Editorial ViEwpoint 2

tEchnical UpdatEs 4

storiEs from thE fiEld 8

Inside this issue:

Honourable guests Mr. Alex Thier, Assistant Administrator of the Policy, Planning and Learning Bureau of USAID/Washington and Mr. Dennis Weller, USAID/Ethiopia Mission Direc-tor, joined by Dr. Yirga Ambaw, Health Specialist and CTO at USAID Ethiopia

Mission, paid a visit to Haro Jila Fulsa Health Post and community in Sebeta Hawase Woreda of Oromia Region. The visit, which took place on July 27th 2013 aimed at learning about the Ethiopian government Health Exten-sion Program (HEP) and the contri-

USAID High Ranking Officials Visit the Ethiopian Health Extension Program

Cont. on page 4

PHOTO

Visitors listen to explanation about the family health card at Haro Jila Health Post

ADDIS ABABA - The Ethiopian Orthodox Tewahedo Church (EOTC) disclosed its support and partnership for safe motherhood and reproductive health programs in the country during its annual conference on June 5, 2013.

The Holy Synod of EOTC expressed its support by passing a ten-point resolution on safe motherhood, reproductive health, and gen-der equity. His Holiness Abune Mathias, the 6th Patriarch of the Ethiopian Orthodox Tewahedo Church, handed over a resolution embalmed with photo frame to Ministry of Women, Youth and His Holiness Abune Mathias and partners

Cont. on page 5

IFHPIntegrated Family Health Program

Holy Synod Declares Commitment for Safe MotherhoodVolume 9, No. 2, April-September 2013

Yebeteseb Mela

Producers and Editorial Committee:Dr. Kidest Lulu Dr. Tesfaye BultoDr. Hibret alemu Solomon AbebeTariku Nigatu Salem Melaku

2

Human resources are the most important assets of a health system. For health institutions to function effectively and efficiently, a well-trained and motivated health workforce must be produced, deployed, maintained and appropriately utilized. Developing capable, motivated workers is essential to overcome bottlenecks hindering the achievement of national and global health goals.

The health policy of Ethiopia emphasizes the training of community-based task-oriented frontline and mid-level health workers. In response to the policy, health professional training institutions have expanded continuously as have health facilities resulting in improved access to health services. However, in order to ensure the continuity of quality health services, health professionals need to be continuously updated, refreshed, and introduced to innovation. Capacity building in-service trainings play a great role in this regard and represent a significant proportion of investments made by the Ministry of Health and development partners.

The government and implementing partners like IFHP are trying to boost the knowledge, skill, attitude and confidence of frontline and mid-level health professionals working in primary health care units (PHCUs). How-ever, reaping the benefits from in-service trainings that is worth the invest-ment has been challenged by many factors. In-service training programs, for example, sometimes fail to balance competency development with potential disruption to service provision due to staff absenteeism. There are also a number of other aspects of in-service training that dwindle the benefits that can be harvested from it. These include among others mis-placement of staff after training, immediate exit or attrition of staff after training, repeated appearance of the same individual in similar trainings, unfair recruitment of trainees and favouritism, and limited participation of female health workers with the exception of HEWs. The latter could be partly because the health work force in Ethiopia is predominately male (AHWO, 2010).

These call for the need to taking steps to maximize the benefit from in-ser-vice trainings. For instance, encouraging steps are being taken by the MOH and its partners by providing Integrated Refresher Training (IRT) for Health Extension Workers (HEWs) to save the financial and time resources needed to do separate refresher trainings. Similarly, providing on the job trainings and service delivery based trainings serve the same purpose. In line with this notion, IFHP has been providing service-based trainings to PHCU staff including HEWs with dual benefits: the health professionals get skill based training, and at the same time, quality services are rendered to the com-munity under the supervision of the trainer. IFHP has also always been cau-tious in allowing fair participation of women as trainers and trainees.

