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FACTORS AFFECTING UTILISATION of —PMTCT“SERVICES in EAST WALLAGA ZONE of OROMIA REGIONAL STATE, Ethiopia

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FACTORS AFFECTING UTILISATION of —PMTCT“SERVICES in EAST WALLAGA ZONE of OROMIA REGIONAL STATE, Ethiopia FACTORS AFFECTING UTILISATION OF —PMTCT“SERVICES IN EAST WALLAGA ZONE OF OROMIA REGIONAL STATE, Ethiopia Basha Namomsa Aga Oromia /Ethiopia 44th International course in Health Development September 24, 2007 œ September 12, 2008 KIT (Royal Tropical Institute) Development Policy and practice/ Vrije Universiteit Amsterdam i FACTORS AFFECTING UTILISATION OF —PMTCT“SERVICES IN EAST WALLAGA ZONE OF OROMIA REGIONAL STATE, Ethiopia A thesis submitted in partial fulfilment of the requirement for the degree of Master in Public Health By Basha Namomsa Aga Oromia / Ethiopia Declaration: Where other people‘s work has been used (either from a printed source, Internet or any other source) this has been carefully acknowledged and referenced in accordance with departmental requirements. The thesis Factors affecting Utilisation of —Pregnant Mother to Child Transmission of HIV“ services in east Wallaga Zone of Oromia regional state, Ethiopia is my own work. Signature _____________ 44th International Course in Health Development (ICHD) September 24, 2007 œ september 12, 2008 KIT ( Royal Tropical Institute)/ Vriji Universiteit Amsterdam Amsterdam, the Netherlands Organised by: KIT (Royal Tropical Institute), Development Policy and Practice Amsterdam, the Netherlands In co-operation with: Vrije Universiteit Amsterdam/ Free University of Amsterdam (VU) Amsterdam, the Netherlands September, 2008 ii List of Acronyms/Abbreviations.....................................................................................v ACKNOWLEDGMENT..........................................................................................................vi ABSTRACT .......................................................................................................................... viii 1 INTRODUCTION:-...........................................................................................................1 1.1 Back ground information..................................................................................2 2 Problem Statement.............................................................................................................6 2.1 Significance of the study..................................................................................7 2.2 Beneficiaries of this study are........................................................................8 2.3 General Objective:-............................................................................................8 2.4 Specific Objectives..............................................................................................8 2.5 Questions to be answered in PMTCT utilization ......................................9 2.6 Expected outcomes/Results ............................................................................9 2.7 Methodology..........................................................................................................9 2.8 Limitations of the study..................................................................................10 3 Literature review..............................................................................................................11 3.1 Physical accessibility including affordability:-........................................12 3.2 Availability of human resources:-...............................................................13 3.3 Availability of material resources/other essential inputs:-...............14 3.4 Organizational quality and consumer responsiveness:-....................15 3.5 Social accountability:-.....................................................................................15 3.6 Relevance of production & utilization of health interventions: .......16 3.7 Timing and continuity:- ..................................................................................18 3.8 Technical quality:- ............................................................................................18 3.9 Effective coverage:-.........................................................................................19 4 RESULTS/FINDINGS:-..................................................................................................22 4.1 Physical accessibility, including affordability..........................................22 4.2 Availability of human resources:-...............................................................25 4.3 Availability of material resources & other essential inputs...............27 4.4 Organizational quality and consumer responsiveness:-....................29 4.5 Social accountability:-.....................................................................................31 4.6 Relevance and utilization of health intervention...................................31 4.7 Timing and Continuity:-..................................................................................38 4.8 Technical quality:- ............................................................................................39 5 Discussion, Conclusion and Recommendations ..............................................................39 5.1 Conclusion............................................................................................................42 5.2 Recommendations.............................................................................................43 References................................................................................................................................45 Annexes............................................................................ Fout! Bladwijzer niet gedefinieerd. Annex 1 Problem Tree...................................................................................................1 Annex 2:- Map of Ethiopia with its federal states ............................................49 Annex 3:- Map of Oromia with its zones .............................................................50 Annex 4:- Location of East Wallaga Zone in Oromia ......................................51 iii List of tables and figures Table 1.Ethiopia, Oromia and east Wallaga zone Health institution and Human power to population ratio --------------------------------5 Table 2.Summary of PRSP problem analysis of east Wallaga PMTCT utilization ---------------------------------------------20 - 21 Table 3.Current distribution in districts and additionally required Health institutions--------------------------------------------------23 Table 4.Distribution of health professionals in east Wallaga zone--------27 Table 5.Maternal health services in Ethiopia, Oromia and East wallaga Zone and Naqamte town-------------------------------------------32 Table 6.Maternal health service utilization by districts in east wallaga Zone and Naqamte town-------------------------------------------33 Table 7.VCT/PICHT/PMTCT and total HIV (CT) by districts providing The service----------------------------------------------------------34 Table 8.HIV/AIDS work plan and achievement of east Wallaga zone And Naqamte town-------------------------------------------------35 Table 9.Age and sex distribution for VCT/PICHT consumers in Naqamte town----------------------------------------------------- 35 Table 10.PMTCT achievement of (rural) east Wallaga & Naqamte town--36 Table 10 A. Analysis of PMTCT Effectiveness---------------------------- --37 Table 10 B. Analysis of PMTCT utilization among pregnant women-------37 iv List of Acronyms/Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ART Antiretroviral Therapy BCC Behavioural Change Communication BF Breast Feeding CBRHA Community Based Reproductive Health Agent CPR Contraceptive Prevalence Rate DHO District Health Office EWZHO East Wallaga Zone Health Office FHEWs Female Health Extension Workers FHI Family Health International FHAPCO Federal HIV/AIDS Prevention and Control Office FMOH Federal Ministry of Health FP Family Planning HC Health Centre HIV Human Immunodeficiency Virus HMIS Health Management Information System HP Health Post IEC Information, Education, communication MCH Maternal and Child Health MTCT Mother to Child Transmission of HIV NACS National AIDS Council Secretariat NTHO Naqamte Town Health Office NGO‘s Non Governmental Organizations OHAPCO Oromiya HIV/AIDS Prevention and Control Office OI Opportunistic Infection OSSA Organization for Social Service for AIDS ORHB Oromia Regional Health Bureau PEPFAR The President‘s Emergency Plan for AIDS Relief PIHCT Provider Initiative HIV Counselling and Test PMTCT Prevention of Mother to Child Transmission of HIV PLHIV People Living with HIV PAC Post Abortion Care PNC Post Natal Care RH Reproductive Health STI/D Sexually Transmitted Infection/Diseases TFR Total Fertility Rate UNAIDS United Nations Programme on AIDS UNICEF United Nations Children‘s Fund USAID United States Agency for International Development VCT Voluntary Counselling and Testing for HIV infection W H O World Health Organization ZHO Zone Health Office v ACKNOWLEDGMENT —Lord I love you and I need you, come into my heart and bless me, my family, my home, and my friends, in Jesus name.“ Amen Above all I thank the Almighty God who helped me through out my carrier, my stay in the Netherlands, and helping me to reach this day. I would like to extend my heart felt thanks for Oromia Regional Health Bureau who select me for this study, East Wallaga zone health office paying me salary and providing with important data‘s and Naqamte town health office for providing me data I need for this thesis. I also like to thank African Development Bank (ADB) for giving me no objection for the
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