Transcript PHC in Ethiopia & MDGs

Health Extension Program
“Health for all in the 21 centaury”
Wondwossen Temiess
April 28-30,2008
Ouagadougou
Burkina Faso
All roads Lead to HEP
Outline
Why the HEP
Implementation Processes & Approaches
Current Status & Impacts
Challenges & Lessons Learnt
Health Indicators
Country Background
Geographical location
PHS coverage
= 87%
Hospital
= 143
HC
= 670
Health post
= 10,996
MMR
= 673/100,000
IMR
= 77/1000
U5MR
= 123/1000
HIV prevalence
= 2.1%
PLWHAs
= 1 million
Pop to Health provide rRatio
Population: 79 million
Economy : 85%
depend on Agriculture
85% of the population
Fundamental Reform Measures (Of paramount
importance)
 Development of a new Health Policy , strategy,
 Formulated a twenty-year health sector investment
program (1998-2018).
 The HSDP was launched in 1997 with the basic objective
of improving the coverage and quality of heath services;
 HSDP III (2005/06-2009/10) is underway in line with
(PASDEP) and guided by MDGs
 In spite of the effort made it was realized that the
essential health services have not reached the grass root.
 The government has chosen from the stock of
experiences by considering the gains and challenges in
the process of phase one HSDP
Why HEP?
•
HSDP 1 review revealed that
• Basic health services had not reached the needy
population at grass-root levels
• Limited expansion of facilities
• Fundamental gap in applying the core principles &
practices of (PHC)
• The uneven distribution of facility based health
services
• lead to the birth of new ideas, strategies
PHC
– Socially acceptable ,
Scientifically proven
HEP laid its foundation
Millennium Development Goals calls
– Universally accessible to
individuals and families in the
community
For 75% reduction of MMR from
880/100,000 in 1990 to 220/100,000
– Full participation of
community
Reduction of malaria death
– At a cost that the community
and the country can afford
– To maintain at every stage of
development in the sprit of
self-reliance and self
determination
Reduction of IMR by 66% from 123 in
1990 to 42 by 2015
Maintaining the current HIV Prevalence
What Should be
Ethiopia’s
pace of Response
To make this reality ?
High, medium, low
or business unusual !!!!
Health Extension Program
Business unusual strategy
The HEP in Ethiopia was embarked in 2002 as
Flag ship program
HEP is
“a package of basic and essential promotive, preventive
and curative health services targeting HOUSHOLDS
in a community, based on the principles of primary
health care (PHC) to improve the families’ health status
with their full participation”
Family and community centered program
Philosophy of HEP
Individual
Households
The underlined convection is that
Produce their own health the
way they produce their
agricultural products
Promise House of HEP
Establishing an Effective &
Responsive Health Delivery System
for those who live in Rural Areas
Overall Goal of the HEP is Create a Healthy Society & Reduce
Rate of Maternal and Child Morbidity and Mortality
Full Community
Participation
Medicine &
Supplies
Construction of Health
post
Train & Deploy
HEWs
Leadership, Monitoring & Evaluation
Implementation Strategy
(1 ) requires substantial
Human Resource
Training criteria
Train & deploy 30,000
HEWs by the end of 2008
Sex
Female
Age
> 17 years
Education
10 grade & above
HEWs will be selected from the communities
they reside
who has Ability to speak
local language
Volunteer to serve 3 years after training
2 HEWs
5000 people
30,000 HEWs
67 million
will be reached
HEP Training
 Existing Technical and vocational educational
training schools (TVETs) of the MOE were
used for training of HEWs
 40 TVET schools provide training to HEWs
and 140 TVET tutors have been trained to
deliver pre-service training
 Tutors are public health nurses, sanitarians
HOs , Home economists were locally
recruited and received 1 month training
 The HEWs receives a 1 year course of
training which includes field work to gain
practical experience
HEP Training Package (16) curriculum
The community can
produce its own health
Disease Prevention
& Control (3)
Family Health (5)
16 Health Extension Package
Health Education
(1)
Hygiene &
Environmental
Health
(7)
What is new with HEWs?
 Health Extension workers are
generalists





Lead the Health program
Health educator,
Planner , Coordinator , trainer
supervisor , M&E expert
With all this there is no departmental
function in HEP at grass root level
Implementation Strategy (2) HP construction
The health system has 4 tires
Operational Center of HEWs is the
HP
HEWs Function under the
supervision of Woreda Health
office, Kebele Administration and
technical support from the nearest
Health center
The country has four tires health
system
PHCU (health center+ 5HP) is
crucial component for achieving
the universal primary health care
coverage
Specialized
Hospital
1 million
Zonal Hospital
Serves 500,000
District Hospital
250,000
Health Center (670)
25,000
Health Post 5000
10,996
Implementation Strategy (3)
Procurement of Contraceptives, Medicine and
Supplies

