Technical Advisory Committee

INTEGRATED FAMILY HEALTH PROGRAM and other related programs

Minutes of Technical Advisory Committee

ADABA WOREDA’S TRIP

Field trip and visit report

West Arsi Zone, OROMIA

June 29 – July 1, 2011

(right –left)

Ato Jibril Gelemo, Adaba Woreda Health Office Head; Ato Hirpa Miacha West Arsi Zone Health Department Deputy Head; Ato Tesfaye Wakjira, Adaba Woreda Adminstrator; and Ato Abdulkadir Jarssso, Woreda staff

INTEGRATED FAMILY HEALTH PROGRAM and other related programs Technical Advisory Committee Quarterly field trip and visit report – West Arsi, OROMIA

June 29 – July 1, 2011

ADABA WOREDA’S TRIP

Participants 1. Wz. Genet Mengistu, Population Coordination Core, Ministry of Finance and Economic Development 2. Ato Alula Sebhatu, Population Coordination Core, Ministry of Finance and Economic Development 3. Ato Gemechu Kufa, Ministry of Health 4. Ato Damena Lema, Ministry of Education 5. Ato Tesfa Teferi, Ministry of Women, Children and Youth 6. Ato Alemu Shiferaw, HIV/AIDS Prevention and Control Office 7. Wz. Gezu Berhanu, Consortium of Reproductive Health Associations 8. Ato Amare Worku, Board member-Consortium of Reproductive Health Associations 9. Ato Getachew Letta, Regional Health Bureau 10. Ato Hundie Tilahun, Bureau of Finance and Economic Development

Staff of IFHP

1. Ato Tilahun Giday, Addis Ababa IFHP Office 2. Ato Girma Kassie, Addis Ababa IFHP Office 3. Ato Fiseha Mamo, Addis Ababa IFHP Office 4. Wz. Salem Melaku, Addis Ababa IFHP Office 5. Ato Mesfin Negussie, Oromia Regional IFHP Office 6. Ato Teshale Deressa, Oromia Regional IFHP Office 7. Wz. Adey Abebe, Addis Ababa IFHP Office

Destination West Arsi Zone

Duration of the visit June 29 – July 1, 2011

Sites visited 1. Population, Health and Environment Ethiopia Consortium project activity 2. West Arsi Zonal Health Department 3. Adaba Woreda Health Office 4. Adaba Woreda Health Center 5. Ejersa and Furuna Health Posts 6. Arsi Negele Health Center 7. Enga le Enga Youth Center

Wednesday, June 29, 2011 PHE project activity, Abiyata

The Technical Advisory Committee (TAC) made its first stop at Abiyata lake to visit project activities of the Sustainable Environment and Development Action (SEDA), a local NGO, member of the Population, Health, and Environment (PHE) Ethiopia Consortium. The visiting group drove over a wide field of what used to be part of the Abiyata lake. TAC members were briefed by a representative of SEDA that over the years the lake had shrunk by 8 kms. Due to rapid population increase around the area, trees have been cut down for fuel wood, homestead construction and for farming; rainfall has decreased and these have negatively impacted on the lake. Talking to an elderly man living in the area, the TAC learned that the number of family planning users was insignificant in the area and households have large families. Most of the children spend their time herding cattle instead of going to school. It was further explained that though there are two Health Extension Workers (HEW) in the area since the kebele is vast and households are located far apart, the HEWs have difficulty to get to all the households.

Ato Tilahun Giday, Country Representative of Pathfinder, informed SEDA that IFHP works in this area and it is important that they work in partnership with IFHP. Large family size is having obvious impact on the environment which in turn is impacting on the lives of the community around Abiyata.

Zonal Health Department, Shashemene

The visiting group then travelled to Shashemene, for briefing the work of the West Arsi Zone Health Department (ZHD) and the IFHP Cluster Office of West Arsi. Ato Mesfin Negiussie, IFHP Oromia Regional Program Manager, welcomed the group and Ato Tilahun Giday explained to the ZHD the purpose of the TAC visit and the composition of the TAC.

