Ethiopia Malaria Diagnosis and Treatment at Private Health Facilities Year One Quarter Four Report July

Private Health Sector Project –Ethiopia

Malaria Diagnosis and Treatment at Private Health Facilities

Year One Quarter Four Report July – September 2016

DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government

USAID ETHIOPIA - PRESIDENT’S MALARIA INITIATIVE (PMI)

Private Health Sector Project - Ethiopia

Malaria Diagnosis and Treatment at Private Health Facilities Year One Quarter Four Report (July – September 2016)

Program: Private Health Sector Project - Ethiopia Prime Partner and Sub-partners: Abt Associates Inc. Cooperative Agreement Number: GPO –A-00-09-00007-00 Project Start / Completion Date: October 2015 – September 2020 Work or Reporting Period: July – September 2016 Submission Date: 21 October 2016

Acronyms

ACT Artemisinin-based Combination Therapy AIDS Acquired Immune Deficiency Syndrome EMLA Ethiopian Medical Laboratory Association EPHFEA Ethiopian private Health facilities Employee Associations FMOH Federal Ministry of Health HC Health Center HIV Human Immune Deficiency Virus IPLS Integrated Pharmaceutical Logistic System IRS Indoor Residual Spraying ITN Insecticide –treated net LLINS Long lasting insecticidal net LMIS Logistic Management Information System MC Medium Clinic MOU Memorandum of Understanding NGO Non -Governmental Organization PF Plasmodium falciparum PV Plasmodium vivax PHSP Private Health Sector Program PMI President’s Malaria Initiative PPM Public private Mix PPP Public Private Partnership RDT Rapid Diagnostic Testing RHB Regional Health Bureau SNNP Southern Nations, Nationalities, and Peoples TAC Technical Advisory Committee TOT Training of Trainers WHO World Health Organization USAID United State Agency for International Development

Contents Acronyms ...... ii

1 Introduction ...... 1

1.1 General Overview ...... 1 1.2 Strategies ...... 1 1.3 The general objectives of this program component are to: ...... 1 2. Key Accomplishments (July – September 2016) ...... 2

2.1 Working with private health facilities ...... 2 2.2 Review meeting and supportive supervision ...... 2 2.3 Partnership with RHB and stakeholders ...... 2 2.4 Formative assessment ...... 2 2.5 Training ...... 3 2.6 Participation and Discussion with FMOH /RHBs ...... 4 2.7 Service Delivery ...... 4 2.8) Gender Mainstreaming ...... 5 3) Summary of Facility Level Report for Quarter Four ...... 7

4) Planned Activities for Next Quarter ...... 7

5. Summary Monitoring and Evaluation Matrix (Private Health Sector Project Ethiopia) ...... 8

6. List of Private Health Sector Project -Ethiopia - Supported Facilities for Malaria Diagnosis and

Treatment Services during this Reporting Quarter (July – September 2016) ...... 10

7 Photo Gallery ...... 17

iii

List of Tables

Table 1: Number of malaria case management training participants by region, July- September 2016...... 3 Table 2: Malaria diagnosis and treatment at 145 private health facilities: July – September2016 ..... 5 Table 3: Malaria cases treated, admitted, referred and died in at 145 PPP supported facilities (July -September 2016) ...... 5 Table 4: Malaria cases by age and sex in Private Health Sector Program supported facilities (July – September 2016) ...... 6

List of Figures

Figure 1: Radar plot of Pretest and Posttest results of malaria case management training, Adama, September 16 -19, 2016...... 3 Figure 2: Trends in Malaria Diagnosis, treatment at Private Health Sector Project -Ethiopia assisted private facilities; October 2014 September 2016 ...... 7

1 Introduction

1.1 General Overview

The Private Health Sector Program (PHSP) was a USAID funded project which supported between a minimum of 44 and a maximum of 117 private health facilities during its four year implementation period. The project was implemented in seven regional states of Ethiopia i.e. Afar, Amhara, Oromia, Southern Nations, Nationalities and People, Tigray, Harari Regions and Dire Dawa City Administration, through which over 868,193 malaria-suspected cases were properly screened, and over 228,049 malaria cases were diagnosed, treated and reported to the town health offices ( April 2012- Sep 2015) .

From October 2015-September 2016, the Private Health Sector Project has supported 149 private health facilities for malaria care services in five regional states of Ethiopia (5 Afar, 35 Amhara, 39 Oromiya, 25 SNNPR and 45 Tigray).From July- September 2016, cases were reported from 131 facilities. Thirteen facilities reported zero case, and 5 facilities were closed.