Health posts should be adequately provided with
equipment, materials and supplies to deliver the
different packages of essential services to the
community

Medicines and supplies are procured and
distributed to the regions by FMOH

Supplies will be provided by Health Centers or
woreda health offices to health posts
HEP Implementation Approach

Model families
 Community Health p
 Health posts
 Governance
 Monitoring & Evaluation
, supportive supervision
The theory behind Model families
(Diffusion Model presents the normal pop. distribution)
Early majo
rity
34%
16%
Laggars
34%
Late majo
ri ty
13.5%
Early ado
pter
In principle not all individuals
in a social system adopt an
innovation at the same time
rather they adopt in a time
sequences
2.5%
Innovators
Diffusion is the process by
which an innovation is
communicated through certain
channels over time among the
members of a social system
90
80
70
60
50
40
30
20
10
0
1st model families HH
will be selected
HEP is an innovative strategy
To implement model families
diffusion theory is adopted
Adopter Categorization on the Basis of Innovativeness
Model Families
implementation cycle
Graduation
If 75%
attended
Innovators
will be volunteer

4 months
Training
for 96 hours
Work with
HEWs & create
early adopters
They are the head
of their own health
40-60 MF
select
HEWs recruit
MF members
(Innovators)
1st batch
(40-60 HH)
2nd batch
(>40-60 HH)
3rd batch
(>40-60 HH)
Model Families Creation per year based on diffusion theory
HEP Current Status
35000
30000
Existing & projected HEW & HP Required
in Ethiopia
HEW
Health Post
25000
30000
24534
20000
17653
15000
15000
10000
9900
5000
0
2800
400
'04/05
9914
10996
4148
'05/06
'06/07
'07/08
'08/09
Impact of HEP on Child Health
Trend on Immunization coverage &
Child Health
200
IMR
180
160
140
Under 5 mortality
120
100
80
EPI Coverage
60
40
Fully Immunized
Children
20
0
2002
2003
2004
2005
2006
2007
Impact of HEP on Maternal Health
Trend on Maternal Health Coverage
60
TT2
50
ANC Coverage
40
30
Birth attended by
skilled personel
20
Postnatal
coverage
10
CPR
0
2002
2003
2004
2005
2006
2007
Impact of HEP in malaria program
5000000
Trend on Bed Net Distirbtuion
2004- 2007
By 2007/8 20 million net
distributed
Bed Net Distribution
Bed net distributed in millions
4000000
IRS spread
3992334
3000000
2000000
1703661
1320814
1357556
1091012
1000000
474260
0
2004
2005
2006
Impact of malaria intervention
6000
5000
Trends on Malaria deaths and epidmic recorded
4932 (34%)
4000
3053(24%)
3000
2000
2160
1000
681
1116 (9%)
80
0
2004
Malaria Deaths
2005
2006
Epidemic Recorded
Progress on HIV/AIDS
2500000




HEWs played a significant role on
social mobilization on HIV/AIDS
Many people underwent
counseling and testing through
Millennium AIDS campaign
Awareness has been raised
Many people have been counseled
and referred for testing of HIV
1922000
2000000
1500000
1000000
436000
548000
500000
0
2005
2006
2007
M&E





Annual review meeting
3200 Supervisors trained and
deployed at 3200 HC accountable to
woreda health office
Research
Monitoring developed
National database system of the HEWs
developed
Challenges



Maternal & Child Survival MDGs at the current pace
will be challenging, needs more resource
Peripheral and mid-level health facilities are still in
critical shortage with regard to appropriately skilled
personal for assisting deliveries
Higher level facilities for management of
complicated cases needs further strengthening
Success story from the rural
community voice
“Of all the things in my kebele that I feel
extremely proud of is hygiene. Almost
everyone has constructed a latrine & as a
community we have had a campaign to
clean the water source and fence it to
prevent animals from entering “
Conti.
Recalling the thousands who died of malaria in her
woreda a few years ago.
“ Thanks to the Health Extension Program, my
community members have better access to antimalaria drugs and bed nets and they live in a healthy
home environment.” says Teguada
Let The Ethiopian New Millennium Bring
us a bright , peaceful and healthy future
like a rainbow