Ato Teshale Deressa, Shashemene IFHP Cluster Office Coordinator then briefed the group on IFHP’s work in the area. He explained that IFHP Oromia supports the Ethiopian government health program by closely working with the health offices at the different levels. This was then followed by a briefing given by Ato Hirpa Miacha, Deputy Head of the ZHD, on the health profile of the West Arsi Zone.

The Zone consists of 13 woredas and 365 kebeles (331 being rural kebeles) and the health program supports a population of over two million. Health services are provided through one district hospital, 66 Health Centers, 314 Health Posts and 67 clinics. Including HEWs, there are 1,883 health professionals providing health services in the Zone.

Ato Hirpa went on to explain achievement gained in the health sector by referring to performance of the last five years. For instance, ANC reached 112% as compared to 54% in 2006/07. Similarly PNC reached from 15% to 64%, Delivery from 9% to 33%, latrine construction from 42% to 94% and family planning services from 18% to 43%. Improvements are due to the hard work of HEWs which again have been assisted by IFHP’s capacity building training, it was explained.

Nonetheless, the good work is not without challenges which was stated to be lack of manpower in Health Centers and furnishing the Centers for proper functioning. Problems of transportation and staff turnover were also said to be additional challenges.

The briefings were then followed by discussion where several issues were raised. As a result of IFHP’s comprehensive operation in the Zone and committed HEWs and Volunteers helped in significantly improving health seeking behaviors of communities. The ZHD stated that IFHP is one of their strong partners with whom they work very closely and which is in fact, considered as one department within the ZHD. The IFHP Cluster Office is actually co-hosting with the ZHD.

A TAC member commented that the figures on HIV/AIDS are misleading in that they could imply that HIV/AIDS prevalence is decreasing. It was explained that the figures refer to the number of HIV positive people only from those receiving VCT services.

Regarding figures on delivery services reference is made to institutional delivery which includes those assisted by HEWs carried out in the Health Posts.

Regarding family planning services it was explained that priority for the provision of Implanon training of HEWs are based on a set of criteria, i.e. the area must be densely populated, must be food insecure area and an area where there is high demand for the service. In addition, it is necessary that there is a functional health posts in the area. However, the plan is to gradually reach all HEWs in all kebeles of the country making long acting family planning service available to all.

Following a suggestion of training religious leaders in community mobilization and behavioral change, it was explained that since HEWs work closely with religious leaders this is already being practiced.

Explaining low performance of PMTCT, it was stated that other partner organizations such as Intra Health are working on this more extensively and IFHP contributes to that effort. PMTCT service is part of IFHP’s program learning initiative and thus is working on only 28 health centers from among 243 health centers it supports. Nonetheless, based on results attained so far the service is planned to be scaled up.

In response to a concern stated regarding contribution made towards improving emergency obstetrics care, it was explained that the government has initiated accelerated midwifery training. This training helps not only in responding to the need in emergency obstetrics care, but also in increasing skilled birth attendants. This in turn means increasing the number of institutional deliveries.

Thursday, June 30, 2011 Adaba Woreda Health Office

The TAC was welcomed by the Adaba Woreda Administration and its health office staff. Ato Tesfaye Wakjira, Woreda Administrator in his welcoming speech informed the visiting group that the Health Extension Program implemented by HEWs has helped bring about significant improvements in reducing maternal, newborn and child mortality in the 24 (especially 22 rural) kebeles of Adaba Woreda. Basic health services being accessible to all has brought about great improvements in health practices of communities. As a result Adaba has been awarded as the best performing woredas in the West Arsi Zone. Nonetheless, there are problems of availability of water, infrastructure (e.g. roads) creating difficulties in transportation, etc.

Ato Jibril Gelemo, Woreda Health Office Head, stated that the Health Office serves a population of 155,264 from among which 32,731 households have graduated as model families. While six health centers provide health services to the population there are 178 health professionals (92 male and 86 female) which includes 46 HEWs. Family planning coverage has reached 40% due to improved behavioral change as a result of community

conversation sessions. HIV/AIDS awareness has also significantly improved through this conversation forum where uptake of VCT services has increased.

