Transcript Slide 1

Overview of
COMMUNITY ENGAGEMENT FOR
MATERNAL HEALTH SERVICES
ETHIOPIAN EXPERIENCE
Tadesse Ketema MD,MPH
Maternal Child Health Advisor ,MOH
1. – CONTEXT
 In Ethiopia 83.6 % lives in rural areas, and has high level
of pregnancy as well as maternal and child morbidity and
mortality including MTCT
 On the other hand most health care facilities were
concentrated in urban areas
 To address this challenge the Government has designed
and implemented the health extension program since 2005.
1.1 The Government targets for 2015 Of
PMTCT
 Provide ANC services to 90 % of pregnant women
 Ensure all women are attended at delivery (62% by skilled
attendant and 38% by HEWs)
 Provide ARV prophylaxis to 90% of HIV positive pregnant
women
 Reduce national incidence of HIV infection by 50%
1.2 The major challenges to PMTCT to be
addressed
 Limited expansion of PMTCT services;
 Inadequate use of PMTCT service where it is available
 Limited access to and utilization of early infant diagnosis
 low percentage of deliveries attended at health institutions
 Attitude of health workers
 Weak community-health facility referral linkages
 Poor male partner involvement
 Slow roll out of HMIS and poor recording and reporting
practices
1.3 Rationale for community engagement
need for MNCH/ PMTCT
 In 2003 EFY (July 2010 to June 2011), 82% of women
accessed ANC services at least once
 As of July 2011, PMTCT services were available in health
facilities where only 54% of women attended for ANC.
 This calls for expansion of PMTCT services to avail it to all
women who have contact with the health service for ANC.
ANC attendants
Tested for HIV
Counseled for PMTCT
900000
800000
700000
600000
500000
400000
300000
200000
100000
0
2007
2008
2009
2010
NB:The ANC coverage report on the
graph
Source :Hapco Report ,June 2010
HIV positive identified
Mothers Received ARV
Babies received ARV
14000
12000
10000
8000
6000
4000
2000
0
2007
2008
2009
2010
Rationale for community engagement cnd...
 Of women who attended ANC clinics at health facilities
that are providing PMTCT services in 2003 EFY (2010/2011),
more than 300, 000 of them (25%) were not tested
 ARV prophylaxis was provided for 8365 (40%) of women
identified as HIV + at these facilities
 4945 (24%) of their new-borns has got ARV
 There is a 23% drop out from counselling to testing and
60% from identification to provision of ARV prophylaxis to
HIV positive pregnant women
Rationale for community engagement contd...
 These missed opportunities can be avoided with improved
through engaging community and improving quality of
care provided to retain women in PMTCT services
including
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linkage to community systems to initiate services and track cases
lost to follow up
close monitoring of these activities
local data utilization for timely identification of gaps
2. Health Extension Program
2.1. General Objective:
 Improving the health of the population through disease
prevention focused expansion, and family and community
centered equitable health services
2.2. Specific Objectives:
 To enable community members to take greater
responsibility for their health, have better decision‐making
on health issues, and improve and maintain their own
health;
 Enhancing community consciousness in strengthening
disease prevention activities and improving health
outcomes;
3.Effective community engagement
Health Extension and Development Army
 A health post built in each kebele through community
participation, to serve an average of 5,000 people in family
and community focused disease prevention and health
promotion services.
 A health center is also organized to support a cluster of five
health posts; it serves approximately 25,000 people on
average.
 Around 30 thousand HEWS trained and deployed in
around 15,000 health posts
 HEWS are tenth grade complete and trained for a year
on 16 packages of the health extension program
 One health post is staffed with two health extension
workers who are all females
 Progress has been registered in reducing under five child
mortality rate, increasing number and use of latrines,
increasing family planning and vaccination coverage as well
as significant decline in death and disabilities due to
malaria
 ANC coverage is tripled and reach to 82% since 2005 and
FP utilization has also shown a dramatic improvement
Level of
Intervention
Priority
Activity
Household
Households with pregnant women;
mothers who delivered recently and
infants;
Households with persons having chronic
health problems; and
Households with satisfactory result in
implementing the health extension
packages.
Family planning, antenatal care, postnatal care and
immunization services;
Provision of basic health care services during household
visits;
Community
Conveying health education and Health
services at the community level;
Health extension workers will deliver
services to members of the community in
outreach program via a cluster of gotts/sub
village;
In delivering the health extension program packages it
is essential to use community social networks (Idir,
Ekub, etc), Associations (women’s, youth and farmers
associations), religious institutions and Government
structures (for example agricultural development
stations).
Institutional Level
In delivering the health extension program
packages it is essential to use community
social networks (Idir, Ekub, etc),
Associations (women’s, youth and farmers
associations), religious institutions and
Government structures (for example
agricultural development stations).
Deliver health education and services at youth centers;
Make schools models of implementation of the health
extension packages and educate students; and
Organize or use existing clubs in the school to train
students on important health issues;
Level
Activity
Health Post
 Provide integrated community case management (ICCM) for childhood illnesses;
 Control and register the temperature for vaccine/maintain cold chains;
 Give vaccination services;
 Provide family planning services;
 Provide ante‐natal and post natal care;
 Identify children, pregnant and breast feeding mothers with nutritional
deficiencies and give nutritional counseling;
 Follow‐up, supportive supervision and assessment/evaluation of quality and
transparency of the activities being implemented by the one‐to‐five networks;
 Prioritizing households with low performance in implementing the package and
support them in all the health extension packages that are relevant to them;
 Providing health education; and
 Support and encourage model households to maintain their progress.
 Organization, follow up, supportive supervision and evaluation of the one‐to‐five
networks and Development teams; and
 Organize and conduct regular meetings every two weeks to evaluate the
performance of the Development teams.
Model Family Training
 Model Household Training is a training program
conducted by the health extension workers and leaders of
one‐to‐five networks on all health extension packages
4. The Role of the MoH in Supporting The
Program
 Strengthening primary health care unit (PHCU);
 Preparing guidelines and other essential
documents/materials that support the health extension
program and ensure its proper implementation;
 Strengthening collaboration and improving
communication among different sector ministries at the
federal level, Regional Councils, Regional Health Bureaus
as well as development partners for the successful
implementation of the health extension program;
 Close follow up and encourage the sharing of information
in promoting collaboration and networking;
 Evaluate the implementation of the program
 Acknowledge and reward those health extension workers
for their outstanding performance
 Design and implement integrated supportive supervision
activities;
 Develop standards for the in‐service integrated refresher
training, further education, career development structure
for the health extension workers and closely follow‐up for
its implementation;
5.Challenges and Recommendations to the
program
Challenge
Strategies for Overcoming Barriers
The health extension program
performance and impact did not have the
expected high velocity and quality since
it was managed in a campaign form, and
lacked the strategic leadership required
to coordinate and organize community
level activities
Establish and use the health development army
Strengthen referral linkage and
Strengthen urban HEW implementation
The health extension workers alone may not be
sufficient to implementing all the packages in the
health extension program.
Hence, it appeared to be essential to organize
community members in development teams and in
one‐to‐five networks
Weak Referral linkage as the rural Health
extension workers are not mandated to
do T & C but link for one ANC visit to
Health Center
 Organizing community members in health
development army empowers the community in
making decisions and owning the program.
 This situation in turn accelerates the implementation
of the program and improves the health of the
community in a short period of time.
 Strengthen the referral linkage within the PHCU
Thank you