The Zero Mothers Die App at Gambo Rural Hospital in Ethiopia: Lessons Learned and ZMD App 2.0

The Zero Mothers Die App at Gambo Rural Hospital in Ethiopia: Lessons Learned and ZMD App 2.0

​Haati Takkallee Lubbuu kenuuf lubbuu dhabuu hin qabdu!


In 2018, the Zero Mothers Die App was launched with a translation to Afaan Oromo thanks to the collaboration with our partners at Gambo Rural Hospital in Ethiopia and Dr. Iñaki Alegria. Since then, the ZMD App has been used by over 170 healthcare workers and thousands of pregnant women.


The main goal of the ZMD app is to reduce preventable causes of maternal and perinatal mortality. The regular monitoring of women’s pregnancy is necessary to allow their correct treatment, to recommend delivery under professional care, and for the identification of women under risk of complications during birth. The ZMD App helps bridge the gap of skilled healthcare workers in under-served health centers in rural communities of Ethiopia.


Gambo Hospital health workers translated the ZMD App content to Afaan Oromo and started the implementation in Gambo Hospital, 10 health centers, 50 health posts and the catchment area. In parallel, training was performed of rural health care workers in «Helping Babies Survive Training», including «Helping Babies Breathe» and «Essential Care for Newborns» to reduce the development of neurological diseases in newborns and ensure their appropriate treatment in the fragile stages of life after birth. ​

Maternal, Newborn and Child Health is a key national health priority for Ethiopia. The current aim is to expand the implementation of ZMD in different regions of Ethiopia with the support of the Ethiopian Federal Ministry of Health.


Unfortunately, Ethiopia’s maternal mortality rate is still very high. It’s estimated to be around 412 mothers deceased for every 100,000 live births, which means around 11,000 maternal deaths per year. Regarding newborns, 46 die before 28 days of life for every 1000 births, which means around 87000 neonatal deaths and 97,000 stillbirths per year. Most of these are avoidable and preventable deaths.

The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. To avoid preventable deaths, the following actions took place, and some of them continue today:

  • Translation and adaptation of ZMD App contents to Afaan Oromo, and subsequent training and implementation of the ZMD App in the Gambo region.
  • Trainings performed in Gambo Rural Hospital on Helping to Save Lives at Birth for Nurses and Midwives from the 10 health centers in Gambo’s catchment area (Training on ).
  • Moreover, a training was performed on Helping Mothers Survive and Helping Babies Breathe (Birth Asphyxia is the main cause of perinatal death, and Postpartum Hemorrhage is the first cause of maternal death). The training was based on simulation scenarios with training material. The main objective was to improve the professional skills to manage the main causes of maternal and perinatal death with the main objective of reducing mortality rates.

After two years of implementation of the Maternal and Neonatal Program and Zero Mothers Die App, the results and outcomes are:

  • 172 health workers trained
  • 30,401 pregnant women attended Ante Natal Care Services
  • 8,768 deliveries attended by qualified midwives and Post Natal Care Program


So how exactly is the ZMD App helping to achieve Ethiopia’s goals of decreasing maternal and neonatal mortality? According to testimonials by the healthcare workers at Gambo Hospital, the ZMD App is facilitating:

  • Awareness creation and improving health education in the community
  • Strengthen Health Extensions Workers Network at all levels, but especially at the community level
  • Improving the reach of and receipt of care
  • Strong referral system and linkage between Health Post, Health Center and Hospital
  • Improving skills
  • Give support and improve the communication for Midwives and Health Professionals
  • Health Education Program
  • Identifying danger signs

The ZMD App 2.0 is now available in Afaan Oromo with new content and features, be sure to check it out! It’s available both for Android and iOS, and in 9 languages! We hope the new features continue to support the health care workers, pregnant women and new mothers in Ethiopia and all over the world. A big thank you to the Gambo Rural Hospital and Dr. Iñaki Alegria for their dedication to bring the Zero Mothers Die initiative to Ethiopia!

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