Addressing the issues indicated above in a coordinated and standardized manner by actors working at all levels within the health system is very crucial. Doing so not only helps maximize the benefit of in-service trainings but also directly contributes to the achievement of the health related Mil-lennium Development Goals of the country.

Improving Efficiency and Effectiveness of In-service Trainings

EDITORIAL VIEWPOINT

GONDAR - The Technical Advisory Committee (TAC) of IFHP visited program implementation in Gondar cluster office on April 22-25, 2013. Welcomed by Dr. Mengistu Asnake, Chief of Party of IFHP and Country Representative of Pathfinder Inter-national-Ethiopia, the committee vis-ited beneficiaries in the health sector as well as community households. During discussions after field visits, TAC members commended IFHP for its integrated approach to promote health, particularly the achieve-ments gained so far in improving fistula case identification and man-agement and strengthening youth friendly services at health centers. “IFHP’s principle is strategically well designed to implementing activities at the grass roots level,” committee members explained and added that IFHP’s strategy is sustainable and lays the corner stone to attain positive impacts in changing the life of com-munity members. Dr. Mengistu on his part said, “IFHP’s work has shown results due to the strong government structure. IFHP makes every effort to fill gaps in the implementation of key interventions to reduce maternal and child mortality in the country.”

The TAC has members from various government sector offices and pro-vides technical support and guidance through field visits and consulta-tive meetings that take place every quarter.

Committee Admires IFHP Support in Fistula and Youth Friendly Services

3

ASELLA - The commemoration of the third African Immunization Week was launched at Asella Town, Arsi Zone of Oromia Region, from April 24 to May 4, 2013, with the theme “Vaccinate, Save Life, and Prevent Disabilities!” The initiative, which was launched in the presence of high level officials from the Ministry of Health, Oromia Region, zones, and woredas as well as distinguished delegates from WHO-AFRO, UNICEF, USAID and development partners, aimed to raise awareness on the im-

portance of immunization, broaden the culture of disease prevention and control through vaccination, and provide vaccination services to vulnerable populations.

IFHP, as one of the child survival partners, assisted in organizing the event at different levels and pro-vided technical, financial and logis-tic support throughout the event. Following the official launching, Arsi Zonal Health Office in collaboration with IFHP conducted community

level social mobilization and pro-vided vaccination to eligible chil-dren. Consequently, close to 25,000 children received vaccination against 10 vaccine-preventable diseases. The African Immunization Week is believed to have strengthened the commitment of health managers to-wards the reduction of child mortal-ity and provided a unique opportu-nity for improving local, regional and national immunization coverage.

The Third African Immunization Week Commemorated

IFHP’s van mobilizing the community for vaccination along side the running race that was part of the commemoration

ASSOSA- The Population Affairs Directorate of the Ministry of Finance and Economic Development, in collaboration with IFHP and other partner organizations celebrated the World Population Day in Assosa, Benishangul Gumuz Regional State.

The 2013 the World Population Day was celebrated under the international theme of Focus is on Adolescent Preg-nancy.

In connection with the event, IFHP organized a media orien-tation for journalists and facilitated mass walk to increase community awareness in preventing adolescent pregnancy.

World Population Day Celebrated

4

Safe Motherhood Campaign is organized and coordinated by the FMOH on a yearly basis to pro-mote skilled birth attendance at health facilities and contribute to the reduction of maternal and newborn mortality. IFHP has been actively participating in the Safe Motherhood Campaign annually. The campaign task force, chaired by the FMOH, prepared promotional materials for television and radio, filmed dramas for community mobi-lization and printed materials such

as posters and brochures distributed to health facilities and communi-ties. IFHP, in addition to actively participating in the activities of the taskforce, deployed its audio visual vans to show the filmed drama pro-duced for community mobilization, reaching over 76,000 population in hard-to reach and pastoralist areas of Afar, Somali, Benishangul, Oromia, Amhara and Tigray regions. After the film shows, woreda health office and health center professionals used the opportunity to provide health

education about the importance of antenatal care, skilled birth attend-ance, and postnatal care. Those who watched the movie, expressed their interest to learn more about skilled birth attendance and pledged to use the services available in their re-spective areas. Woreda and health center staff on their part expressed their dedication to do their best to promote skilled birth attendance and assist families to use the service.

