) improved the quality of care at facilities, 3) forged or improved connections between facility-based health teams and community health leaders and 4) ensured the use of evidence-based practices.

The health network aimed to ensure the use of evidence-based practices at all levels. At the community level, the project incorporated traditional birth attendants, who attend nearly half of all deliveries in communities. The project worked directly with the MOH, mobile community health teams, local community leaders and community-level NGOs.

Key Activities

  • Developed an integrated network of public and private providers of community- and facility-based EONC providers, including traditional birth attendants and public health care providers;
  • Strengthened the cultural acceptability and quality of health care in county and provincial health facilities;
  • Increased community access to, demand for and use of the network of EONC services;
  • Provided training for traditional birth attendants in recognizing danger signs and risk factors in mothers and newborns and in counseling mothers and families on how and when to refer patients to hospitals; and
  • Conducted research on the role of traditional birth attendants in postpartum care.


  • A significant increase occurred in access to EONC services by rural communities.
  • Participating facilities are providing better care.
  • Hospital birth care has been adapted to meet the cultural preferences of delivering mothers and their families.
  • Referral mechanisms have been implemented and are being expanded.
  • Patient-centered advocacy organizations are developing.
  • The Ministry of Health has adopted the Cotopaxi model and is scaling it up countrywide.

Quick Facts

Geographic Focus
Cotopaxi Province, Ecuador

US Agency for International Development