Hiluf: Ethiopia
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Newborn2013Hiluf: Ethiopia
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Newborn2013HOME BASED NEWBORN CARE: COUNTRY SUCCESSES AND CHALLENGES
Mihret Hiluf (BSc, MPH) Director, AHPDPD FMoH Ethiopia NEWBORN 2013: Global Newborn Health Conference, Johannesburg April 17, 2013
Outline
Background Overview of HEP
Objectives HEWs Packages Service delivery modalities &
Organizational support
Achievements &
Challenges
Background
Geographic location=
Horn of Africa
Second most populous
nation in Africa
It covers 1,104,300 square
kilometers
Estimated total population
in 2013= 86 million.
Population growth rate = 2.6%
83.6% rural, 16.4% urban
Background
Predominately young with 47% < 15 years and 15.4% <5 years 9 Regions and 2 City Administrations, (more than 810 Districts)
EDHS 2011
Fertility rate = 4.8 births per woman Contraceptive prevalence rate: 29% Only 10% of births are attended by skilled personnel.
Background
300
Neonatal mortality rate Under 5 mortality rate MDG 4 Target
Mortality per 1000 live births
200
88
100
68
37
0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010* 2015
Over fifty percent of infant and forty percent of under five deaths in Ethiopia are neonatal Chronic Malnutrition has dropped from 47% to 44% Ethiopia could meet MDG 4 with accelerated progress (from the current rate of 4.4% annual reduction to 6%) and more focus on neonatal deaths Data sources: Updated from Opportunities for Africas Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 data
Background .
Major direct causes of newborn deaths are
- Preterm 37% - Intrapartum related complication (birth asphyxia) 28% - Severe infection 24%.
(Liu L. et al.2012 Global, Regional & National Causes of Child Mortality in 2000-2010).
25 to 45 % of all neonatal deaths occur in the first 24 hours,
with about three-quarters occurring in the first week
Background
Ethiopian Health Tier System
Specialized Hospital (3.5-5.0 million people) General Hospital (1-1.5 million people) Primary Hospital (60,000-100,000 people) Health Centre (15-25,000 people) Health Post (3-5,000 people)
Tertiary level health care
Secondary level health care
Primary level health care
PHCU
Woreda Health Office
One HC Five HPs 15-25,000 Pop.
100,000 Health Center 25,000
District Health office
Health Center Health Posts
5,000
Health Post A
Health Post B
Health Post C
Health Post D
Health Post E
Overview of HEP
Objective: to increase equitable access to essential promotive,
preventive and selected high impact curative health interventions targeting households at the community level.
Fundamental philosophy: if the right health knowledge and
skill is transferred, households can take responsibility for producing and maintaining their own health.
It promotes community involvement, ownership,
empowerment, skill multiplication and self-reliance to ensure sustainability.
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Overview of HEP HEWs
HEWs are 10th grade complete & one year certificate trained
community health workers. More than 95% are females. They are selected with participation of the rural community Paid by government. Two per 3,000-5,000 people at the village level Over 38,000 HEWs being deployed (over 34,000 in rural & 4,000 in Urban). More than 15,000 HPs were constructed and equipped with necessary materials. Supported by Community health development army.
Health Post
Health Post A
1,000 HHs 150 - 200 1 to 5 network Leaders 30 40 HDTs
Serves app 3 - 5,000
people (1,000 HHs) 2 HEWs 30 40 HDTs 150 - 200 1 to 5 network leaders
2 HEWs
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Overview of HEP Packages
Family Health (5)
Hygiene & EH (7)
16 Health Extension Packages
Disease Prevention & control (3)
Health Education
Community level activities : Addressing the three main causes of newborn deaths
Preterm birth complications Prevention of preterm birth & LBW (LLINs ) Clean & Safe delivery Promotion of Skilled attendance & EmONC Essential newborn care as part of PNC ICCM CKMC (Pilot in 10 districts) Intrapartum related (Birth Asphyxia) FANC Clean & Safe delivery Promotion of institutional delivery ENC as part of PNC ICCM Newborn infection
Antenatal management of maternal infections Clean & Safe delivery & promotion of SD ICCM ENC as part of PNC CBNC (Learning phase)
Platform: Health Services Extension Program (HSEP)
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Overview of HEP
Service Delivery Modalities
House Hold Out reach Health Post
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Overview of HEP
HEP Organizational Support Primary Health Care Unit (PHCU)
One HC with five Health Posts Technical & administrative support
Planning Implementation Monitoring Supply
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Achievements & Challenges
MNCH Component Coverage (%)
CPR** ANC* ANC 4+** Skilled delivery* Clean & Safe delivery* Percentage of deliveries of HIV-positive women who received a full course of ARV prophylaxis* PNC* PNC within 2 days** PAB** Exclusive breast feeding < 6months ** Health facilities providing IMNCI * HPs providing ICCM*
Source: * FMoH 2011/12 **EDHS 2011
29 89.1 19 20.4 13 26 44.5 7 48 52 68 77
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Thank You!