Ato Jibril said that there is strong linkage among the Woreda Health Office, Health Centers and Health Posts. Each Woreda Health Office staff is assigned to one Health Center to closely support and supervise. Again Health Center staff are assigned to Health Posts.

TAC members observed that the distance between health centers and health posts is challenging especially considering the breath of kebeles and the distance of each kebele from the Woreda Health Office. The Woreda Health Office informed the TAC that distance between any two health facilities is on average 6 kms. The existence of only two motor bikes in the Woreda does not really help the situation. This challenge becomes more apparent when staff of the Woreda Health Office go out for monitoring and supervision tasks which they state could take a full month to accomplish.

It was commented that training and graduating model households is important not only because it ensures diffusion of beneficial health practices but that it is also a way of ensuring male involvement in family health matters.

The visiting team was then taken around the Woreda Health Office where they visited each office. They also journeyed to the adjacent compound and visited around the Health Center by dropping into the different wards.

Family planning room: in this room two mid-wifery nurses; Sr. Sinkinesh WoldSenbet and Nurse Kebede Abera provide family planning services through the provision of different methods with the exception of IUCD. IUCD method seekers are referred to hospitals. Permanent family planning method has not been in demand so far but should the need arise, this is also referred to hospitals. It was explained that there is a good referral system. Ato Tilahun Giday stated that training the staff in insertion of IUCD is imperative and thus, IFHP will ensure that the Health Center receives this training.

Antenatal room: attached to the family planning room mothers who come for their regular follow up are provided with health education and PMTCT services in the Antenatal room. For mothers tested HIV positive, follow up service is provided. In addition, using the opportunity related services such as child growth monitoring, EPI, etc. services are also provided. Services are integrated to maximize benefits that a mother can get in one visit.

ART room: here clients tested as HIV positive are closely followed especially those who started ART, through a case manager who has direct contact and link with each community. Drug shortage is a problem which the unit faces at times and in such cases they approach nearby health facilities for supplies.

Upon completing the visit around the Health Center, the TAC members then divided into two groups and drove to visit Ejersa and Furuna Health Posts.

Rejoining after their health post visits the two groups provided feedback to the Woreda Administrator and Health Office based on observations they made.

• Encouraging results are seen and this is because HEWs are committed to their work as has been verified by the positive changes households have shown in household cleanness, construction of separate sheds for cattle, usage of latrine, etc. A representative of the Oromia Regional Health Bureau expressed its willingness to continue supporting Zonal Health Department and Woreda Health Office in realizing the Health Extension Program.

• The strong working relationship between the Health Center and Health Posts is very good. The inter-departmental linkage is also commendable, for instance, the linkage between the HIV and family planning units. This has enabled the Health Center staff gain full information and understanding of the work of HEWs. However, HEWs need to be assisted by the Health Center in the provision of delivery services (since they are not trained).

• Working with the Health Development Army is an opportunity which the Woreda Health Office is not using and this needs to be improved in order to widely disseminate practices of the 16 health packages and consequently be able to meet the Millennium Development Goals (MDGs) 4 and 5.

• As observed from visits made to other regions, Woreda Advisory Committees (WAC) are helpful in bringing about desirable changes in health practices. They are influential bodies being a composition of different government sectoral offices, women’s and youth associations, and religious leaders. If Adaba woreda has not yet established such a body it would be advisable to do so and work through the committee.

• Documentation of information is exemplary at all levels: Woreda Health Office, Health Center and Health Posts. The Woreda Health Office has a very good system which starts from a billboard outside the office that displays the strategic mapping of the activities of the Office.

• It would be useful to involve a representative of women’s affairs in the work of the Woreda Health Office. Working with the youth in school and out-of-school is also necessary.

• Improving provision of equipment and materials for services such as EPI at Health Post level appears to be in demand. Refrigerators were not available and this in turn 7

affects the cold chain system considering the distance between health centers within the Woreda. Delivery kits and autoclave were also not available.

• The initiative of encouraging government-NGO relationship was appreciated where not only was the Health Office working with IFHP but with other NGOs such as Save the Children.

• In general, considering the many challenges that existed when the Health Extension Program started it is very encouraging to see today tangible achievements. The support provided by the Woreda Administration and Health Office to HEWs was appreciated.

