hiluf: ethiopia
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HOME BASED NEWBORN CARE: COUNTRY
SUCCESSES AND CHALLENGES
Mihret Hiluf (BSc, MPH)Director, AHPDPD
FMoH Ethiopia
NEWBORN 2013: Global Newborn HealthConference, Johannesburg
April 17, 2013
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Outline
Background
Overview of HEP
ObjectivesHEWs
Packages
Service delivery modalities &Organizational support
Achievements &Challenges
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Background
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Geographic location=Horn of Africa
Second most populous
nation in Africa
It covers 1,104,300 squarekilometers
Estimated total populationin 2013= 86 million.
Population growth rate =2.6%
83.6% rural, 16.4% urban
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Background
Predominately young with 47% < 15 years and 15.4%
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Data sources: Updated from Opportunities for Africas Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 data
Background
37
88
68
0
100
200
300
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010* 2015
Mortalityper1000livebirths
Neonatal mortality rate
Under 5 mortality rate
MDG 4 Target
Over fifty percent of infant and forty percent of under five deaths in Ethiopia are neonatal Chronic Malnutrition has dropped from 47% to 44%
Ethiopia could meet MDG 4 with accelerated progress (from the current rate of 4.4% annual reduction to 6%)and more focus on neonatal deaths
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http://www.childmortality.org/http://www.childmortality.org/ -
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Background .
Major direct causes of newborn deaths are
- Preterm 37%
- Intrapartum related complication (birth asphyxia) 28%
- Severe infection 24%.(Liu L. et al.2012 Global, Regional & National Causes of Child Mortality in2000-2010).
25 to 45 % of all neonatal deaths occur in the first 24 hours,with about three-quarters occurring in the first week
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Background
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Ethiopian Health Tier System
Specialized Hospital
(3.5-5.0 million people)
Tertiary level health care
General Hospital
(1-1.5 million people)
Primary Hospital
(60,000-100,000 people)
Health Centre
(15-25,000 people)
Health Post
(3-5,000 people)
Secondary level health care
Primary level health care
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PHCU
One HC
Five HPs
15-25,000 Pop.
100,000
DistrictHealth office
25,000
Health
Center
5,000
HealthPosts
Woreda Health Office
Health Post A Health Post B Health Post CHealth Post D Health Post E
Health Center
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Overview of HEP
Objective: to increase equitable access to essential promotive,preventive and selected high impact curative healthinterventions targeting households at the community level.
Fundamental philosophy: if the right health knowledge andskill is transferred, households can take responsibility forproducing and maintaining their own health.
It promotes community involvement, ownership,empowerment, skill multiplication and self-reliance to ensuresustainability.
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Overview of HEP HEWs
HEWs are 10th grade complete & one year certificate trainedcommunity health workers.
More than 95% are females.
They are selected with participation of the rural community Paid by government.
Two per 3,000-5,000 people at the village level
Over 38,000 HEWs being deployed (over 34,000 in rural &
4,000 in Urban). More than 15,000 HPs were constructed and equipped with
necessary materials.
Supported by Community health development army.
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Health Post
Serves app 3 - 5,000people (1,000 HHs)
2 HEWs
30 40 HDTs
150 - 200 1 to 5 networkleaders
1,000 HHs
150 - 200
1 to 5network
Leaders
30 40
HDTs
2 HEWs
Health Post A
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Overview of HEP Packages
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16 HealthExtensionPackages
FamilyHealth (5)
DiseasePrevention& control
(3)
HealthEducation
Hygiene &EH (7)
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Community level activities : Addressing thethree main causes of newborn deaths
Preterm birthcomplications
Prevention of pretermbirth & LBW (LLINs )
Clean & Safe delivery
Promotion of Skilledattendance & EmONC
Essential newborn careas part of PNC
ICCM
CKMC (Pilot in 10districts)
Intrapartum related(Birth Asphyxia)
FANC Clean & Safe
delivery
Promotion ofinstitutional delivery
ENC as part of
PNC
ICCM
Newborn infection
Antenatalmanagement ofmaternal infections
Clean & Safedelivery &promotion of SD
ICCM ENC as part of
PNC CBNC(Learningphase)
Platform: Health Services Extension Program (HSEP)
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Overview of HEP
Service Delivery Modalities
House Hold
Out reachHealth Post
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Overview of HEP
HEP Organizational Support
Primary Health Care Unit (PHCU)
One HC with five Health Posts
Technical & administrative support
Planning
Implementation
MonitoringSupply
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Achievements & Challenges
MNCH Component Coverage (%)
CPR** 29ANC* 89.1ANC 4+** 19Skilled delivery*
20.4
Clean & Safe delivery* 13
Percentage of deliveries of HIV-positive women whoreceived a full course of ARV prophylaxis*
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PNC* 44.5PNC within 2 days** 7PAB** 48Exclusive breast feeding < 6months ** 52Health facilities providing IMNCI * 68HPs providing ICCM* 77
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Source: * FMoH 2011/12 **EDHS 2011
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Thank You!
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