IFHP Integrated Family Health Program

Yebeteseb Mela Volume 9, No. 2, April-September 2013 Holy Synod Declares Commitment for Safe Motherhood ADDIS ABABA - The Ethiopian Orthodox Tewahedo Church (EOTC) disclosed its support and partnership for safe motherhood and reproductive health programs in the country during its annual PHOTO conference on June 5, 2013.

The Holy Synod of EOTC expressed its support by passing a ten-point resolution on safe motherhood, reproductive health, and gen- der equity. His Holiness Abune Mathias, the 6th Patriarch of the Ethiopian Orthodox Tewahedo Church, handed over a resolution embalmed with photo frame to His Holiness Abune Mathias and partners Ministry of Women, Youth and

Cont. on page 5 USAID High Ranking Officials Visit the Ethiopian Health Extension Program

Inside this issue:

Editorial Viewpoint 2

Technical Updates 4

Stories from the Field 8

Visitors listen to explanation about the family health card at Haro Jila Health Post Honourable guests Mr. Alex Thier, Mission, paid a visit to Haro Jila Fulsa Assistant Administrator of the Policy, Health Post and community in Sebeta Planning and Learning Bureau of Hawase Woreda of Oromia Region. USAID/Washington and Mr. Dennis The visit, which took place on July Weller, USAID/Ethiopia Mission Direc- 27th 2013 aimed at learning about the tor, joined by Dr. Yirga Ambaw, Health Ethiopian government Health Exten- Specialist and CTO at USAID Ethiopia sion Program (HEP) and the contri- Cont. on page 4 EDITORIAL VIEWPOINT Committee Admires Improving Efficiency and Effectiveness of IFHP Support in In-service Trainings Fistula and Youth Human resources are the most important assets of a health system. For Friendly Services health institutions to function effectively and efficiently, a well-trained and GONDAR - The Technical Advisory motivated health workforce must be produced, deployed, maintained and Committee (TAC) of IFHP visited appropriately utilized. Developing capable, motivated workers is essential program implementation in Gondar to overcome bottlenecks hindering the achievement of national and global cluster office on April 22-25, 2013. health goals. Welcomed by Dr. Mengistu Asnake, The health policy of Ethiopia emphasizes the training of community-based Chief of Party of IFHP and Country task-oriented frontline and mid-level health workers. In response to the Representative of Pathfinder Inter- policy, health professional training institutions have expanded continuously national-Ethiopia, the committee vis- as have health facilities resulting in improved access to health services. ited beneficiaries in the health sector However, in order to ensure the continuity of quality health services, health as well as community households. professionals need to be continuously updated, refreshed, and introduced During discussions after field visits, to innovation. Capacity building in-service trainings play a great role in this TAC members commended IFHP for regard and represent a significant proportion of investments made by the its integrated approach to promote Ministry of Health and development partners. health, particularly the achieve- ments gained so far in improving The government and implementing partners like IFHP are trying to boost fistula case identification and man- the knowledge, skill, attitude and confidence of frontline and mid-level agement and strengthening youth health professionals working in primary health care units (PHCUs). How- friendly services at health centers. ever, reaping the benefits from in-service trainings that is worth the invest- “IFHP’s principle is strategically well ment has been challenged by many factors. In-service training programs, designed to implementing activities for example, sometimes fail to balance competency development with at the grass roots level,” committee potential disruption to service provision due to staff absenteeism. There members explained and added that are also a number of other aspects of in-service training that dwindle the IFHP’s strategy is sustainable and lays benefits that can be harvested from it. These include among others mis- the corner stone to attain positive placement of staff after training, immediate exit or attrition of staff after impacts in changing the life of com- training, repeated appearance of the same individual in similar trainings, munity members. Dr. Mengistu on unfair recruitment of trainees and favouritism, and limited participation of female health workers with the exception of HEWs. The latter could be his part said, “IFHP’s work has shown partly because the health work force in Ethiopia is predominately male results due to the strong government (AHWO, 2010). structure. IFHP makes every effort to fill gaps in the implementation of key These call for the need to taking steps to maximize the benefit from in-ser- interventions to reduce maternal and vice trainings. For instance, encouraging steps are being taken by the MOH child mortality in the country.” and its partners by providing Integrated Refresher Training (IRT) for Health Extension Workers (HEWs) to save the financial and time resources needed The TAC has members from various to do separate refresher trainings. Similarly, providing on the job trainings government sector offices and pro- and service delivery based trainings serve the same purpose. In line with vides technical support and guidance this notion, IFHP has been providing service-based trainings to PHCU staff through field visits and consulta- including HEWs with dual benefits: the health professionals get skill based tive meetings that take place every training, and at the same time, quality services are rendered to the com- quarter. munity under the supervision of the trainer. IFHP has also always been cau- tious in allowing fair participation of women as trainers and trainees.