1.2 Strategies

• Policy dialogue with RHBs to engage private facilities in Public Private Mix (PPM) -based malaria case management, and policy dialogue and advocacy to establish a PPM implementation guideline for malaria prevention and control through the private sector. • Public Private Mix for malaria care service site expansion. • Building the capacity of health providers through Team Training (case managers, lab professionals and supply chain mangers), Joint Supportive Supervision and Mentoring. • Rapid assessment to map geographic distribution of migrant and mobile workforce. • Technical Assistance to malaria program officers in Afar, Gambella and Beneshangul- Gumuz. • Working through partnership with all stakeholders for improving access to effective and efficient malaria care services.

1.3 The general objectives of this program component are to:

• Increase access and uptake of malaria services from the private health facilities. • Enhance capacity of local partners to ensure the sustainability of PPM partnerships. • Enhance pharmaceutical supply chain management and rational drug use at private health facilities including work places.

• Enhance program learning and innovative ventures. • Generate evidence on malaria service needs of migrant and mobile workforce for decision making and programming.

2. Key Accomplishments (July – September 2016)

2.1 Working with private health facilities

In the reporting period, malaria cases (diagnosis and treatment) were reported from 131 facilities, and 46 new facilities were assessed in four regions. 2.2 Review meeting and supportive supervision  From August 1 through 28 2016, joint supportive supervision was conducted in four regional states (Tigray, Amhara, Oromia and SNNP).  The Private Health Sector Project facilitated program review meetings from September 27 -28 2016 in Tigray and SNNP Regions.  The project, in collaboration with the Ethiopian Sugar Corporation, prepared a three-day malaria program review. The participants were delegates of all nine sugar development projects. Each project presented its achievements, challenges and lesson learned.  Follow up conducted on unusual malaria case in Beles, Kessme Metehara and Kuraz SDPs ( Sugar Development project .

2.3 Partnership with RHB and stakeholders  Facility readiness assessment was conducted in three regions (Afar, Beneshangul Gumuz and Gambella). Out of the 30 private health facilities assessed, 27 were willing and committed to working in partnership with the public sector (See Photos 3, 4 & 5).  A list of project-supported workplace malaria facilities was shared with ICAP. This helps both projects to avoid duplication of efforts. 2.4 Formative assessment The formative assessment on the situation of migrant or mobile workers and malaria-related health needs was conducted in seven regional states (Afar, Amhara, Benishangul Gumuz, Gambella, Oromia, SNNP and Tigray). The formative assessment documented the existence of an estimated 1 million seasonal migrant workers in all seven regional states. The situation of malaria among migrant workers was more complex and difficult to address through routine malaria prevention and control strategies. More detailed findings will be presented in the final report from the assessment, which will be ready in Q1 of year II.

2.5 Training

The Private Health Sector Project, in collaboration with Oromia Regional State Health Bureau, facilitated a malaria case management training at World Training Center (WTC), Adama (Photos 1,& 2). The total participants were 27 of which 15 (55.6 percent) were nurses, 10 (37.0 percent) were health officers, 1 (3.8 percent was a lab professional and 1 (3.8percent) was a medical doctor. Out of 27 malaria case management trainees, 18 were from newly assessed and enrolled malaria facilities. The remaining 9 participants were recruited to replace attrition of trained healthcare providers in partner facilities. Trainee performance improvement was measured using standard pre- and post-test scores. The average performance improvement was 19.0 percentage points (59.0 percent scored in a pretest and 78.0percent in a post-test) (figure 1).

1 27 2 26100% 3 25 80% 4 24 60% 5 23 40% 6 22 20% 7 Pretest 21 0% 8 Posttest 20 9 19 10 18 11 17 12 16 15 14 13

Figure 1: Radar plot of pretest and posttest results of malaria case management training, Adama, September 16 -19, 2016. Table 1: Number of malaria case management training participants by region, July - September 2016.

Malaria Case management (YI QIV) # of facilities in # of trainees new # of replacement No Region the region facilities trainees Total 1 Afar 5 10 0 10 2 Amhara 35 0 0 0 Benshangul 3 Gumuz 0 0 0 0

4 Gambella 0 0 0 0 5 Oromia 39 4 6 10 A 6 SNNP 25 5 0 5 half- 7 Tigray 45 1 1 7 day Total 149 20 7 27 briefing on the Logistics Management Information System (LMIS) using Standard Operating Procedures of Integrated Pharmaceutical Logistics System (IPLS) for 27 health care workers was delivered ( which is the part of the previous training ) . The trainees were given the opportunity to practice on stock management

tools (Bin Cards, Stock Cards, Goods Receiving and Issue Memos, Inventory forms, Drug Reporting and Requesting Forms).

