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Health E xtension P rogram

Health E xtension P rogram. “Health for all in the 21 centaury”. Wondwossen Temiess April 28-30,2008 Ouagadougou Burkina Faso. All roads Lead to HEP. Outline. Why the HEP. Implementation Processes & Approaches. Current Status & Impacts. Challenges & Lessons Learnt.

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Health E xtension P rogram

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  1. Health Extension Program “Health for all in the 21 centaury” Wondwossen Temiess April 28-30,2008 Ouagadougou Burkina Faso

  2. All roads Lead toHEP Outline Why the HEP Implementation Processes & Approaches Current Status & Impacts Challenges & Lessons Learnt The Community can produce their own health

  3. Health Indicators PHS coverage = 87% Hospital = 143 HC = 670 Health post = 10,996 MMR = 673/100,000 IMR = 77/1000 U5MR = 123/1000 HIV prevalence = 2.1% PLWHAs = 1 million Pop to Health provide rRatio Country Background Geographical location Horn of Africa Health Indicators Population: 79 million Economy : 85% depend on Agriculture Resides in rural area 85% of the population

  4. Fundamental Reform Measures (Of paramount importance) • Development of a new Health Policy , strategy, • Formulated a twenty-year health sector investment program (1998-2018). • The HSDP was launched in 1997 with the basic objective of improving the coverage and quality of heath services; • HSDP III (2005/06-2009/10) is underway in line with (PASDEP) and guided by MDGs • In spite of the effort made it was realized that the essential health services have not reached the grass root. • The government has chosen from the stock of experiences by considering the gains and challenges in the process of phase one HSDP

  5. Why HEP? • HSDP 1 review revealed that • Basic health services had not reached the needy • population at grass-root levels • Limited expansion of facilities • Fundamental gap in applying the core principles & • practices of (PHC) • The uneven distribution of facility based health • services • lead to the birth of new ideas, strategies

  6. HEP laid its foundation Millennium Development Goals calls • For 75% reduction of MMR from 880/100,000 in 1990 to 220/100,000 • Reduction of IMR by 66% from 123 in 1990 to 42 by 2015 • Reduction of malaria death • Maintaining the current HIV Prevalence PHC • Socially acceptable , Scientifically proven • Universally accessible to individuals and families in the community • Full participation of community • At a cost that the community and the country can afford • To maintain at every stage of development in the sprit of self-reliance and self determination What Should be Ethiopia’s pace of Response To make this reality ? High, medium, low or business unusual !!!!

  7. Health Extension ProgramBusiness unusual strategy The HEP in Ethiopia was embarked in 2002 as Flag ship program HEP is “a package of basic and essential promotive, preventive and curative health services targeting HOUSHOLDS in a community, based on the principles of primary health care (PHC) to improve the families’ health status with their full participation” Family and community centered program

  8. Philosophy of HEP Produce their own health the way they produce their agricultural products Transfer Ownership & Responsibility of Producing Health to Individual Households The underlined convection is that

  9. Promise House of HEP Establishing an Effective & Responsive Health Delivery System for those who live in Rural Areas Overall Goal of the HEP is Create a Healthy Society & Reduce Rate of Maternal and Child Morbidity and Mortality Train & Deploy HEWs Medicine & Supplies Construction of Health post Full Community Participation Leadership, Monitoring & Evaluation

  10. Implementation Strategy (1 ) requires substantial Human Resource Training criteria • Sex Female • Age > 17 years • Education 10 grade & above • HEWs will be selected from the communities they reside • who has Ability to speak local language • Volunteer to serve 3 years after training Train & deploy 30,000 HEWs by the end of 2008 67 million will be reached 30,000 HEWs 2 HEWs 5000 people

  11. HEP Training • Existing Technical and vocational educational training schools (TVETs) of the MOE were used for training of HEWs • 40 TVET schools provide training to HEWs and 140 TVET tutors have been trained to deliver pre-service training • Tutors are public health nurses, sanitarians HOs , Home economists were locally recruited and received 1 month training • The HEWs receives a 1 year course of training which includes field work to gain practical experience

  12. The community can produce its own health HEP Training Package (16) curriculum HIV/TB/Malaria 1st AID Personal Hygiene& water sanitation , Food hygiene t Latrine Execrate wastage disposal Housing construction insecticide and MCH FP Immunization Nutrition Adolescent Health Disease Prevention & Control (3) 16 Health Extension Package Family Health (5) Hygiene & Environmental Health (7) Health Education (1)

  13. What is new with HEWs? • Health Extension workers are generalists • Lead the Health program • Health educator, • Planner , Coordinator , trainer • supervisor , M&E expert • With all this there is no departmental function in HEP at grass root level

  14. Implementation Strategy (2) HP construction The health system has 4 tires 143 • Operational Center of HEWs is the HP • HEWs Function under the supervision of Woreda Health office, Kebele Administration and technical support from the nearest Health center • The country has four tires health system • PHCU (health center+ 5HP) is crucial component for achieving the universal primary health care coverage 10,996

  15. Implementation Strategy (3) • Procurement of Contraceptives, Medicine and Supplies • Health posts should be adequately provided with equipment, materials and supplies to deliver the different packages of essential services to the community • Medicines and supplies are procured and distributed to the regions by FMOH • Supplies will be provided by Health Centers or woreda health offices to health posts

  16. HEP Implementation Approach • Model families • Community Health p • Health posts • Governance • Monitoring & Evaluation , supportive supervision

  17. The theory behind Model families(Diffusion Model presents the normal pop. distribution) HEP is an innovative strategy • To implement model families diffusion theory is adopted • Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system • In principle not all individuals in a social system adopt an innovation at the same time rather they adopt in a time sequences 1st model families HH will be selected 2.5% 13.5% 34% 34% 16% Adopter Categorization on the Basis of Innovativeness

  18. Model Familiesimplementation cycle  They are the head of their own health

  19. 1st batch (40-60 HH) 2nd batch (>40-60 HH) 3rd batch (>40-60 HH) Model Families Creation per year based on diffusion theory

  20. HEP Current Status

  21. Impact of HEP on Child Health

  22. Impact of HEP on Maternal Health

  23. Impact of HEP in malaria program By 2007/8 20 million net distributed

  24. Impact of malaria intervention

  25. Progress on HIV/AIDS • HEWs played a significant role on social mobilization on HIV/AIDS • Many people underwent counseling and testing through Millennium AIDS campaign • Awareness has been raised • Many people have been counseled and referred for testing of HIV

  26. M&E • Annual review meeting • 3200 Supervisors trained and deployed at 3200 HC accountable to woreda health office • Research • Monitoring developed • National database system of the HEWs developed

  27. Challenges • Maternal & Child Survival MDGs at the current pace will be challenging, needs more resource • Peripheral and mid-level health facilities are still in critical shortage with regard to appropriately skilled personal for assisting deliveries • Higher level facilities for management of complicated cases needs further strengthening

  28. Success story from the rural community voice “Of all the things in my kebele that I feel extremely proud of is hygiene. Almost everyone has constructed a latrine & as a community we have had a campaign to clean the water source and fence it to prevent animals from entering “

  29. Conti. Recalling the thousands who died of malaria in her woreda a few years ago. “ Thanks to the Health Extension Program, my community members have better access to anti-malaria drugs and bed nets and they live in a healthy home environment.” says Teguada

  30. Let The Ethiopian New Millennium Bring us a bright , peaceful and healthy future like a rainbow

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