The Woreda Health Office Head, Ato Jibril Gelemo, appreciating the feedback given by the TAC members said that achievements witnessed today have not been easy to reach but are encouraging because people in the Zone have better awareness of health issues now. IFHP through its Cluster Office staff have helped the Health Office in reaching remote communities and expanding health services. The basis of success is the integration of all government sectors in implementing development programs.

The Woreda Administrator, Ato Tesfaye Wakjira, stated that since the TAC visits the different Woredas and Kebeles in Amhara, Tigray and SNNP regions it would be helpful for Woredas to learn from the experiences of each other. Appreciating the continued support they receive from partners, Ato Tesfaye stated that HEWs, their supervisors and staff of the Woreda work with great commitment. However, it is important to address their problems, such as transportation, which is the most challenging.

Friday, July 1, 2011 Arsi Negelle Health Center, Arsi Negelle

The following day driving to Arsi Negelle, the TAC dropped into the Health Center and was met by Ato Bokona Dhaabaa, Health Officer, who briefly informed the group on the work of the Health Center. Ato Bokona said that the Health Center has six health posts under it and it also has a Youth Friendly Service (YFS) unit. It serves a population of 40,000 in urban areas and 30,982 in rural areas. Some of the common health problems addressed by the Health Center are typhoid, intestinal parasites, pneumonia, diarrhea, etc. Though it addresses problems of malaria, incidents have greatly reduced due to awareness raising work carried out by 12 HEWs who work with the Health Center. As part of its YFS, the Health Center works with youth in-schools and out-of-schools by teaching them about reproductive health. The Health Center also links to Community Conversation sessions of the Kebeles and raises awareness on harmful traditional practices.

The TAC was informed that IFHP provides the Health Center with capacity building training on YFS, family planning/HIV integration, etc. It also provides financial and material support.

The visiting group was informed that while the number of mothers coming to the Health Center for antenatal care services is high only a small number from this deliver at the health facility. The problem is mostly the distance of the Health Center from the center of the town where transportation especially at dark is difficult. There are closer private facilities which mothers prefer to go to or they will be assisted by traditional birth attendants and deliver in their homes. Nonetheless, as compared to previous times the number of mothers delivering at Arsi Negelle Health Center has increased because services provided since a year ago have become completely free of charge.

The greatest challenge of the Health Center is the size of its manpower which is too small to serve the large population in its catchment area. There is shortage of water in the area and this is the reason why problems of intestinal parasites is high and latrine usage is also poor.

Following this briefing the TAC visited around the Health Center and dropped into the family planning, EPI, PMTCT, ART, IMNCI and YFS wards. At the end of its visit the TAC provided Ato Bokona feedback on what they observed.

The TAC observed that child growth monitoring service is not provided in the family planning room; in the EPI section monitoring chart was not available; and registry in the PMTCT Unit was not being filled out properly. These should be improved. Furthermore in the ART Unit although service is given in integration with family planning the existing set up of the office does not allow privacy since a data manger is placed in the same room. Denying clients their privacy is unethical and standard practice needs to be maintained. The Youth Friendly Services (YFS) unit does not have a waiting room and thus, modification to the existing room should be made to facilitate this. The unit was also advised to commence post abortion care services immediately since this is one of the most important life saving services that should be given in any YFS. The visiting group learnt that only a few items are lacking to start the service and IFHP stated that it shall look into this and help commence the service immediately. It was later on noted that the equipment provided is complete but that training on its use should be provided.

It was further commented that the management of the Health Center should meet more regularly in order to improve its services and assess its performance. Since the Health Center is severely under-staffed to serve such a large population, and reason why quality of service is being seriously compromised, the TAC informed Ato Bokona, that the Ministry of Health shall discuss with the Zonal Health Department for ways to resolving this problem.

The documentation system of the Health Center was also seen to be needing improvement and suggestion was made if IFHP could provide support for this.

Commenting on its strengths is was stated that services given in the Integrated Management of Neonatal and Childhood Illness (IMNCI) Unit was said to provide mothers and children utmost benefit through the integration of different health services. This is why 25 children per day visit this Unit (as Sr. Mesert informed the visiting group).