2.6 Participation and Discussion with FMOH /RHBs

 During Year I Quarter IV, the project continued its technical support as a member of the National Malaria Technical Advisory Committee (TAC) and malaria control support team (MCST).  The Private Health Sector Project was represented in the regular Technical Advisory Committee (TAC) meeting at FMOH on August 18, 2016.  In the era of malaria elimination, the importance of scaling up of Public Private Mix (PPM) malaria care services and the development of PPM Implementation Guidelines was advocated and discussed with FMOH state minster. Upon request of FMOH, the project shared the PPM DOTS Implementation Guidelines (2012), and the state minster directed the project to develop a malaria PPM implementation guideline.  During the reporting period, our office provided financial and technical support for the finalization of malaria case management training manuals. A four-day workshop on this topic was held in Addis Ababa, at Cyan City Hotel, from September 19 - 22, 2016

2.7 Service Delivery From July – September 2016, the Private Health Sector Project - Ethiopia collected data from 131 private facilities which provide malaria case diagnosis and treatment. Details are depicted in tables 2 and 3 below:

Table 2: Malaria diagnosis and treatment at private health facilities: July – September 2016

All . malaria Microscopy RDT Presu suspecte Total med Region d cases cases TBF Pos percent PF PV Mixed TRDT Pos percent PF PV Mixed Dx Afar 3631 885 3452 885 26 582 270 33 179 0 0 0 0 0 0

1,86 Amhara 21161 4072 20,179 3776 19 8 1,596 312 982 296 30 94 135 67 0

Oromia 19605 2021 19006 1890 10 886 897 107 595 127 21 33 92 2 4

SNNP 19177 3317 17197 2176 13 833 1,215 128 1738 899 52 473 415 11 242

2,96 Tigray 16071 6377 12156 3849 32 2 781 106 3915 2528 65 1,264 834 430 0

7,13 Total 79,645 16,672 71990 12576 17 1 4,759 686 7409 3850 52 1,864 1,476 510 246

NB : pos =positive , Dx =diagnosis ,: *CQ = Chloroquine, **AM= Artemether, Artsun= Artesunate, PF ( plasmodium falciparum ),PV ,plasmodium vivax

Table 3: Malaria cases treated, admitted, referred and malaria-related deaths in private health facilities (July -September 2016)

Treated Number of Malaria cases Region Total Cases treated AL CQ* Quinine AM** Artsun Admitted Referred Deaths Afar 885 615 270 0 0 0 0 0 0

Amhara 4068 2,223 1,724 53 69 8 52 5 0

Oromia 2016 1,038 942 15 21 50 1 0

SNNP 3314 1,508 1,654 19 110 16 35 15 0

Tigray 6353 4,667 1,615 3 63 5 0 0 0

Total 16636 10,051 6,205 57 257 50 137 21 0

2.8) Gender Mainstreaming During this quarter, the Private Health Sector Project facilitated malaria case management training with 27 case managers, out of which 10 (37.05 percent) were females while the rest 17(63.0percent) were males. The sex ratio (F:M) of participation was 1:2. Moreover, from all malaria cases, 11,566 (69.3percent) of malaria patients were males while the rest 5106 (29.7percent) were females. The following (table 4) depicts the distribution of service beneficiaries by age and sex.

Table 4: Malaria cases by age and sex in Private Health Sector Program supported facilities (July – September 2016)

Age in Years and Sex Disaggregation < 5 5 - 14 >=15 Total Total Region Cases Male Female Male Female Male Female PW* Male Female Afar 885 107 72 75 56 424 151 0 606 279

Amhara 4072 188 159 251 258 2,176 1,040 605 2615 1457

Oromia 2021 121 104 247 179 924 446 1 1,292 729

SNNPR** 3317 208 160 260 145 1,531 1,013 14 1,999 1,318

Tigrai 6377 157 132 324 212 4,573 979 6 5,054 1,323 All Regions 16,672 781 627 1,157 850 9,628 3,629 626 11,566 5,106  PW= Pregnant Women ** SNNP= Southern Nation Nationalities and Peoples Region

3) Summary of facility-level report

 During the reporting period, reports were collected from 131 private health facilities (5 from Afar, 31 from Amhara, 35 from Oromia, 19 from SNNP and 41 from Tigray Regions).  In quarter IV, facility readiness assessments were conducted and an additional 45 facilities were identified in three regions (14 in Afar, 12 in Gambella, and 19 in Beneshangul Gumuz).  Almost all (99 percent or 16426/16672) malaria suspected cases were investigated for parasitological confirmation.  The positivity rate for blood films (BFs) was 17 percent (12576/71990) while the positivity rate for RDTs was 52 percent (3850/7409 ). 4) Planned Activities for Next Quarter