Strengthening Partnership to Promote Skilled Birth Attendance

Film show at night in Afar Region to promote skilled birth attendance

bution made by the United States Government to make this initiative successful. Dr. Hibret Alemu, Deputy Chief of Party and Technical Direc-tor of IFHP and Mr. Mesfin Nigussie, IFHP’s Oromia Regional Program Manager, welcomed the distin-guished guests and made introduc-tion of the woreda officials and community representatives.

The Woreda administrator remarked that Ethiopia has shown significant improvement in health since the inception of the HEP which has

USAID High ranking Officials ...Cont’d from Page 1

brought access to and availability of essential primary health services closer to communities. He under-scored that USAID is one of the close allies who provided immense financial, logistics and technical assistance through its programs and expressed his wishes that this strong tie and assistance will con-tinue.The visiting team also listened to a presentation about the concept, principles and structure of Ethiopia’s primary health care unit and IFHP’s contribution to the health system.

Technical Updates

In subsequent visits to health posts and households, the visitors learned that families have become adher-ent users of health services. When concluding the visit, Mr. Weller said that he has witnessed the excellent relationship that USAID has with implementing partners and the government and that resources are being used effectively to save and improve lives.

5

There are several partners supporting the health system in Tigray Region. Before the revitalization of the partners’ forum two years back, the coordination of different programs among different partners in the region was poor resulting in duplication of ef-forts . Taking this situation into account, the regional health bureau (RHB) took the initiative to strengthen relationships and harmonize efforts among part-ners. Since the revitalization of the partners’ forum, a regional health partners’ consultative committee was established and several steps were taken to strengthen the health system. Part of these steps was engaging all partners in joint planning, implementa-tion, monitoring and evaluation of health programs including conducting integrated supportive supervi-sion (ISS).

The ISS in the region has been a regular bi-annual activity for the last two years. At the initial step, a checklist was revised and enriched by RHB experts and partners for use during ISS. Each ISS session targets all the 14 public owned hospitals, 210 health centers, one health post under each visited health center and members of the community and women development army. To cover all these facilities, it takes three weeks and involves 12 to 13 teams with 6-7 members per team. In addition to sending their staff to take part in ISS, partners mobilize vehicles and financial resources to cover related expenses.

Before the teams go to the field, they receive a one-day orientation on some technical details and ap-proaches on how to carry out the task. Depending on the findings, members of the teams provide technical assistance on the spot at each of the visited facility, and debrief both woreda health/administration and

zone administration offices. The teams record best practices within their assigned area and report to the different levels of the health system. Following the compilation of the ISS findings at regional level, best and weak performing facilities are identified. To help learn both from the failure and success, videos are recorded and shared with all the facilities and woredas within the region during regional bi-annual review meetings and several other occasions. In Tigray, ISS has become a regular activity of the health system and it is conducted twice a year.

The lessons learned in carrying out ISS have proved to be worthy of sharing as they have contributed to improvements in the overall performance of health programs of the region. Some of the regional level achievements include: significant increase in institu-tional delivery from around 10 percent to nearly 50 percent, increase in EPI coverage to 99 percent (as re-ported from survey in Eastern Zone), improved cover-age of family planning and maternal health services, attractive health facility environment, strong health development army, improved community participa-tion and increased commitment of health workers and political leaders. Many model health centers have demonstrated nearly 100 percent institutional delivery within their catchment areas.

IFHP’s Tigray regional office, through the gener-ous support of the people and government of the United States of America, has been promoting strong partnership in the region since its establishment. In addition to its role in different committees under the partners forum, IFHP has supported four ISS sessions by deploying technical staffs and vehicles and by cov-ering part of the expenses.