Addressing the issues indicated above in a coordinated and standardized manner by actors working at all levels within the health system is very crucial. Doing so not only helps maximize the benefit of in-service trainings but also directly contributes to the achievement of the health related Mil- lennium Development Goals of the country. Producers and Editorial Committee: Dr. Kidest Lulu Dr. Tesfaye Bulto Dr. Hibret alemu Solomon Abebe Tariku Nigatu Salem Melaku 2 The Third African Immunization Week Commemorated

IFHP’s van mobilizing the community for vaccination along side the running race that was part of the commemoration ASELLA - The commemoration of the portance of immunization, broaden level social mobilization and pro- third African Immunization Week the culture of disease prevention vided vaccination to eligible chil- was launched at Asella Town, Arsi and control through vaccination, dren. Consequently, close to 25,000 Zone of Oromia Region, from April and provide vaccination services to children received vaccination against 24 to May 4, 2013, with the theme vulnerable populations. 10 vaccine-preventable diseases. “Vaccinate, Save Life, and Prevent The African Immunization Week is Disabilities!” The initiative, which IFHP, as one of the child survival believed to have strengthened the was launched in the presence of high partners, assisted in organizing the commitment of health managers to- level officials from the Ministry of event at different levels and pro- wards the reduction of child mortal- Health, Oromia Region, zones, and vided technical, financial and logis- ity and provided a unique opportu- woredas as well as distinguished tic support throughout the event. nity for improving local, regional and delegates from WHO-AFRO, UNICEF, Following the official launching, Arsi national immunization coverage. USAID and development partners, Zonal Health Office in collaboration aimed to raise awareness on the im- with IFHP conducted community

World Population Day Celebrated

ASSOSA- The Population Affairs Directorate of the Ministry of Finance and Economic Development, in collaboration with IFHP and other partner organizations celebrated the World Population Day in Assosa, Benishangul Gumuz Regional State.

The 2013 the World Population Day was celebrated under the international theme of Focus is on Adolescent Preg- nancy.

In connection with the event, IFHP organized a media orien- tation for journalists and facilitated mass walk to increase community awareness in preventing adolescent pregnancy.

3 Technical Updates

Strengthening Partnership to Promote Skilled Birth Attendance

Film show at night in Afar Region to promote skilled birth attendance Safe Motherhood Campaign is as posters and brochures distributed education about the importance of organized and coordinated by the to health facilities and communi- antenatal care, skilled birth attend- FMOH on a yearly basis to pro- ties. IFHP, in addition to actively ance, and postnatal care. Those who mote skilled birth attendance at participating in the activities of the watched the movie, expressed their health facilities and contribute taskforce, deployed its audio visual interest to learn more about skilled to the reduction of maternal and vans to show the filmed drama pro- birth attendance and pledged to use newborn mortality. IFHP has been duced for community mobilization, the services available in their re- actively participating in the Safe reaching over 76,000 population in spective areas. Woreda and health Motherhood Campaign annually. hard-to reach and pastoralist areas center staff on their part expressed The campaign task force, chaired by of Afar, Somali, Benishangul, Oromia, their dedication to do their best to the FMOH, prepared promotional Amhara and Tigray regions. After the promote skilled birth attendance and materials for television and radio, film shows, woreda health office and assist families to use the service. filmed dramas for community mobi- health center professionals used lization and printed materials such the opportunity to provide health