 Facilitate launching of Public Private Mix (PPM) for malaria care service in three regions (Beneshangul Gumuz, Gambella, and Afar).  Conduct malaria case management training for newly enrolled facilities and consider replacement trainees to make-up for attrition in Gambella and Beneshangul Gumuz Regions.  Assess and identify additional malaria care facilities in SNNP, Afar, Beneshangul Gumuz Regions.  Conduct malaria case management training for new facilities and emerging regions .  Support the initiation of malaria care services in newly identified and prepared facilities.  Provide technical support to private health facilities associations and . Figure 2: Trends in Malaria Diagnosis and Treatment at –project-assisted private facilities; October 2015- September 2016

18000 102.0% 16000 99.8% 99.6% 99.2% 100.0% 14000 98.5% 12000 98.0% 10000 16672 96.0% 8000 16636 6000 94.0% 96869666 9495

4000 9153 percentofcases malaria

Number of Malaria Malaria of NumberCases 74707483 92.0% 2000 0 90.0% Y1Q1 Y1Q2 Y1Q3 Y1Q4

Diagnosed Malaria Treated Malaria % Confirmed Malaria

5. Summary of Monitoring and Evaluation Matrix (Private Health Sector Project Ethiopia)

No Indicator Indicator /output Planned Achieved October 2015- October2015- September September 2016 2016 1 Dialogue to engage /initiate Malaria in PHFs with in three regions Number of meetings 3 3 (Beneshangul- Gumuz , Gambella, Afar) /preliminary discussions 2 Participate in the national celebration of World Malaria Day 2016 Number of event/ proceeding 1 1 3 Adopt and print BCC materials for Migrant workers with one of the PMI Number of posters 0 0 Partners working on Social and Behavioral Change Communication (SBCC) 4 Conduct a facility readiness assessment and select 73 additional eligible Number of assessment 73 130 private health facilities (PHFs)for Malaria services 5 Prepare a launching ceremony and facilitate signing MoUs between RHBs Number of Singed MOU 73 79 and 73 PHFs in newly emerging regions Number of region

6 Initiate Malaria services in 68 additional new facilities ( for -profit ) Number of facilities initiate 68 94 malaria services

7 Initiate Workplace Malaria care services in 5 sites Number of facilities initiate 5 3 Malaria services 8 Facilitate the Identification of over 98percent of Malaria cases based on Proportion of parasitological >95percent 98.5percent parasitology diagnosis in selected private health facilities identified cases 9 Provide standard malaria treatment for 100percent of Malaria patients in Proportion of appropriate >98percent 99.7percent the selected private facilities treatment 10 Participate in Malaria outbreak /epidemic identification, and response Number of rumor identified 1 1 and reported to higher level 11 Provide three rounds of four days training on Malaria diagnosis and Number of participants 55 84 treatment to 85 health care workers (doctors, health officers, nurses) pre/post test scores recruited from private clinics (assumption 1 HWs per facility ) 12 Provide three rounds five days training on Malaria diagnosis techniques to Number of participants 30 102 85 lab personnel recruited from private health facilities attended, pre/post test scores 13 Print and distribute 85 sets of job aids and treatment guidelines to 85 Number of sets (job aids 85 112 private health facilities /guidelines/SOPs distributed) 14 Provide three session IPLS training for 85 health workers Number of participants 55 112

No Indicator Indicator /output Planned Achieved October 2015- October2015- September September 2016 2016 15 Link all Selected PPM for malaria care facilities to Public Supply Chain Number of PHF access with 61 61 system to access Artemether Lumefantinerine (AL) AL 16 Facilitate the provision of rapid diagnostic test (RDT) supply from RHBs to Number of Facilities 15 15 50 Lower/primary clinics receiving RDT 17 Conduct formative assessment to address the Malaria prevention and Number of assessment 1 1 control need of migrant workers Number of report 18 Print and distribute HMIS tools (Comprehensive Lab Register, Morbidity, Number of facilities using 117 149 Report forms) to 117 facilities these forms 19 Collect and facilitate submission of Malaria weekly reports to PHEM at Number of facilities using 117 131 Woreda Health Offices /weekly report / these forms and # submitted 20 Collect and facilitate submission of HMIS (Malaria) monthly reports to Number of facilities using 117 131 Woreda Health Offices these forms and # submitted 21 Provide lab mentoring for existing 44 Malaria sites twice a year (EMLA) Number of labs mentored 44 44 22 Strengthen linkage of 44 existing malaria sites in regional EQA scheme for 100percent of 44 sites 44 01 Malaria microscopy quarterly received EQA & 90percent of them passed minimum score

1 EQAs can not conducted for malaria slides , shortage of manpower at the RHB and regional lab

6. List of Private Health Sector Project - Ethiopia Supported Facilities for Malaria Diagnosis and Treatment Services during this Reporting Quarter (July – September 2016)

