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Task shifting and regulatory frame work, Ethiopia Yibeltal Assefa National HIV/AIDS prevention and control office. June 14,2007 Kigali. Background . Population around 78 million National adult HIV prevalence- ANC based- 3.5 PLWHAs - 1.3 million (ANC data) Need ART----280,000

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Task shifting and regulatory frame work, Ethiopia Yibeltal AssefaNational HIV/AIDS prevention and control office

June 14,2007

Kigali


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Background

  • Population around 78 million

  • National adult HIV prevalence-

    • ANC based- 3.5

  • PLWHAs - 1.3 million (ANC data)

  • Need ART----280,000

  • More than 150, 000 people are started on chronic care.

  • More than 90,000 people are started on ART



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HEW and the Ethiopian heath system

  • The Ethiopian health system is organised around the concept of the HNW model with different components:

    • PHC (community, health posts and health centres) providing service for 25,000 people

    • Hospitals of different levels

  • HEW are assigned at the Health post


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Health extension workers

  • They are community health workers assigned at the health post

  • Two HEW provide service for 5000 people at each health post

  • More than 9000 HEW are already deployed

  • We have planned to produce 30,000 HEW in total (two per Kebele or health post).

  • Their main task is preventive and promotive (very little on curative)


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The process of introduction of HEW(The regulatory frame work)

  • MOH raised the need to introduce HEP as a vehicle to attain MDGs

  • MOH Proposed :

    • the components of the package and key intervention area

    • duties and responsibilities of the HEW

    • Proposed Recruitment criteria

    • Duration and training Methodology


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The process, contnd…

  • All relevant ministries and bodies were involved from the inception

    • MOCB- approves Keble level civil service structure

    • Civil service agency-approves minimum job requirements and grading

    • MOE

    • MOFED

    • CBO/FBO

  • The process has taken almost two years


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Recruitment

  • Female

    • Empowerment

    • Easily accepted by the community

    • Can stay longer in the community

  • High school graduates

  • Selected by the community

  • Need to speak the local language


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Training and Deployment

  • A one year training

  • Both class room and practical sessions

  • After completion they will be certified

  • They need to go to their locality after graduation

  • Defined career structure and promotion

  • System designed for continuous ongoing training

  • Working condition – 75% outreach and 25% at Health post

  • Supervises 15-20 Voluntary CHWs


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M&E and quality& safety

  • There is a plan to really evaluate whether the HEW are doing what

    they are supposed to do

  • As part of the HNW they are also considered to be mentored by the health centre staff


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Summary

  • HEW has been planned with a greater involvement of the concerned bodies from the very beginning and its implementation is also being monitored with all the concerned parties so that it will be effective and sustainable.


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