Working in partnershipCountdown for Child Survival in EthiopiaLondon13-14 December 2005Working in partnershipCountdown for Child Survival in EthiopiaLondon13-14 December 2005
Federal Ministry of Health of the Democratic Republic ofEthiopiaFederal Ministry of Health of the Democratic Republic ofEthiopia
OutlineOutline
•Background•Background
•Partnership•Partnership
•HSDP III and areas of focus•HSDP III and areas of focus
•The two acceleration vehicles•The two acceleration vehicles
•Challenges and the way forward•Challenges and the way forward
•Conclusion•Conclusion
•Utilization of health services: 0.36/person/ year (2004)•Utilization of health services: 0.36/person/ year (2004)
•Per capita Health expenditure, all sources: US$ 5.60(2000)•Per capita Health expenditure, all sources: US$ 5.60(2000)
•Projected population :•Projected population :
77,4 million in 2005 (85 %rural)
•U5 mortality : 140/1000•U5 mortality : 140/1000
•29% of deaths in neonatalperiod•29% of deaths in neonatalperiod
•MMR : 871/100,000•MMR : 871/100,000
Neonatal, 25%
Malaria, 20%
Pneumonia,
28%
Diarrhea, 20%
AIDS, 1%
Measles, 4%
Other, 2%
What are Children Dying from?What are Children Dying from?
Malnutrition57%
HIV/AIDS11%
Experience of working in partnershipExperience of working in partnership
•First Global Child Survival Partnershipmission in December 2003 to initiatediscussion on Partnership•First Global Child Survival Partnershipmission in December 2003 to initiatediscussion on Partnership
•National Child Health situation analysisdone•National Child Health situation analysisdone
•First National Child Survival PartnershipConference held - April 22-24, 2004•First National Child Survival PartnershipConference held - April 22-24, 2004
•National Child Survival Core TechnicalWorking Group established•National Child Survival Core TechnicalWorking Group established
•Child Survival strategy developed andendorsed November 2004.•Child Survival strategy developed andendorsed November 2004.
Strong partnership led by governmentStrong partnership led by government
•Government commitment at all levels•Government commitment at all levels
•effective linkage of HSDP III with PASDEP•effective linkage of HSDP III with PASDEP
•Consensus among partners on HSDP III•Consensus among partners on HSDP III
–13 partners Signed Code of Conduct onharmonization–13 partners Signed Code of Conduct onharmonization
One Plan, One Budget, One Monitoring systemOne Plan, One Budget, One Monitoring system
(Harmonization)(Harmonization)
Institutionalizationof the Child Survival StrategyInstitutionalizationof the Child Survival Strategy
•Incorporated in the third Health Sector DevelopmentProgram•Incorporated in the third Health Sector DevelopmentProgram
•Central to the MDG based Plan for Accelerated andSustainable Development Program (PASDEP)•Central to the MDG based Plan for Accelerated andSustainable Development Program (PASDEP)
•Improved harmonization and alignment of in-countrypartners•Improved harmonization and alignment of in-countrypartners
•Health Extension Program identified as the principalvehicle for delivery of essential Child Survivalinterventions•Health Extension Program identified as the principalvehicle for delivery of essential Child Survivalinterventions
•Community ownership•Community ownership
Institutionalization is critical in translating vision into actionInstitutionalization is critical in translating vision into action
HSDP III prioritiesHSDP III priorities
•Focus Areas•Focus Areas
–Maternal Health; CPR 75%–Maternal Health; CPR 75%
–Child Health; DPT 3 = 90%–Child Health; DPT 3 = 90%
–HIV/AIDS prevention and control–HIV/AIDS prevention and control
–Malaria prevention and control–Malaria prevention and control
•2 bednets/HH – all HHs in malarious areas•2 bednets/HH – all HHs in malarious areas
Government commitment:No more “business as usual”Government commitment:No more “business as usual”
HSDP III prioritiesHSDP III priorities
•Vehicles (the two lines of 1o health care)•Vehicles (the two lines of 1o health care)
–Health extension Program (HP)–Health extension Program (HP)
–Accelerated health center expansion–Accelerated health center expansion
•Systems•Systems
–Health Management and info System (HMIS)–Health Management and info System (HMIS)
–Logistics management system (LMIS)–Logistics management system (LMIS)
–Finance System–Finance System
Universal Primary Health Care by2008Universal Primary Health Care by2008
The two acceleration vehicles - strategiesThe two acceleration vehicles - strategies
1.Accelerated expansion of Health Posts –1 HP/village (Health ExtensionPackage)1.Accelerated expansion of Health Posts –1 HP/village (Health ExtensionPackage)
2.Accelerated expansion of HealthCenters – 1 HC/ 25,000 population2.Accelerated expansion of HealthCenters – 1 HC/ 25,000 population
Health Extension ProgramHealth Extension Program