ID Name of Facility Facility Level Ownership Region Zone Town 1 Adinas Higher Clinic Higher Clinic Private Amhara Bahir Dar Bahir Dar 2 Ayehu Farm Clinic Work Place Private Amhara Awi Ankesha 3 Bekele Higher Clinic Medium Clinic Private Amhara West Gojam Bure 4 Belese Sugar Dev Medium Clinic Government Amhara Awi Fendika 5 Birr Farm Clinic Work Place Private Amhara West Gojam Jabi Tena 6 Dilnesa Medium Clinic Medium Clinic Private Amhara West Gojam Finoteselam 7 Dr Bekele Higher Clinic Higher Clinic Private Amhara South Gondar Woreta woreta 8 Dr Birhanu Higher Clinic Higher Clinic Private Amhara West Gojam Durbete 9 Dr Gashaw Medium Clinic Medium Clinic Private Amhara Awi Fendika 10 Dr Melaku Medium Clinic Medium Clinic Private Amhara West Goajam Finoteselam 11 Dr. Abera Medium Clinic Medium Clinic Private Amhara North Wollo Woldia 12 Dr. Mulugata MC Medium Clinic Private Amhara Awi Chagni 13 Gambi Hospital Hospital Private Amhara Bahir Dar Bahir Dar 14 Hayat Medium Clinic Medium Clinic Private Amhara Awi Chagni 15 St. George Hospital Hospital Private Amhara West Gojam Bure 16 Urso Line Sisters Catholic Health Center NGO Amhara North Wollo Kobo 17 Yifat Primary Hospital Hospital Private Amhara North Shoa Shoa Robit 18 Gashaw MC Medium clinic Private Amhara North Shoa Shoa Robit 19 Biruk MC Medium Clinic Private Amhara North Shoa Shoa Robit 20 Agmasse MC Medium clinic Private Amhara Bahir Dar Bahir Dar 21 Dr. Aemero MC Medium clinic Private Amhara West Gojjam Dembecha 22 Tesfu MC Medium Clinic Private Amhara West Gojjam Shindie 23 Lalibela Medium clinic Medium Clinic Private Amhara West Gojjam Shindie 24 Kef- ale MC Medium Clinic Private Amhara West Gojjam Shindie 25 Demisse MC Medium Clinic Private Amhara West Gojjam Merawi 26 Bernesh Medium clinic Medium Clinic Private Amhara West Gojjam Finote Selam 27 Belse Sugar Developmeny Work Place Government Amhara Awi Fendika HC II 28 Al-Buraq Medium Clinic Medium clinic Private Amhara Awi Chagni 29 Binalfew Medium Clinic Medium Clinic Private Amhara Awi Fendika 30 Dagmawi Deresegn Medium clinic Private Amhara North Gondar Chuhait Medium Clinic 31 Birr Farm Primary Clinic Work Place Private Amhara West Gojjam Jabih tehina 2

ID Name of Facility Facility Level Ownership Region Zone Town 32 Arjo Dedessa Sugar Dev Work Place Government Oromia East Wolega Arjo Dedessa Clinic 33 Fincha Sugar Factory Work Place Government Oromia Horo Gudru Fincha 34 Metehara Sugar factory – Work Place Government Oromia East Shoa Metehara Hospital 35 Wonji Sugar Factory Hospital Government Oromia East Shoa Wonji Hospital 36 Abyssinia HC Higher clinic Private Oromia East Shoa Modjo 37 Sama Senbet Hospital Hospital Private Oromia East Shoa Modjo 38 Addis Hiwot HC Higher Clinic Private Oromia I/Abbabora Bedelle 39 Agape MC Medium clinic Private Oromia West Shoa Ambo 40 Amob HC Higher Clinic Private Oromia West Shoa Ambo 41 Bako MY HC Health Center NGO Oromia West Shoa Backo 42 Dembel HC Higher clinic Private Oromia West shoa Ambo 43 Ethio- Africa HC Higher Clinic Private Oromia Jimma Jiimma 44 Hora Medium clinic Medium Clinic Private Oromia Finifine Z Sebeta 45 Jarra HC Higher clinic Private Oromia West Wolega Nejo 46 Jimma HC Higher Clinic Private Oromia Jimma Jimma 47 Kera HoraHC Higher Clinic Private Oromia East Shoa Bishoftu 48 Miskir Higher Clinic Higher Clinic Private Oromia East shoa Adama 49 Tropical MC Medium Clinic Private Oromia East Sjoa Metehara 50 Universal Higher Clinic Higher Clinic Private Oromia Shashemene Shashemene 51 Feya General Hospital Hospital Private Oromia Shashemene Shashemene 52 Gizaw HC Higher Clinic Private Oromia Shashemene Shashemene 53 Shashemene Catholic Health Center NGO Oromia Shashemene Shashemene 54 Universal Higher Clinic Higher Clinic Private Oromia Jimma Jimma 54 Dr. Amanuel MC Medium Clinic Private Oromia East shoa Bishoftu 56 Rift Vally G. Hospital Hospital Private Oromia East shoa Adama 57 AT (Hibret )HC Higher clinic Private Oromia East Shoa Adama 58 Lukas HC Higher clinic Private Oromia East Shoa Adama 59 Tedal Medium C Medium clinic Private Oromia East shoa Bishoftu 60 Africa Service committee Medium Clinic NGO Oromia East shoa Batu/Zeway 61 Addisu Poly clinic Higher Clinic Private Oromia East Shoa Batu/Zeway 62 Meki Catholic Pediatric Medium Clinic NGO Oromia East shoa Meki 63 Missionary of charity Medium Clinic NGO Oromia Jimma Jimma 64 Rhobot Higher Clinic Higher Clinic Private Oromia Finifine Zuria Burayou 65 Holeta M C Medium Clinic Private Oromia Finfine Zuria Holeta 66 Boji MC Medium Clinic Private Oromia West Wellega Bila

