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 2 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. 3 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. 4 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 5 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.