Integrated Supportive Supervision in Tigray

Children Affairs, IFHP, FMOH, UNFPA and USAID. The resolution is meant to show the Church’s commitment and determination to teach its fol-lowers concepts of maternal, child, and reproductive health issues as well as gender equality in accord-ance with the scriptures.

IFHP provides financial and tech-nical support to “Promoting Safe Motherhood and Reproductive Health through the Teaching of EOTC” Project implemented by EOTC. The project has developed a detailed and feasible guidelines and resolutions on safe motherhood, reproductive Health, and gender.

The conference was attended by member archbishops of the Holy Synod, representatives of Ethiopian Orthodox Church Development and Inter Church Aid Commission (EOC - DICAC) and civil society organiza-tions.

Holy Synod...Cont’d from Page 1

Technical Updates

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Implementation of integrated community case man-agement (ICCM) was initiated two years ago to create access to curative services for major under-five child-hood illnesses in rural communities by building the capacity of health extension workers (HEWs). Malaria case management was part of the ICCM training for HEWs. Though observation show that service utiliza-tion for under five has improved tremendously at the supported health posts, it was found necessary to as-sess the contributions of this intervention in improving the quality of malaria case management by HEWs. The objective of the assessment was to verify the contri-bution of ICCM intervention in improving the quality of malaria diagnosis and treatment at health posts in West Hararghe Zone, Oromia Regional State.

IFHP conducted facility-based study in West Hararghe Zone by selecting 90 health posts from intervention areas and 80 health posts from comparison woredas through multistage sampling technique. Descriptive statistics and bivariate analyses were performed. A fre-quency distribution and cross tabulation (chi-square) statistical analyses were also carried to understand the difference in malaria case management between inter-vention and control areas.

The overall assessment indicates that a significant dif-ference exists between ICCM implementation woredas and non-ICCM woredas with regard to quality of malar-ia case management. Regarding correct administration of the Coartem, 94% and 86% of HEWs in ICCM and non-ICCM woredas responded correctly on the number of days and daily schedule of drugs. Nonetheless, the percentage of correct length of days of treatment and daily schedule were found to be much better in the in-tervention woredas (98% and 95%) when compared to control woredas (89.9% and 76%). With regard to coar-tem and chloroquine administration, higher percentage of correctly identified number of days and daily sched-ule were reported by HEWs from intervention woredas when compared with comparison woredas. The correct administration of anti- malaria drugs showed signifi-cant association with ICCM implementation.

Furthermore the study showed that the HEWs in in-tervention woredas have better knowledge on correct administration of coartem (P=0.029) and chloroquine (P=0.001) when compared with their counterparts. When records for five recent malaria classifications were inspected, the quality of malaria case manage-ment was found to be much better in kebeles with

Assessing the Contribution of ICCM on Quality of Malaria Case Management

A HEW assessing a sick child in West Hararghe Zone

Technical Updates

7

ICCM trained HEWs when compared to those with no ICCM training.

Hence, ICCM training and availability of service delivery standard (particularly ICCM chart booklet) were inde-pendent predictors for improved quality of malaria

case management at health posts.

IFHP has produced a detailed report on the findings of this assessment and the findings will be published in a scientific journal.

IFHP has been implementing adolescent and youth sexual and reproductive health (AYSRH) activities in various universities in order to avail sexual and repro-ductive health (SRH) information, services and com-modities. Before implementing program activities, IFHP conducts a rapid assessment on the SRH and gen-der situation of the universities selected for support. Subsequently, it organizes a one day conference for the university officials, academic and administrative staff, and students to present the findings of the rapid assessment and introduce IFHP’s current initiatives. By the end of the conference, an action plan to improve the SRH services at universities is developed.