ID Name of Facility Facility Level Ownership Region Zone Town 67 Abaya Medium Clinic M clinic Private SNNP Gamo Gofa Arbaminch 68 Abraham Medium Clinic M Clinic Private SNNP Gamo Gofa Arbamich 69 Alkeso Medium Clinic Medium Clinic NGO SNNP Silte Alkesso 70 Amanuel Medium clinic Medium Clinic Private SNNP Guragie Wolkite 71 Amibara Farm Clinic Work place Private SNNP Gamo Gofa Arbamich 72 Beteseb Medium Clinic Medium Clinic Private SNNP Halaba Klito Alaba 73 Beteseb Medium Clinic Higher Clinic Private SNNP Guragie Wolkite Wolkite 75 Soddo Christian Hospital Higher Clinic NGO SNNP Welayita Soddo 76 St. Gebriel Medium Clinic Medium Clinic Private SNNP Hawassa Hawassa 77 Abrham MC Medium Clinic Private SNNP Gedio Dilla 78 Unity MC Medium Clinic Private SNNP Gedio Dilla 79 Yohannes Medium Clinic Medium Clinic Private SNNP Hawassa Hawassa 80 Selam MC Medium Clinic Private SNNP Gamo Gofa Arbamich 81 Beteseb MC Medium Clinic Private SNNP Gamo Gofa Arbamich 82 Halaba MC Medium Clinic Private SNNP Alaba S. Kulito Werda 83 Bitsuham MC Medium Clinic Private SNNP Hadiya Hossana 84 Fikir MC Medium Clinic Private SNNP Hadiya Hossana 85 Kuraz Sugar Development Medium Clinic Workplace SNNP South Omo Hanna/Main Project I town 86 Kuraz Sugar Development Medium Clinic Workplace SNNP South Omo Bench Maji Project III 87 Kidist Mariam Medium Medium Clinic Private Tigray Western Kafta Humera Clinic Humera 88 Maykadira Medium Clinic Medium Clinic Private Tigray Western Kafta Humera 89 Selam Higher Clinic Higher Clinic Private Tigray Western Setit Humera Humera 90 Selam Medium Clinic Medium Clinic Private Tigray Western Kafta Humera 91 Dr. Tsegaye Yibrah SP Int Med Sp Clinic Private Tigray Western Shire Clinic Shire Medium Clinic 92 St. Agostina Medium Clinic Medium Clinic NGO Tigray Western Shire 93 Midere Genet Internal Internal Med Sp Private Tigray Western Shire Medicine Specialty Clinic Clinic 94 Wolyaikt Sugar Medium Clinic Workplace Tigray Western MayGaba Development Clinic 95 Dr. Yibrah SSC Specialty C Private Tigray Western Shire 96 Mulu Medium C Medium clinic Private Tigray Western May Gaba 97 Eleni MC Medium clinic Private Tigray Western Sheraro 98 Hiberet MC Medium clinic Private Tigray Western Shetraro 99 Temesgen MC Medium clinic Private Tigray Western Sheraro