Despite being over-burdened the Health Center’s link to communities was appreciated and it was encouraged to strengthen this.

The cleanliness of the facility was appreciated but being a large facility, trying to maintain this with the help of only two cleaners was seen to be a challenge. The TAC advised that the facility should maximize its benefits gained from the health financing system to improve quality of its services and think about accessibility.

In general, the TAC stated the need for the Health Center to improve its services in becoming more responsive to the needs of clients to become, appealing, and friendly to attract more clients and ensure opportunities are not missed for mothers coming in for any maternal and child health services.

Enga le Enga, Shashemene

The visiting group driving to Shashemene town dropped into Enga le Enga Youth Center and was greeted by Wz. Fetelework. She briefly informed the group how an anti HIV/AIDS club grew and became a youth center. This youth center generates its own income by providing various services which are provided all in one compound on land given by the town administration in support of their work. Today Enga le Enga has set itself as an example encouraging similar youth centers to be established in other towns.

The youth center is run by 14 full time staff and several volunteer youths. Twenty two youth who served as full time staff have left to join university but always return to continue serving as volunteers.

One of the greatest challenges Enga le Enga faces is acquiring funding which is in fact holding back the youth center’s expansion plan.

The TAC member applauded the effort that the young people were making and appreciated the miles travelled from when they were first established. Thus, they were encouraged to keep moving forward, if possible learning from the experience of other countries. Planning to expand their work was commended but advise was given to first review their past success and failures and see how to improve in their new endeavor. Upkeep and maintenance of the youth center was also stressed as an important measure that needs to be taken immediately and if assistance is required IFHP could help if requested. Leaking roof and damaged ceiling of the main building was observed during the visit

The TAC Quarterly Meeting The TAC concluded its two and a half day visit by getting together for its quarterly meeting.

Minutes of the last TAC Meeting A summary overview of the minutes of the last TAC visit made to Tigray Region, Eastern Zone and held from March 30 – April 01, 2011 was given. This was then followed by discussing matters arising from the minutes.

Referring to the section “The way forward”, appreciation was expressed that according to the suggestion given at the last TAC visit on minimizing number of sites visited, this has indeed been realized with the current visit. TAC members felt they had enough time to visit, discuss and give feedback at each site they visited. Referring to the attendance of TAC members, it was appreciated that almost all were attending on this visit.

The representative of the Ministry of Health reported that following the last TAC visit to Mekelle Hospital, where the Cervical Cancer Prevention (CCP) project supported by the Center for Disease Control/PEPFAR and implemented by Pathfinder was visited his office is now discussing the issue of scaling up cervical cancer prevention services to many more hospitals around the country.

It was suggested that progress on decisions made at past meetings be reported. Regarding the layout of the report, suggestion was made that the cover page be in full color.

As an encouragement to partners visited, suggestion was made to invite people in whose honor the previous TAC visit was named to subsequent TAC visits. The idea was supported by the TAC members.

With these suggestions and comments the previous TAC minutes was approved.

Presentation of quarterly report A presentation on IFHP’s achievements during the last quarter (January – March 2011) was made. The TAC members then raised certain questions and discussion followed.

‘Under’ and ‘over’ achievement of activities which was observed from the presentation of the report was explained to be a result of unforeseen circumstances occurring or IFHP using opportunities (which were not planned for). It was noted that government priorities also affect implementation of IFHP’s plan, which could mean cancelling planned programs. Internal problems of staff turnover also were said to affect performance. However, these are only quarter performances and adjustments will be made in subsequent quarters to achieve the annual plan.

On the subject of CCP it was reported that out of 99 HIV positive women tested the finding for 20 women was abnormal. In response to a question for clarification of the term ‘abnormal’, it was explained that this refers to cervix that displays tissues that are about to be cancerous. It was however, suggested that the expert on the subject be present at the next TAC meeting to give full information.

Raising the issue of IFHP follow up activities as compared to the Integrated Supportive Supervision (ISS), it was explained that ISS is a government initiative which IFHP supports financially and technically. However, IFHP’s follow up program starts from visiting household at random and goes all the way up to Woreda Health Office aiming to ensure appropriate implementation of capacity building support it has provided and observe impact resulting from these efforts.

