hiluf: ethiopia

7/28/2019 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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hiluf: ethiopia

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