PRIMARY HEALTH CARE IN PRACTICE: PROVISION OF PREVENTIVE AND BASIC CURATIVE CARE AT THE COMMUNITY LEVEL THROUGH HEALTH EXTENSION WORKERS - PowerPoint PPT Presentation

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PRIMARY HEALTH CARE IN PRACTICE: PROVISION OF PREVENTIVE AND BASIC CURATIVE CARE AT THE COMMUNITY LEVEL THROUGH HEALTH EXTENSION WORKERS

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special session countdown to 2015 in ethiopia primary health care in practice: provision of preventive and basic curative care at the community level – PowerPoint PPT presentation

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Title: PRIMARY HEALTH CARE IN PRACTICE: PROVISION OF PREVENTIVE AND BASIC CURATIVE CARE AT THE COMMUNITY LEVEL THROUGH HEALTH EXTENSION WORKERS


1
PRIMARY HEALTH CARE IN PRACTICE PROVISION OF
PREVENTIVE AND BASIC CURATIVE CARE AT THE
COMMUNITY LEVEL THROUGH HEALTH EXTENSION WORKERS
SPECIAL SESSION COUNTDOWN TO 2015 IN ETHIOPIA
Neghist Tesfaye (MD, MSc. IH) National Program
Coordinator for MNCAH Director of the Urban
Health Promotion and Disease Prevention
Directorate Federal Ministry of Health Addis
Ababa, 24 April 2012
2
Outline
  • Health Extension Program/Health Extension Workers
  • Successes
  • Challenges
  • Scale up strategy/Health Development Army
  • Way forward

3
Health Extension Program
  • Community-based health service delivery program
  • approach is based on the innovation-diffusion
    model, which holds that community behavior is
    changed step by step early adopters, laggards
    (16)..
  • Health Extension Program assumes that health
    behavior can be enhanced in communities by
    creating model families

4
Health Extension Program
  • Flagship program of Ethiopia with strong support
    from the political leaders
  • as a sub-component of Health Sector Development
    Program II (2002 2005), Health Sector
    Development Program III 2005/6 -2009/2010, Health
    Sector Development Program IV 2010/11 2014/15
  • One of the Bloodlines in Health Sector
    Development Program IV

5
Health Extension Workers
  • Health Extension Workers
  • Female
  • 10 grade and above with one year training (rural
    and pastoralist)
  • Speak local language
  • Resident in the village
  • Paid by government
  • Rural , Urban, Pastoralist

2HEW
5000 people
34000 rural 4000 urban
6
  • Ethiopian Health Tier System
  • 1. Primary level health care
  • Health post
  • Health center
  • Primary hospital
  • Urban Health center for 40,000 people
  • 2. Secondary level health care
  • General hospital
  • 3. Tertiary level health care
  • Specialized hospital

7
Increasing access
  • Upward trend in building infrastructure
  • construction of Health Post reaching 15,095 in
    2010/11
  • construction of Health Centers reaching 2,800 in
    2012

8
Trend of Health Extension Workers deployed
Cumulative number of Health Extension Workers
trained and deployed (target reached in 2010)
9
HIV/TB Malaria First AID
Personal Hygiene Water and sanitation Food
hygiene Latrine Solid liquid waste disposal
Housing construction Insects Rodents control
MCH FP Immunization Nutrition Adolescent Health
10
Health Extension Program
  • Services provided
  • Promotion, Prevention and Basic curatives
    services
  • Skill based
  • Clean and safe delivery provision of
    Misoprostol
  • Integrated Community Case Management of common
    childhood illness (Malaria, Pneumonia and
    Diarrhea)
  • Task shifting- Implanon insertion by Health
    Extension Workers
  • Community Directly Observed Treatment (DOTS)

11
Health Extension Worker inserting single rod
Implants
12
Career development
  • Integrated Refresher Training
  • CMNCH
  • EPI
  • TB/HIV
  • Integrated Community Case Management of common
    childhood illness (Malaria, Pneumonia and
    Diarrhea)
  • First Aid
  • Upgrading of Health Extension Worker- from Level
    3 (certificate) to Level 4 , 1700, 1 year
    training in health science college (diploma)

13
  • Success

14
Trend in population-based indicators
Health Extension Workers contributed to an
increase in coverage of some MCH services
15
Total Fertility Rate (TFR)
16
Contraceptive Prevalence Rate
17
Trend in antenatal care, delivery assisted by
skilled attendant and postnatal care coverage
18
Challenges
19
Challenges
  • Referral linkage in the Primary Health Care Unit
    was not optimal and we did not tap the full
    potential of the Health Extension Program
  • High MMR-3 delays
  • deciding to seek appropriate medical help for an
    obstetric emergency
  • reaching an appropriate obstetric facility and
  • receiving adequate care when a facility is
    reached

20
Scale up strategy addressing delay one
  • Designed to scale up new technologies and health
    extension packages (HEPs) best practices in a
    short period of time with high coverage.
  • Core issue to ensure scale up strategy is
    building capacity by establishing Health
    Development Army (HDA) thereby ensuring prompt
    and sustainable development.
  • Determined for blanket coverage in a short period
    of time.
  • Intends to develop capacity to solve the
    development bottlenecks in the area of
    leadership, attitude and skill.
  • Creates strong network between the health centre
    and health posts

21
Health Development Army
  • Health Development Army will be strengthened at
    all levels
  • 1 to 5 networking is the main tool used in
    Health Development Army
  • Implementation of all Health Extension Packages
    at the community to produce and sustain their own
    health
  • Best mechanism to improve capacities of families
    at the household level in the area of skill and
    attitude and increase demand for services.

22
Health Development Army
  • The leader of the 1-5 network will be chosen by
    the community based on performance of Health
    Extension Packages
  • Leader will have 5 households as followers
  • Approach builds strong support and monitoring
    mechanism in identifying bottlenecks and gaps and
    seeking solutions as early as possible
  • High political commitment

23
1 to 5 networking
  • One kebele has 1000 households
  • One development team has 5 networks
  • One development team has 20-30 households
  • One kebele has 30-33 development teams

Development Team
  • Kebele

1-5
1-5
1-5
1-5
1-5
Development Team
1-5
1-5
1-5
1-5
1-5
24
Addressing delay two
  • Ambulances- one for each woreda
  • Tricycle Ambulances- being tested to be scaled
    in all kebeles
  • Experience from some regions- Traditional
    ambulances using people, using other sector
    ministry cars

25
Way forward
  • Health Extension Program and Health Development
    Army work toward increasing awareness and
    changing health seeking behavior
  • Strengthening Primary Health Care Unit and
    improving referral linkage to better support
    Health Extension Workers
  • Strengthening Health System and better finance to
    address delays 2 and 3 for better maternal and
    newborn health outcomes

26
Thank You
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