Responding to queries on research undertaken during the quarter, it was stated that IFHP has provided research method training for the four regional health bureau staff in its operational areas and for IFHP staff as well. The training was given by School of Public Health which will closely follow up actually research work to be carried out in 2012. It was stressed that utilizing the skills learned will be important and IFHP will work to encourage undertaking research activities in operational and program areas.

Replying to a question on how contraceptive distribution is carried out, it was said this is need-based and thus supplied to where the need has been identified. Follow up of usage is identified during stock out monitoring and from reports of contraceptive requesting organizations.

A TAC member noted that records at health facilities of new clients for family planning users are not correctly entered because there appears to be confusion between clients revisiting and clients coming for the first time. It was therefore suggested that the Ministry of Health should work on clarifying and correcting this matter. Nonetheless, one possible reason for such confusion was said to be inconsistent HMIS. HMIS has not yet been standardized and IFHP is providing training on the new HMIS. Once this is rolled out it is hoped that documentation will improve.

In relation to a question on IFHP’s budget allocation to its regional offices, it was stated that IFHP has made regional budget allocation but for the sake of concise presentation, only the total amount was mentioned in the presentation.

Suggestion from TAC members were given on the establishment of a Woreda Advisory Committee (WAC) in West Arsi Zone since at their last visit to Tigray, they have observed that the WAC is instrumental in promoting health issues. The TAC was informed by IFHP that WACs are established based on the willingness and readiness of Woreda’s to work through such committees. Thus, if there is a strong need IFHP will look into the matter and see if there is need for establishment of WAC. 12

Discussing the issue of NGO mapping in the regions and their performance the TAC recommended that the Ministry of Health look into this issue especially in terms of comparing performance of non-IFHP implemented areas to IFHP implemented areas in integrating programs for better provision of health services. It was however, stressed that not all NGOs are mandated to carry out integrated programs and thus, consideration should be made of this fact. Taking this into consideration, TAC members stated that NGO mapping will help to see the larger program of how national development goals are met and IFHP’s contribution towards that and encouraged that it be undertaken.

Impressions on the field visit Participants were then invited to state their impressions of the two and a half day field visit which they gave as follows:

• It is important to invite higher government officials such as Zonal Administrator and/or head of Health Department to the TAC meetings so joint discussions could be made.

• It was impressive to see how IFHP works jointly with the Zonal Health Department since this has resulted in the exemplary performance of the Adaba Health Center.

• Arsi Negelle Health Center needs to improve its service provision, manpower staffing and capacity building of existing staff by working through its management committee which appears to be either weak or non-existent. It would also be beneficial to include post abortion care services for the youth within the Youth Friendly Services.

• The work of the TAC should be documented as one of the best practices and disseminated to others to encourage replication. It would also be useful to organize one dissemination forum annually. Furthermore, to motivate TAC members, it would also be useful to organize experience sharing visits outside of the country.

• It would be helpful for Woredas to also share the experiences with each other so as to scale up successful approaches. For instance, Arsi Negelle can learn from the practice of other woredas and health centers.

• While the impact of IFHPs effort is visible at household level, there are also gaps at health post level which need to be addressed. For instance, there are health posts that do not provide delivery services.

• Looking back to the time when Community Based Reproductive Health Agents (CBRHA) had to work with HEWs, there were numerous challenges. Today most of

these have been overcome. Now working with the newly established Development Army is a priority that Woreda Health Offices are very much encouraged to use.

Naming of the trip Upon conclusion of the meeting participants discussed naming the trip after an exemplary or impressive project or individual they observed, as is usually done with each TAC trip. Certain suggestions were proposed and these were: • Sr. Meseret from Arsi Negelle who had enthusiastically briefed the TAC on the IMNCI and YFS services given at Arsi Negelle Health Center; and • Adaba Woreda for its commendable overall performance the results of which were obvious at household level. However, it was finally decided that Adaba Woreda be honored with the naming of the trip. The Woreda Administration closely working with the Woreda Health Office has several exemplary practices of which its documentation system and its close link to health posts and households came out as the strongest. Thus, the trip was named ‘Adaba Woreda Trip’.