University clinics play a crucial role in providing AYSRH and HIV services to students. IFHP helps these clinics by training the care providers on sexually transmitted diseases, post abortion care and youth friendly ser-vices. Additionally, the program supports the clinics by providing the relevant equipment and furniture as well as consumable and supplies such as pregnancy testing kits and emergency contraceptives to the student clin-ics. Students get the opportunity to read information and communication/behavioral change communica-tion (IE/BCC) materials and watch educational films

Expanding Youth Friendly Services to New Universities

which are availed in the waiting areas of the clinics.

Most importantly, IFHP provides training to selected students, both female and male, to help them become peer educators in sexual and reproductive health as well as HIV prevention. The peer educators, in addition to sharing SRH information with their peers, coordi-nate welcoming events to newly enrolled students through coffee ceremonies. At these events, students learn from each other through various activities such as literature and drama, making the learning environ-ment also a fun place to be. IFHP also provides limited financial assistance to needy students and important materials such as sanitary pads, cleaning items and stationery to girls who cannot afford to buy them. IFHP has been supporting Mekelle, Hawassa, Adama, Dilla, Jijiga, and Medawolabu, universities, and recently, has expanded these AYSRH activities to emerging universities such as Adigrat, Wachemo and Woldiya. The universities, after having received the package of assistance from IFHP, have pledged to use the material and the technical support fruitfully.

(L) Peer educators practic-ing sharing of sexual and reproductive health messages through role play

Technical Updates

Fatuma Yusuf, a mother of two, lives in Chafe Banti Kebele in West Hararge Zone. Her 18 month old daughter, Ekram Abrahim got treatment for diarrhea at Chafi Banti Health Post, which is a 10 minute walk from where Fatuma lives. In the past, families in Chafi Banti Kebele travelled for three hours on foot or, when they could afford, paid ten birr to mini vans to get to the nearest health centers. However, since health extension workers began providing curative services for under-five children, the situation has improved. Fatuma says, “Thanks to the government that there is a health post near our houses. We do not have to travel long distances or pay for transportation to reach the nearby clinic and we do not pay for treatment of medicine”.

The two health extension workers at Chafe Banti Health Post have attended the inte-grated community case management (ICCM) training provided by the USAID-funded Integrated Family Health Program in collaboration with West Hararghe Zonal Health Desk. When Fatuma came to the health post to get treatment for her daughter who suffered from diarrhea for three days, Yenensh Gugsa, one of the HEWs, assessed the little girl and gave the appropriate treatment. Then she advised the mother to administer the drug as prescribed and to come back the next day for follow up. Fatuma describes, “It would have been difficult for me to take my child to the distant health center for treat-ment, let alone for check up. But now that the health post is very close to where I live and my child could get treatment and medicine, I came on the appointment day so that the HEW will examine my child and tell me the progress. Ekram has recovered from her illness after she got the treatment. She has no diarrhea or dehydration anymore. But I will continue to give her the drug for ten days as advised by the HEW.”

IFHP has supported the Ethiopian government train, mentor and equip more than 11,000 HEWs on ICCM to enable them to provide quality case management services to sick children at health posts.

Bringing Curative Services Close to Families

Integrated Family Health ProgramTel. +251 11 320 3501

P.O.Box 12655Nefas Silk Lafto Sub City

Kebele 05Del Gebeya Area

Addis Ababa, Ethiopia

The Integrated Family Health

Program (IFHP) is a five year

(2008-2013) USAID-funded program

that is implemented by Pathfinder

International (PI) Ethiopia and John

snow, Inc (JSI). IFHP supports US-

AID/Ethiopia’s strategic objecitve of

“investing in people” with the overall

goal of creating and consolidating

functional and effective network

of well integrated family health

services to communities within the

framework of the primary health

care unit and more specifically the

health extension program. IFHP is

implemented in the four large re-

gions of Ethiopia: Amhara, Oromia,

SNNPR and Tigray.

Volume 9, No. 2, April-September 2013

8

Stories from the Field

Investing in people for improved family health

Fatuma getting treatment for her sick child at Chafe Benti Health Post, West Hara-rghe Zone, Oromia Region