•Train > 30,000 Health extension workers –2HEWs / village of 5,000 population•Train > 30,000 Health extension workers –2HEWs / village of 5,000 population
–2800 deployed in 2004 and 7,100 will be deployed thismonth = 9900–2800 deployed in 2004 and 7,100 will be deployed thismonth = 9900
•Build 12,500 Health Posts•Build 12,500 Health Posts
–4148 built–4148 built
“Households are the primary producers of Health”“Households are the primary producers of Health”
HEP’s Major ComponentsHEP’s Major Components
•Family Health•Family Health
•Communicable Disease Prevention andControl•Communicable Disease Prevention andControl
•Hygiene and Environmental Health•Hygiene and Environmental Health
•First Aid•First Aid
There are 16 packages under the above 4 broad areasThere are 16 packages under the above 4 broad areas
Action Steps – HEP implementationAction Steps – HEP implementation
•Discuss with administrators and association leadersand reach consensus•Discuss with administrators and association leadersand reach consensus
•Conduct base line survey•Conduct base line survey
•Select model families (30-45 households at once) onvoluntary basis•Select model families (30-45 households at once) onvoluntary basis
•Train selected households for 96 hours•Train selected households for 96 hours
•Graduate trained households in 2-3 months (Oath)•Graduate trained households in 2-3 months (Oath)
•Monitor progress after graduation (HEW and CHWs)•Monitor progress after graduation (HEW and CHWs)
•Enforce environmental law and penalize communitymembers who practice otherwise (Social court)•Enforce environmental law and penalize communitymembers who practice otherwise (Social court)
In many areas where HEP is being implemented, CPR is reaching up to
80%
Accelerated expansion of HealthCentersAccelerated expansion of HealthCenters
•Train 3,000 Health Officers in 3 Years•Train 3,000 Health Officers in 3 Years
–Up to 2000 HOs already enrolled–Up to 2000 HOs already enrolled
•Upgrade 2167 clinics to health centers, build563 new•Upgrade 2167 clinics to health centers, build563 new
–619 HCs exsting, 443 will be upgraded this year–619 HCs exsting, 443 will be upgraded this year
•We are on schedule in relation to the twoacceleration targets set for 2008•We are on schedule in relation to the twoacceleration targets set for 2008
US$ 3.1 Billion needed to reach child health MDGWith estimated average annual allocation of US$ 307 MillionUS$ 3.1 Billion needed to reach child health MDGWith estimated average annual allocation of US$ 307 Million
Marginal Budgeting for Bottlenecks model:
overall reduction of under-5 mortality
of 48% by 2010 and 61% by 2015
Key ChallengesKey Challenges
•Moving from strategy to acceleratedimplementation•Moving from strategy to acceleratedimplementation
–Human Resource development–Human Resource development
–System strengthening–System strengthening
–Expansion of health infrastructure–Expansion of health infrastructure
•Resources for HEP•Resources for HEP
•Effectively broadening the NationalPartnership to MNCH•Effectively broadening the NationalPartnership to MNCH
Sustainability Issues -Sustainability Issues -
•Organizing around priorities and outcomes•Organizing around priorities and outcomes
•Integrated health system•Integrated health system
•Social mobilization with concreteexpectations from communities•Social mobilization with concreteexpectations from communities
–Health financing (HI - tap own resources)–Health financing (HI - tap own resources)
•Accelerate implementation (Scale-up)expansion of health services – Pilotingonly in exceptional situations - BBP•Accelerate implementation (Scale-up)expansion of health services – Pilotingonly in exceptional situations - BBP
ConclusionsConclusions
•Government commitment•Government commitment
–Set clear directions in PASDEP II and HSDP III childsurvival being a key focus area–Set clear directions in PASDEP II and HSDP III childsurvival being a key focus area
–Prepared Child survival strategy–Prepared Child survival strategy
–Identified two acceleration vehicles for fast scale-up–Identified two acceleration vehicles for fast scale-up
–Started implementing the two strategies and onschedule in relation to set targets for 2008–Started implementing the two strategies and onschedule in relation to set targets for 2008
–Harmonization is taking shape (CoC)–Harmonization is taking shape (CoC)
•Above all, we are ready to face any challengeand take any risk to reach our goals – we valueyour partnership to realize our vision.•Above all, we are ready to face any challengeand take any risk to reach our goals – we valueyour partnership to realize our vision.
We are determined to win the fight.We are determined to win the fight.
1st National Child Survival PartnershipConference, April 22-24, 20041st National Child Survival PartnershipConference, April 22-24, 2004
Together wecan make adifferencefor the futureof our GlobeTogether wecan make adifferencefor the futureof our Globe
Thank youThank you