USAID High ranking Officials... Cont’d from Page 1 bution made by the United States brought access to and availability In subsequent visits to health posts Government to make this initiative of essential primary health services and households, the visitors learned successful. Dr. Hibret Alemu, Deputy closer to communities. He under- that families have become adher- Chief of Party and Technical Direc- scored that USAID is one of the ent users of health services. When tor of IFHP and Mr. Mesfin Nigussie, close allies who provided immense concluding the visit, Mr. Weller said IFHP’s Oromia Regional Program financial, logistics and technical that he has witnessed the excellent Manager, welcomed the distin- assistance through its programs relationship that USAID has with guished guests and made introduc- and expressed his wishes that this implementing partners and the tion of the woreda officials and strong tie and assistance will con- government and that resources are community representatives. tinue. being used effectively to save and The visiting team also listened to improve lives. The Woreda administrator remarked a presentation about the concept, that Ethiopia has shown significant principles and structure of Ethiopia’s improvement in health since the primary health care unit and IFHP’s inception of the HEP which has contribution to the health system.

4 Technical Updates

Integrated Supportive Supervision in Tigray There are several partners supporting the health zone administration offices. The teams record best system in Tigray Region. Before the revitalization of practices within their assigned area and report to the partners’ forum two years back, the coordination the different levels of the health system. Following of different programs among different partners in the compilation of the ISS findings at regional level, the region was poor resulting in duplication of -ef best and weak performing facilities are identified. To forts . Taking this situation into account, the regional help learn both from the failure and success, videos health bureau (RHB) took the initiative to strengthen are recorded and shared with all the facilities and relationships and harmonize efforts among part- woredas within the region during regional bi-annual ners. Since the revitalization of the partners’ forum, review meetings and several other occasions. In a regional health partners’ consultative committee Tigray, ISS has become a regular activity of the health was established and several steps were taken to system and it is conducted twice a year. strengthen the health system. Part of these steps was engaging all partners in joint planning, implementa- The lessons learned in carrying out ISS have proved tion, monitoring and evaluation of health programs to be worthy of sharing as they have contributed to including conducting integrated supportive supervi- improvements in the overall performance of health sion (ISS). programs of the region. Some of the regional level achievements include: significant increase in institu- The ISS in the region has been a regular bi-annual tional delivery from around 10 percent to nearly 50 activity for the last two years. At the initial step, a percent, increase in EPI coverage to 99 percent (as re- checklist was revised and enriched by RHB experts ported from survey in Eastern Zone), improved cover- and partners for use during ISS. Each ISS session age of family planning and maternal health services, targets all the 14 public owned hospitals, 210 health attractive health facility environment, strong health centers, one health post under each visited health development army, improved community participa- center and members of the community and women tion and increased commitment of health workers development army. To cover all these facilities, it and political leaders. Many model health centers takes three weeks and involves 12 to 13 teams with have demonstrated nearly 100 percent institutional 6-7 members per team. In addition to sending their delivery within their catchment areas. staff to take part in ISS, partners mobilize vehicles and financial resources to cover related expenses. IFHP’s Tigray regional office, through the gener- ous support of the people and government of the Before the teams go to the field, they receive a one- United States of America, has been promoting strong day orientation on some technical details and ap- partnership in the region since its establishment. In proaches on how to carry out the task. Depending on addition to its role in different committees under the the findings, members of the teams provide technical partners forum, IFHP has supported four ISS sessions assistance on the spot at each of the visited facility, by deploying technical staffs and vehicles and by cov- and debrief both woreda health/administration and ering part of the expenses.