Next TAC visit and meeting The TAC members then agreed that as per their already developed annual calendar, the next meeting should be held in three months time in September in SNNP region. Details as to specific areas to be visited and specific dates will be communicated to members of the TAC well in advance by IFHP.

Any other business • Inclusion of legal bodies in Woreda Advisory Committees Following a suggestion given at the last TAC meeting held in March, on the inclusion of legal bodies in the composition of Woreda Advisory Committees the meeting was informed that IFHP will discuss the matter with its regional offices.

• Appreciation Ato Mesfin Negussie, IFHP Oromia, Regional Program Manger expressed sincere appreciation of each TAC member for the commitment they have shown during the visit. The critical observation they made and comments they gave are most helpful in improving the program. The revitalized committee is already providing valuable support and he assured them that their suggestions and recommendations will be followed through.

ANNEX I COMMITMENT FOR CHANGE

Adaba Woreda is found in West Arsi Zone of Oromia Region and has a population of 159,767. There are six health centers and twenty health posts in the woreda which provide health services. Two more health posts are under construction. Through these health facilities health services have become easily accessible to the population. Linkage between health facilities and communities has greatly improved and this has resulted in increased awareness on accessing quality health services. As a result of such behavioral changes families now utilize health services provided by health facilities more frequently.

There are 46 Health Extension Workers (HEWs) serving in 22 rural kebeles and 4 HEWs serving 2 urban kebles in Adaba Woreda. Moreover there are 4 urban health extension professionals. The HEWs help in bringing basic health services closer to communities and teaching beneficial health practices.

As a result maternal and child health have improved in terms of increased EPI, growing number of family planning users and more mothers following up antenatal care, post natal care including delivery services. Positive changes in sanitation are evident in terms of improved coverage and utilization of latrine and reduced diarrheal disease. There is better awareness of the transmission and how to control communicable diseases such as tuberculosis, HIV/AIDS, etc. In addition, communities now work in the disarmament of harmful traditional practices. Religious leaders play a significant role in all of these as they work with HEWs in raising awareness on health issues and on matters of ending harmful practices.

Adaba Woreda Health Office Head explains the strategic mapping of the activities of the Office displayed on a billboard in the local language

Adaba Health Center in particular has a strong health system where health posts and health centers are closely linked in their work creating exemplary primary health care units. Furthermore, the inter-sectoral collaboration among the different sector office and support provided from the administrative office is commendable. The Health Center monitors its performance periodically and its management and use of health data, from woreda health office to the health post level, for decision making are among its impressive and strong qualities.

Consequently, Adaba Woreda is one of the exemplary Woredas in West Arsi Zone. The health extension program is applied in almost all its kebeles and in each kebele strong primary health care units have been established. The majority of kebeles have functional health posts. Thus, health practices at household level have reached remarkable stages. The Woreda Health Office also undertakes strong monitoring and evaluation activities to ensure that result sustain.

In recognition of its achievements Adaba Woreda has been awarded a computer and a motor bike from the Regional Health Bureau and a certificate of appreciation from the Zonal Health Department. The Woreda has also hosted various experience sharing visits.

While all individuals found at the different levels have helped bring about this achievement, the

Woreda Administrator, Ato Tesfaye Wakjira; Woreda Health Office Head, Ato Jibril Gelemo; Woreda Health Office Deputy Head, Ato Ahmed Aman; and BPR Focal Person, Ato Assefa Gire, deserve special appreciation for the effort they made in positively reversing the health situation in Adaba Woreda.

ANNEX II

THE VISIT (in pictures)

TAC members wishing the best for Enga le Enga Youth Center

IFHP Cluster Office Coordinator at Shashemene briefing on IFHPs work in West Arsi Zone to the HEWs have built confidence over the years and a healthy relationship with TAC Volunteers thus bringing about positive health impacts in their communities’

Health provider and her client at Arsi Negelle Health Center

TAC members and Woreda and Kebele Officials making a visit to a household