Optimizing the Health Extension Program (OHEP) - Jan 2017
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The document outlines a project aimed at increasing the use of community-based newborn care (CBNC) and integrated community case management of childhood illness (ICCM) services in Ethiopia, initiated due to high rates of under-five deaths. Despite significant training efforts, service utilization remains low, prompting the need for innovative demand generation strategies and capacity building interventions. Key stakeholders, including the Ethiopian Ministry of Health, BMGF, and UNICEF, are collaborating to enhance community awareness and improve health outcomes through education and resource allocation.
Optimizing the Health Extension Program (OHEP) - Jan 2017
- 1. Optimizing the Health Extension Program 17-03-08 Page 1 A collaborative effort to increase use of community based newborn care (CBNC) and integrated community case management of childhood illness (iCCM) services in Ethiopia January, 2017
- 2. Outline ■ Background ■ Evolution of OHEP ■ Expected results ■ Learnings ■ Challenges 17-03-08 Page 2
- 4. Background ■ Ethiopia is one of the 12 Low Income Countries that achieved MDG 4 target. ■ However, 184,000 under five deaths is happening each year. More than 40% of these deaths happen in newborns. ■ Pneumonia, Diarrhea, Malaria and Malnutrition remain to be the leading cause of deaths. 17-03-08 Page 4
- 5. 17-03-08 Page 5 ICCM is implemented at scale where over 30,000 HEWs are trained on competency based training CBNC rolled-out as of 2013 ICCM quality of care as measured by consistency between Assessment, Classification and Treatment is over 80% Utilization has been persistently low. E.g After two years of implementation only 8% of Expected Pneumonia cases and 1% of Diarrheal Disease were treated at HP (Tadesse, 2014).
- 6. Evolution of OHEP 17-03-08 Page 6
- 7. Evolution of OHEP ■ Given the low uptake of the services, FMOH identified the need for innovative demand generation interventions. ■ To be sustainable these interventions needs to be integrated in the existing structure. ■ FMOH and BMGF in collaboration with PATH and UNICEF agreed to take up this challenge ■ Led by FMOH, BMGF, UNICEF and PATH designed this project as a learning and a capacity building agenda for future scale- up 17-03-08 Page 7
- 8. Optimizing the Health Extension Program Partners ■ BMGF- Funder ■ FMOH – Coordinator ■ PATH and UNICEF- Demand side ■ R4D and CHAI – Supply side (Amox DT, ORS and Zn) ■ LSHTM, EPHI and 4 Local Universities for external evaluation 17-03-08 Page 8
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- 12. 17-03-08 Page 12 Barriers to low uElizaEon • Misconcep*ons and myths related to childhood illness and disease causa*on • Lack of awareness on iCCM/CBNC services • Preference for tradi*onal healers or home remedies • Perceived poor quality of services/capacity of HEWs
- 13. Barriers to low uElizaEon • Weak iCCM/CBNC program ownership • Service interrup*on (unscheduled closure) • Drug stock-out • Limited skill and confidence, mainly in trea*ng newborns 17-03-08 Page 13
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- 16. GOAL: To contribute for the improvement of Newborn and Child Health Increased iCCM and CBNC service utilization Ensuring program ownership and accountability Building Capacity to ensure availability of quality iCCM/ CBNC services and sustainable demand generation activities Community Education and Mobilization to improve care seeking and household care and practices for newborns and children 17-03-08 Page 16 Project Objectives
- 17. PHCU/Kebele Command Post HDA Community Woreda: ImplementaEon focus Demand generation capacity building Support print and media materials: Low lit. tools, Projecting Health, Radio Increase depth of Knowledge on illness causation and service availability Capacity building Advocacy for ownership Level-1 CBDDM Gap filling training for HEWs, PRRT, ISS District Health Office/ District AdministraEon
- 18. Interventions Community Education and Mobilization Capacity Building Ensuring ownership and accountability HP open house CBDDM and Level-1 training for HDA Advocate for the inclusion of iCCM/CBNC indictors as performance evaluation Engaging traditional leaders, schools, Ag. Extension workers Command post, PRT, HEWs Support the integration of iCCM/CBNC in WBP, ISS and RM Projecting health, radio, speaking book Gap filling training for HEWs Advocate for the allocation of budget to fill gaps in commodities Community meetings for feedback on health services Outreach kits for treating sick children during home visits Advocate for standard schedule for HP 17-03-08 Page 18
- 19. Key beneficiaries Secondary Ag. Extension workers, religious and traditional leaders, School community, HDA Primary Mothers/care givers 17-03-08 Page 19 CreaEng an enabling environment ImpacEng depth of knowledge, building skills; changing percepEons
- 20. Engaging the Woreda from the outset Ø Plan Alignment Workshop Ø Engaged in woreda based planning ensuring iCCM/CBNC received due attention and activities are included in the annual plan 17-03-08 Page 20
- 21. Engaging religious/ traditional healers 17-03-08 Page 21
- 22. Sensitization for Agriculture Extension Workers 17-03-08 Page 22 Ø AEWs have interacEon both with women and men -- serve as good channel for informaEon on child health
- 23. Sensitization for school community 17-03-08 Page 23
- 24. Field testing the KCP orientation guide 17-03-08 Page 24
- 26. Learnings ■ For the sustainability woreda need to be the focus and interventions need to be aligned with the Woreda transformation agenda. ■ Addressing ownership from the outset is critical. ■ Innovations that look at the family and the community within the context of their society is important for success. ■ Integrating a monitoring and feedback approach helps to generate evidence for possible scale-up. ■ Engaging the woreda administration for multi-sectoral engagement and political commitment and accountability is important. ■ Active leadership role of the FMOH and RHBs is critical for successful implementation and scale-up. ■ The partnership helps in improving the tools and in having a standardized approach 17-03-08 Page 26
- 27. Challenges ■ Supply: drug stock-out ■ Competing priority by the public sector ■ Nationally rolled out trainings such as the Level-I HDA training are delayed ■ Relevant data are not part of the HMIS (e.g treated newborns) ■ FHG- translation is not yet completed 17-03-08 Page 27
- 28. Thank you ! 17-03-08 Page 28