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Rapid Assessment of Factors for Access to Malaria Prevention and Control Interventions Among Migrant Workers in Seven Regional States of Ethiopia

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Rapid Assessment of Factors for Access to Malaria Prevention and Control Interventions Among Migrant Workers in Seven Regional States of Ethiopia RAPID ASSESSMENT OF FACTORS FOR ACCESS TO MALARIA PREVENTION AND CONTROL INTERVENTIONS AMONG MIGRANT WORKERS IN SEVEN REGIONAL STATES OF ETHIOPIA Private Health Sector Project The Private Health Sector Project is a technical assistance project to support the Government of Ethiopia. The Private Health Sector Project is managed by Abt Associates Inc. and is funded by the United States Agency for International Development (USAID), under Contract No. AID-663-LA-16-00001 Recommended Citation: Rapid Assessment of Factors for Access to Malaria Prevention & Control Interventions Among Migrant Workers in Seven Regional States of Ethiopia, April 2017, Ethiopia. Bethesda, MD: Private Health Sector Health Program, Abt Associates Inc. Submitted to: Dr. Mesfin Tilaye: Agreement Officer’s Representative, Health Network Program Advisor USAID| Ethiopia Addis Ababa, Ethiopia Submitted by: Dr. Mesfin Teferi, Chief of Party USAID| Private Health Sector Project Abt Associates Inc. | 4550 Montgomery Avenue | Suite 800 North |Bethesda, Maryland 20814 | T. 301.347.5000 | F. 301.913.9061 www.abtassociates.com | RAPID ASSESSMENT OF FACTORS FOR ACCESS TO MALARIA PREVENTION & CONTROL INTERVENTIONS AMONG MIGRANT WORKERS IN SEVEN REGIONAL STATES OF ETHIOPIA 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 CONTENTS Acronyms and Abbreviations ................................................ iii Acknowledgments ................................................................... v Abstract .................................................................................... 1 1. Introduction ......................................................................... 3 2. Study Background ............................................................... 5 3. Objectives............................................................................. 7 3.1 General Objective ........................................................................... 7 3.1.1 Specific Objectives ............................................................. 7 4. Methodology ........................................................................ 9 4.1 Study Design ..................................................................................... 9 4.2 Study Area and Period ................................................................... 9 4.3 Study Population .............................................................................. 9 4.4 Sampling and Sample Size ............................................................ 10 4.5 Data Collection Tools .................................................................. 11 4.6 Data Quality ................................................................................... 11 4.7 Data Processing and Analysis ..................................................... 11 4.8 Operational Definition ................................................................. 12 4.9 Ethical Considerations ................................................................. 12 5. Results ................................................................................ 13 6. Recommendations............................................................. 29 7. Concluson ........................................................................... 31 Annex A: Information Sheet ................................................ 29 Annex B: የየየየ የየየየ ........................................................ 37 Annex C: Bibliography .......................................................... 57 i List of Tables Table 1: Malaria Incidence Per 1000,000 Population At Risk in 2016 (FMOH 2015/16) .....................................................................9 Table 2: Number of Organizations and Their Respondents, and Key Informants by Region, Zone and Wereda, September 2016................................................................................... 10 Table 3: Summary of Themes and Subthemes in Reporting the Findings of the Study ........................................................................... 13 Table 4: Still needs Title ............................................................................. 16 Table 5: Size of Migrant Workers by Sex Employed in the Different Types of Business Categories in Seven Regions in Ethiopia, October 2016 ..................................................................... 16 Table 6: Size of Permanent and Long Term Employement in Seven Regional States of Ethiopia, October 2016 ....................... 17 Table 7: Mapping of Seasonal Migrant Workers by Destination and Origins in Seven Regional States of Ethiopia, October 2016....................................................................................... 50 Table 8: Personnnel Assigned to Collect Data ..................................... 55 List of Figures Figure 1: Number of Major Business Categories Which Employ Migrant and Mobile Workers in Ethiopia, October 2016 ......... 14 Figure 2: Size of Migrant Workers by Destination Weredas, October 2016....................................................................................... 15 ii ACRONYMS AND ABBREVIATIONS ACT Artemisinin Combined Therapy ANRS Amhara National Regional State ARS Afar Regional State BGNRS Benishangul Gumuz National Regional State CQI Continuous Quality Improvement FMOH Federal Ministry of Health IOM International Organization for Migration IRS Indoor Residual Spray ITN Insecticide Treated Nets LLIN Long Lasting Insecticide Treated Nets MOP Malaria Operational Plan ONRS Oromia National Regional State PFSA Pharmaceutical Fund and Supply Agency Pf Plasmodium falciparum PMI President’s Malaria Initiative PPM Public Private Mix Pv Plasmodium vivax RDT Rapid Diagnostic Tests RHB Regional Health Bureau SNNP Southern Nations Nationalities and Peoples SNNPRS Southern Nation Nationalities and peoples Regional State THO Town Health Office TNRS Tigray National Regional State USAID United States Agency for International Development WHO World Health Organization iii ACKNOWLEDGMENTS We would like to express our sincere gratitude to Afar, Amhara, Benishangul Gumuz, Gambella, Oromia, Southern Nations, Nationalities and People (SNNP) and Tigray Regional States Health Bureaus for their endorsement of this formative assessment. We are also thankful to all the respondents for their invaluable time and sharing us their opinions. v ABSTRACT Background: Mobile or migrant workers are at a higher risk of acquiring malaria infection, and can be the primary source of reintroduction of the disease in unstable transmission areas. The aim of this formative assessment is to describe access to malaria prevention and control services among migrant and mobile workers in seven regional states of Ethiopia. Methods: A prospective cross-sectional, exploratory and descriptive study was conducted from August 11 through October 12 2016. Interviewer-administered questionnaires, semi structured key informant in-depth interviews, and content analysis was used to gather the information to describe access to malaria prevention and control interventions among seasonal migrant workers. The qualitative data were analyzed through four themes and thirteen subthemes. Results: The study included 58 organizations that employ seasonal migrant workers and 23 key informants. In addition, secondary data were collected from sector offices including departments for Agriculture, Mining, and Investment in the study regions. The results show that there are about one million seasonal migrant and mobile workers working for different business categories which include large scale crop cultivating farms (sesame, sorghum, ground nuts, and soy beans), sugar cane plantations, horticulture, road and house construction works, and gold mining and panning. Both bidirectional and circular movement of migrant workers was documented. Seasonal workers employed in sugar plantations, horticulture, and floriculture crop production move from their origin to current employers’ locations for longer periods of time (October through June). While seasonal migrant workers who were employed in crop cultivation (sesame, soya bean, sorghum, maize, groundnut, etc.) move to and from their origin and destination locations for a shorter periods (June through November) but their movement is circular and during the high transmission season. Moreover, these workers frequently change employers within destination woredas. Housing facilities vary based on employment relationship. Relatively well-structured houses are constructed for permanent and long-term staff. Unfortunately, the housing structure for seasonal migrant workers is poor and over-crowded, making the risk of acquiring malaria high. Seasonal migrant workers spend the whole night in the field when employment includes watering farm lands, harvesting sesame, and transporting sugar cane from the field to factories. Moreover, the routine malaria prevention and control activities do not target these seasonal migrant workers. Government-owned large scale farms and construction sites offer basic health services to all seasonal migrant workers. Unfortunately, the majority of migrant workers who are employed with private farms are not offered basic health services and seek care from public health facilities such as health centers and health posts, as well as private health facilities. Some of the efforts made by the regional state health bureaus to improve healthcare for the workers include
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