ID Name of Facility Facility Level Ownership Region Zone Town 100 Dr. Tsegaye IMSC Medium clinic Private Tigray Western Humera 101 Dr. Solomon SpC Medium clinic Private Tigray Western Humera 102 Wolkayit MC Medium clinic Private Tigray Western Humera 103 Dr. Negassi MC Medium clinic Private Tigray Western Humera 104 Dr. Tedros MC Medium clinic Private Tigray Western Humera 105 Abune Aregawi MC Medium clinic Private Tigray Western Maykadra 106 Angesome MC Medium clinic Private Tigray Western Sheraro 107 KaftaHumera MC Medium clinic Private Tigray Western May karda 108 Dagnew MC Medium clinic Private Tigray Western Dansha 109 Luel MC Medium clinic Private Tigray Western Dansha 110 Dr. Yibeyin MC Medium clinic Private Tigray Western Dansha 111 Mehoni MC Medium clinic Private Tigray Southern Mehoni 112 Deberesina MC Medium clinic Private Tigray Southern Mehoni 113 Arsema MC Medium clinic Private Tigray Southern Mehoni 114 Raya MC Medium Clinic Private Tigray Southern Mehoni 115 Beza MC Medium Clinic Private Tigray Southern Alamata

116 Dr Kumneger Sur SP C Surgical Sp Clinic Private Tigray Southern Alamata 117 Dr Meaza Int Med Sp C Internal Med Sp C Private Tigray Southern Alamata 118 St Mary Catholic HC Health Center NGO Tigray Central EdagaHamus 119 Hossana MC Medium Clinic Private Tigray Central Wukro 120 Kahsa MC Medium Clinic Private Tigray Central Wukro 121 Zenebu & Lemlem MC Medium Clinic Private Tigray Central Wukro 122 Hiwot MC Higher Clinic Private Tigray Southern Alamata 123 Almicom Farm Primary clinic Work place Tigray Western Kafta Humera 124 Hiwot Mechanized Farm Work place Tigray Western Kafta Humera clinic 1 Primary 1 MARET 125 Hiwot Mechanized Farm Work place Tigray Western Kafta Humera clinic 2 Primary MARET 126 Hiwot Mechanized Farm workplace Tigray Western Kafta Humera clinic 3 Primary MARET 127 Tendaho Sugar * Medium Clinic Workplace Afar 1 Assayita Development-Dubti 128 Tendaho Sugar * Medium Clinic Workplace Afar 1 Assayita Development- Detbahiri 129 Tendaho Sugar * Medium Clinic Workplace Afar 1 Assayita Development-Asayita 130 Kessem Sugar** Medium Clinic Workplace Afar 3 Kebena Development Proj – Kebena 131 Kessem Sugar** Medium Clinic Workplace Afar 3 Saburie Development Proj Saburie

ID Name of Facility Facility Level Ownership Region Zone Town

Private Health Sector Project Supported Facilities with Closed, inaccessible or Zero Report Sept 2016 ID Name of Facility Facility Level Ownership Region Zone Town 1 Medium Cliinic Private North Eneyew Medium Clinic Amhara Gondar Aykel 2 Medium Cliinic Private North Ethiopia Medium Clinic Amhara Gondar Metema 3 Hailesselasie Medium Medium Cliinic Private Clinic Amhara West Gojam Merawi 4 Hayat Medium Clinic Medium Cliinic Private North Gendawuha Amhara Gondar Gendawuha 5 Medium Cliinic Private Bishoftu Beteseb Medium Clinic Oromia Town Bishoftu 6 Highjer Cliinic Private West Dr Chali Higher Clinic Oromia Wollega Gimbi 7 Shashemene Poly Int. Int Med Sp Clinic Private Shashemene med. Sp clinic Oromia Town Shashemene 8 Medium Cliinic Private Yonas Medium Clinic Oromia Guji Shakiso 9 Medium Cliinic Private Addis Medium Clinic SNNP Gedeo Dilla 10 Medium Cliinic Private Dr Adane Medium Clinic SNNP Welayita W.Sodo 11 Medium Cliinic Private Dr Mulat Medium Clinic SNNP Hawassa Hawassa 12 Medium Cliinic Private Hikma Medium Clinic SNNP Gedeo Dilla 13 Medium Cliinic Private Murida Medium Clinic SNNP Silte Werabe 14 Medium Cliinic Private Nur Medium Clinic SNNP Silte Werabe 15 Medium Cliinic Private Daniel Medium Clinic Tigray Western Dansha 16 Medium Cliinic Private Kedron Medium Clinic Tigray Southern Alamata 17 Kidist Mariam Medium Medium Cliinic Private Tigray Clinic Maykadra Western Maykadra 18 Mebrahitom Medium Medium Cliinic Private Tigray Clinic Western Dansha

Private Health Sector Project Newly Assessed and selected facilities by region October 2016.