Holy Synod... Cont’d from Page 1 Children Affairs, IFHP, FMOH, UNFPA IFHP provides financial and tech- The conference was attended by and USAID. The resolution is meant nical support to “Promoting Safe member archbishops of the Holy to show the Church’s commitment Motherhood and Reproductive Synod, representatives of Ethiopian and determination to teach its fol- Health through the Teaching of Orthodox Church Development and lowers concepts of maternal, child, EOTC” Project implemented by Inter Church Aid Commission (EOC and reproductive health issues as EOTC. The project has developed a - DICAC) and civil society organiza- well as gender equality in accord- detailed and feasible guidelines and tions. ance with the scriptures. resolutions on safe motherhood, reproductive Health, and gender.

5 Technical Updates Assessing the Contribution of ICCM on Quality of Malaria Case Management

A HEW assessing a sick child in West Hararghe Zone Implementation of integrated community case man- The overall assessment indicates that a significant dif- agement (ICCM) was initiated two years ago to create ference exists between ICCM implementation woredas access to curative services for major under-five child- and non-ICCM woredas with regard to quality of malar- hood illnesses in rural communities by building the ia case management. Regarding correct administration capacity of health extension workers (HEWs). Malaria of the Coartem, 94% and 86% of HEWs in ICCM and case management was part of the ICCM training for non-ICCM woredas responded correctly on the number HEWs. Though observation show that service utiliza- of days and daily schedule of drugs. Nonetheless, the tion for under five has improved tremendously at the percentage of correct length of days of treatment and supported health posts, it was found necessary to as- daily schedule were found to be much better in the in- sess the contributions of this intervention in improving tervention woredas (98% and 95%) when compared to the quality of malaria case management by HEWs. The control woredas (89.9% and 76%). With regard to coar- objective of the assessment was to verify the contri- tem and chloroquine administration, higher percentage bution of ICCM intervention in improving the quality of correctly identified number of days and daily sched- of malaria diagnosis and treatment at health posts in ule were reported by HEWs from intervention woredas West Hararghe Zone, Oromia Regional State. when compared with comparison woredas. The correct administration of anti- malaria drugs showed signifi- IFHP conducted facility-based study in West Hararghe cant association with ICCM implementation. Zone by selecting 90 health posts from intervention areas and 80 health posts from comparison woredas Furthermore the study showed that the HEWs in in- through multistage sampling technique. Descriptive tervention woredas have better knowledge on correct statistics and bivariate analyses were performed. A fre- administration of coartem (P=0.029) and chloroquine quency distribution and cross tabulation (chi-square) (P=0.001) when compared with their counterparts. statistical analyses were also carried to understand the When records for five recent malaria classifications difference in malaria case management between inter- were inspected, the quality of malaria case manage- vention and control areas. ment was found to be much better in kebeles with 6 Technical Updates ICCM trained HEWs when compared to those with no case management at health posts. ICCM training. IFHP has produced a detailed report on the findings of Hence, ICCM training and availability of service delivery this assessment and the findings will be published in a standard (particularly ICCM chart booklet) were inde- scientific journal. pendent predictors for improved quality of malaria Expanding Youth Friendly Services to New Universities

(L) Peer educators practic- ing sharing of sexual and reproductive health messages through role play

