Supporting the Regional Health Bureaus in Ethiopia

Zenebe Melaku, MDICAP-Ethiopia

ICAP Guiding Principles• Integration with national AIDS control plans

• Capacity building for health systems and broad infrastructure support

• Involvement of PLWHA - adherence, social support

• Integration of Prevention, Care & Treatment

• Family-centered care (adults and children)

• Multidisciplinary Team Approach

• High quality services with program evaluation, operations research, and program improvement

FMOH - National Road Map& ICAP Support

Regional Road MapImplementation

Facility Level Implementation

ICAP- CU

ICAP- CU

National Level - TAICAP- CU

ICAP - Ethiopia

National• Pediatrics; EID; TB-HIV; •PLWHA; MLDM

National• Pediatrics; EID; TB-HIV; •PLWHA; MLDM

Four RHBs • Capacity Building/TAFour RHBs • Capacity Building/TA

Comprehensive Site Level SupportComprehensive Site Level Support

Regional Univ.Regional Univ.

Characteristics of ICAP-E Program

Oromiya : 29,118,188Somali : 4,325,446Dire Dawa : 388,731Harari : 194,745Total Population : 34 million

Characteristics of ICAP-E Program

Health Care System - Ethiopia

FMOHFMOH

RHBRHB RHBRHBRHBRHB

• Policy•National Strategy •Guideline and •Training Curriculum

• Policy•National Strategy •Guideline and •Training Curriculum

• Oversee Program Implementation and Monitoring

• Oversee Program Implementation and Monitoring

HH HH

HCHCHCHCHCHC

Initial Step:

• Needs assessment with RHBs– Identification of gaps

• Critical Gaps Identified:- – Coordination and Strategic planning

– Human Resource

– Infrastructure

– Systems

Modalities of Support:

• Two mechanisms:

– Direct support: • Short/Medium term

– Sub-agreement:• Medium/Long term

Regional level Capacity Building – Coordination and Strategic Planning

• TA in the development of regional annual plan

• Regional Partners Forum

• Joint Regional Planning and Review Meetings

Building Regional Ownership through Participatory Planning

A Key Strategy for Sustainability

Regional level Capacity Building –

Training:Training:

Multi-pronged Approach:

Multi-pronged Approach:

• Basic and ToT

• Local/International

• Basic and ToT

• Local/International

• Clinical • Program Mx• Financial Mx

• Clinical • Program Mx• Financial Mx

Secondment/Additional staff

Secondment/Additional staff

MentoringMentoring

Enabling EnvironmentEnabling Environment

•Program staff•Accountant•Data clerks….

•Program staff•Accountant•Data clerks….

•Clinical, Program & Finance•Clinical, Program & Finance

•Access to Internet•Resource centers•Office furnitures …..

•Access to Internet•Resource centers•Office furnitures …..

Human ResourceHuman Resource

Capacity Building: Human Resources (Training)

Regional Capacity Building – Resource Center

Regional level Capacity Building –

Infrastructure – Training Centers

Training Center with Video-conferencing Facility

Regional level Capacity Building –

• Laboratory System:– Development of SOPs: Sample referral– Implementation of EQA systems

• Monitoring and Evaluation System:– Data QA systems– Data use for CQI

• Referral System:– SOPs for decentralization

• Financial Management System:– Development of SOPs

SystemsSystems

Key Achievements and the Way Forward

• Increased scope of activities with increased funding (5X)

Responsibilities handed over to the RHBs :– Annual review and planning meetings– Quarterly Supportive Supervisions– Hiring of supernumerary staff – Sample transport system– Management of minor renovations

In the future:– Phased and Incremental Manner

Challenges:

• Human Resource:– Shortage– Work overload– Lack of staff motivation– High Staff Turn-over

• Financial management system

At All Levels

Conclusions-Lessons learned

• Regional level capacity building– Key strategy for successful transition

• Requires commitment from government, availing HR and other required inputs

• It requires longer time-frame

• Phased and Incremental Manner• Attention: Maintaining the ‘Desired Quality’

.

Thank YouObrigad

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