ID Name of Facility Facility Level Ownership Region Zone Town 1 Sher Ethiopia Primary Hospital Private Oromia East Shoa Batu/Zeway Hpspital 2 Selam Medium Clinic Medium Clinic Private Afar One Assayita 3 Semera Medium Clinic Medium Clinic Private Afar One Assayita 4 Biruk Medium Clinic Medium Clinic Private Afar One Dubti 5 Zemzem Medium Clinic Medium Clinic Private Afar One Dubti 6 Selalo Medium Clinic Medium Clinic Private Afar One Dubti 7 Merhaba Medium Clinic Medium Clinic Private Afar Three Dubti 8 Yibrah higher clinic Higher Clinic Private Afar Three Awash 7 kilo 9 Awash Marble Factory Medium Clinic Work place Afar Three Awash 7 kilo 10 Kidane Meheret MC Medium Clinic Private Afar Three Awash 7 kilo 11 Kidist Mariam MC Medium Clinic Private Afar Three Awash 7 kilo 12 Layila Mediu Clinic Medium Clinic Private Afar Three Awash 7 kilo 13 Lucy Primary Clinic Primary Clinic Private Afar Three Awash 7 kilo 14 Kidist Arsema MC Medium Clinic Private Afar Three Awash 7 kilo 15 Selam Medium Clinic Medium Clinic Private Afar Three Awash 7 kilo 16 Sober Medium Clinic Medium Clinic Private Benishagul Assossa Bambasi Gumuz 17 Bambasi Medium Clinic Medium Clinic Private Benishagul Assossa Bambasi Gumuz 18 Bamzawit Medium C Medium Clinic Private Benishagul Assossa Assossa Gumuz 19 Mitiku Medium Clinic Medium Clinic Private Benishagul Assossa Assossa Gumuz 20 Eman Medium Clinic Medium Clinic Private Benishagul Assossa Assossa Gumuz 21 Erkiya Medium Clinic Medium Clinic Private Benishagul Assossa Assossa Gumuz 22 Sola Medium Clinic Medium Clinic Private Benishagul Assossa Assossa Gumuz 23 Medihamialem MC Medium Clinic Private Benishagul Assossa Assossa Gumuz 24 Kiya Medium Clinic Medium Clinic Private Benishagul Assossa Assossa Gumuz 25 Muhambaw MC Medium Clinic Private Benishagul Assossa Assossa Gumuz 26 Assossa MC Medium Clinic Private Benishagul Assossa Assossa Gumuz 27 Berhanu MC Medium Clinic Private Benishagul Assossa Assossa Gumuz 28 Dr. Solomon MC Medium Clinic Private Benishagul Assossa Assossa Gumuz 29 Hiwot Medicum clinic Medium clinic Private Benishagul Metekel Mandura Gumuz

ID Name of Facility Facility Level Ownership Region Zone Town 30 Metekel Primary (Catholic) Medium clinic NGO Benishagul Metekel Mandura Gumuz 31 Bole Medium Clininc MC Private Benishagul Metekel Gilgel Beles Gumuz 32 Selam MC Private Benishagul Metekel Manbok Gumuz 33 Al-afia MC Private Benishagul Metekel Pawe Gumuz 34 St.Rufael Catholic MC NGO Benishagul Metekel Pawe Gumuz 35 Nati MC Medium Clinic Private Gambella Gambella Gambella 36 Bethel MC Medium Clinic Private Gambella Gambella Gambella 37 Dong Fang MC Medium Clinic Private Gambella Gambella Gambella 38 Dr. Tekeste MC Medium Clinic Private Gambella Gambella Gambella 39 Elshaday MC Medium Clinic Private Gambella Gambella Gambella 40 Sintayehu MC Medium Clinic Private Gambella Gambella Gambella 41 Bethelhem MC Medium Clinic Private Gambella Gambella Gambella 42 St. Gabriel MC Medium Clinic Private Gambella Gambella Gambella 43 Eyob MC Medium Clinic Private Gambella Gambella Gambella 44 Dr. Muluken MC Medium Clinic Private Gambella Gambella Gambella 45 Addis Hiwot MC Medium Clinic Private Gambella Gambella Gambella 46 Kidist Arsema MC Medium Clinic Private Gambella Gambella Gambella

7 Photo Gallery

Photo 1: Partial view of malaria case management trainees, WTC, Adama, (Photo: Argaw MD.)

Photo 2: Dr. Yonas Petros, facilitating malaria case management, WTC , Adama (Photo: Argaw MD.)

Photo 3: Partial view of assessed facility for malaria (Asoossa Medium Clinic) Benishagul Gumuz, (Photo: Argaw MD.)

Photo 4: Partial view of Lab facility assessed for malaria (Kiya Medium Clinic) Benishagul Gumuz, (Photo: Argaw MD.)

Photo 5: Partial view of waste management assessed facility for malaria (Berhanu Medium Clinic) Benishagul Gumuz, (Photo: Argaw MD.)

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