IFHP has been implementing adolescent and youth which are availed in the waiting areas of the clinics. sexual and reproductive health (AYSRH) activities in various universities in order to avail sexual and repro- Most importantly, IFHP provides training to selected ductive health (SRH) information, services and com- students, both female and male, to help them become modities. Before implementing program activities, peer educators in sexual and reproductive health as IFHP conducts a rapid assessment on the SRH and gen- well as HIV prevention. The peer educators, in addition der situation of the universities selected for support. to sharing SRH information with their peers, coordi- Subsequently, it organizes a one day conference for nate welcoming events to newly enrolled students the university officials, academic and administrative through coffee ceremonies. At these events, students staff, and students to present the findings of the rapid learn from each other through various activities such assessment and introduce IFHP’s current initiatives. By as literature and drama, making the learning environ- the end of the conference, an action plan to improve ment also a fun place to be. IFHP also provides limited the SRH services at universities is developed. financial assistance to needy students and important materials such as sanitary pads, cleaning items and University clinics play a crucial role in providing AYSRH stationery to girls who cannot afford to buy them. IFHP and HIV services to students. IFHP helps these clinics has been supporting Mekelle, Hawassa, Adama, Dilla, by training the care providers on sexually transmitted Jijiga, and Medawolabu, universities, and recently, diseases, post abortion care and youth friendly ser- has expanded these AYSRH activities to emerging vices. Additionally, the program supports the clinics by universities such as Adigrat, Wachemo and Woldiya. providing the relevant equipment and furniture as well The universities, after having received the package of as consumable and supplies such as pregnancy testing assistance from IFHP, have pledged to use the material kits and emergency contraceptives to the student clin- and the technical support fruitfully. ics. Students get the opportunity to read information and communication/behavioral change communica- tion (IE/BCC) materials and watch educational films 7 Stories from the Field Bringing Curative Services Close to Families

Investing in people for improved family health

The Integrated Family Health Program (IFHP) is a five year (2008-2013) USAID-funded program that is implemented by Pathfinder International (PI) Ethiopia and John snow, Inc (JSI). IFHP supports US- AID/Ethiopia’s strategic objecitve of “investing in people” with the overall goal of creating and consolidating functional and effective network of well integrated family health services to communities within the framework of the primary health care unit and more specifically the Fatuma getting treatment for her sick child at Chafe Benti Health Post, West Hara- health extension program. IFHP is rghe Zone, Oromia Region implemented in the four large re- Fatuma Yusuf, a mother of two, lives in Chafe Banti Kebele in West Hararge Zone. Her gions of Ethiopia: Amhara, Oromia, 18 month old daughter, Ekram Abrahim got treatment for diarrhea at Chafi Banti Health SNNPR and Tigray. Post, which is a 10 minute walk from where Fatuma lives. In the past, families in Chafi Banti Kebele travelled for three hours on foot or, when they could afford, paid ten Integrated Family Health Program birr to mini vans to get to the nearest health centers. However, since health extension workers began providing curative services for under-five children, the situation has Tel. +251 11 320 3501 improved. Fatuma says, “Thanks to the government that there is a health post near our P.O.Box 12655 houses. We do not have to travel long distances or pay for transportation to reach the Nefas Silk Lafto Sub City nearby clinic and we do not pay for treatment of medicine”. Kebele 05

The two health extension workers at Chafe Banti Health Post have attended the inte- Del Gebeya Area grated community case management (ICCM) training provided by the USAID-funded Addis Ababa, Ethiopia Integrated Family Health Program in collaboration with West Hararghe Zonal Health Desk. Volume 9, No. 2, When Fatuma came to the health post to get treatment for her daughter who suffered April-September 2013 from diarrhea for three days, Yenensh Gugsa, one of the HEWs, assessed the little girl and gave the appropriate treatment. Then she advised the mother to administer the drug as prescribed and to come back the next day for follow up. Fatuma describes, “It would have been difficult for me to take my child to the distant health center for treat- ment, let alone for check up. But now that the health post is very close to where I live and my child could get treatment and medicine, I came on the appointment day so that the HEW will examine my child and tell me the progress. Ekram has recovered from her illness after she got the treatment. She has no diarrhea or dehydration anymore. But I will continue to give her the drug for ten days as advised by the HEW.”

IFHP has supported the Ethiopian government train, mentor and equip more than 11,000 HEWs on ICCM to enable them to provide quality case management services to sick children at health posts.

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