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Overview of COMMUNITY ENGAGEMENT FOR MATERNAL HEALTH SERVICES ETHIOPIAN EXPERIENCE

Overview of COMMUNITY ENGAGEMENT FOR MATERNAL HEALTH SERVICES ETHIOPIAN EXPERIENCE Tadesse Ketema MD,MPH Maternal Child Health Advisor ,MOH. 1. – CONTEXT.

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Overview of COMMUNITY ENGAGEMENT FOR MATERNAL HEALTH SERVICES ETHIOPIAN EXPERIENCE

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  1. Overview of COMMUNITY ENGAGEMENT FOR MATERNAL HEALTH SERVICES ETHIOPIAN EXPERIENCE TadesseKetema MD,MPH Maternal Child Health Advisor ,MOH

  2. 1. – CONTEXT • In Ethiopia 83.6 % lives in rural areas, and has high level of pregnancy as well as maternal and child morbidity and mortality including MTCT • On the other hand most health care facilities were concentrated in urban areas • To address this challenge the Government has designed and implemented the health extension program since 2005.

  3. 1.1 The Government targets for 2015 Of PMTCT • Provide ANC services to 90 % of pregnant women • Ensure all women are attended at delivery (62% by skilled attendant and 38% by HEWs) • Provide ARV prophylaxis to 90% of HIV positive pregnant women • Reduce national incidence of HIV infection by 50%

  4. 1.2 The major challenges to PMTCT to be addressed • Limited expansion of PMTCT services; • Inadequate use of PMTCT service where it is available • Limited access to and utilization of early infant diagnosis • low percentage of deliveries attended at health institutions • Attitude of health workers • Weak community-health facility referral linkages • Poor male partner involvement • Slow roll out of HMIS and poor recording and reporting practices

  5. 1.3 Rationale for community engagement need for MNCH/ PMTCT • In 2003 EFY (July 2010 to June 2011), 82% of women accessed ANC services at least once • As of July 2011, PMTCT services were available in health facilities where only 54% of women attended for ANC. • This calls for expansion of PMTCT services to avail it to all women who have contact with the health service for ANC.

  6. NB:The ANC coverage report on the graph                    Source :Hapco Report ,June 2010

  7. Rationale for community engagement cnd... • Of women who attended ANC clinics at health facilities that are providing PMTCT services in 2003 EFY (2010/2011), more than 300, 000 of them (25%) were not tested • ARV prophylaxis was provided for 8365 (40%) of women identified as HIV + at these facilities • 4945 (24%) of their new-borns has got ARV • There is a 23% drop out from counselling to testing and 60% from identification to provision of ARV prophylaxis to HIV positive pregnant women

  8. Rationale for community engagement contd... • These missed opportunities can be avoided with improved through engaging community and improving quality of care provided to retain women in PMTCT services including • linkage to community systems to initiate services and track cases lost to follow up • close monitoring of these activities • local data utilization for timely identification of gaps

  9. 2. Health Extension Program 2.1. General Objective: • Improving the health of the population through disease prevention focused expansion, and family and community centered equitable health services 2.2. Specific Objectives: • To enable community members to take greater responsibility for their health, have better decision‐making on health issues, and improve and maintain their own health; • Enhancing community consciousness in strengthening disease prevention activities and improving health outcomes;

  10. 3.Effective community engagement Health Extension and Development Army • A health post built in each kebele through community participation, to serve an average of 5,000 people in family and community focused disease prevention and health promotion services. • A health center is also organized to support a cluster of five health posts; it serves approximately 25,000 people on average. • Around 30 thousand HEWS trained and deployed in around 15,000 health posts

  11. HEWS are tenth grade complete and trained for a year on 16 packages of the health extension program • One health post is staffed with two health extension workers who are all females • Progress has been registered in reducing under five child mortality rate, increasing number and use of latrines, increasing family planning and vaccination coverage as well as significant decline in death and disabilities due to malaria • ANC coverage is tripled and reach to 82% since 2005 and FP utilization has also shown a dramatic improvement

  12. Model Family Training • Model Household Training is a training program conducted by the health extension workers and leaders of one‐to‐five networks on all health extension packages

  13. 4. The Role of the MoH in Supporting The Program • Strengthening primary health care unit (PHCU); • Preparing guidelines and other essential documents/materials that support the health extension program and ensure its proper implementation; • Strengthening collaboration and improving communication among different sector ministries at the federal level, Regional Councils, Regional Health Bureaus as well as development partners for the successful implementation of the health extension program;

  14. Close follow up and encourage the sharing of information in promoting collaboration and networking; • Evaluate the implementation of the program • Acknowledge and reward those health extension workers for their outstanding performance • Design and implement integrated supportive supervision activities; • Develop standards for the in‐service integrated refresher training, further education, career development structure for the health extension workers and closely follow‐up for its implementation;

  15. 5.Challenges and Recommendations to the program

  16. Thank you

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