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HMIS in Ethiopia

VIEWS: 237 PAGES: 39

									Health Sector Development
Programme, the Ethiopian Case

            May, 2007
          For GAVI Board
       Outline of the presentation
Background
Health Policy and health sector development plan
Health care financing
Progress on EPI and Major communicable
diseases
Challenges and the way forward
                  Country Profile
1.1 million sq.km
77.3 million population
Population growth rate:
2.7% /year
Rural population:85%
Federal government :
– 9 Regional States, and 2
  City Administration
– 624 Woredas (districts)
– 15,000 kebeles (villages)
 Main focus of Health policy of Ethiopia
Decentralized health system
Capacity building
Social mobilization
Universal access to primary health care
Development of the preventive and promotive
components of the health service
– Maternal and Child Health
– HIV/AIDS, TB and Malaria
Harmonization
        How the health system works?

A four-tier health delivery system
Comprised of health posts (HEP) and Health
centers – Primary health care unit (PHCU)
Followed by District, Zonal and Specialized
hospitals
PHCU Unit is planned to serve 25,000 people
District and Zonal hospitals are expected to serve
250,000 and 1,000,000 people respectively.
      Summary of HSDP III Outcomes and
                  Targets
Focus areas Targets                       Vehicle            Bloodline

Maternal Health   CPR >60%                HEP: 30,000 HEWs; HMIS: Information
                  Emergency surgery:      15,000 HPs
                  1/100,000

Child Health      Immunization >80%       HC: 5000 HO, 3200 LMIS: commodity
                                          HCs

                  Reach every Household
HIV/TB                                    HO: QA; GP         FS: Finance System:
                  ART 258,000


Malaria           20 million bednets                         Harmonization
            Three scenarios
Scenario 1: US$ 4.8 per capita per year over 5 years
– Full implementation of the HEP
   • access to health post 100% (13,635 health post, human
     resource, essential inputs)
   • access to health center 80% (2,229 health center, human
     resource, essential inputs, functional B-EOC)
Scenario 2: US$7.5 per capita per year over 5 years
– HEP plus expansion of first referral clinical

Scenario 3: US$13.3 per capita per year over 5 years
– No resource constraints
   • access to health center 94% (3,153 health center, human
     resource, essential inputs, functional C-EOC
   • High coverage targets for clinical care e.g. 80% ARV
   • All health MDGs achieved
Main Vehicles for HSDP III Implementation
 Health Extension Program (HEP)
 – Health as a product produced by a HH
 – GoE flagship program to improve access and equity to
   preventive essential health interventions
 – 16 packages of promotive, preventive and basic curative
   services
 – 2 HEWs and a HP in each village of 5000 population
 – High school grads with 1 year certificate training
 Accelerated expansion of PHC facilities
 –   1 Health center for 25,000 population
 –   Need is > 3,000 health centers (existing 670)
 –   Headed by HO (total need 5,000 health officers)
 –   Focus mainly on curative services as a back-up to HEP
    Health Extension Worker’s Profile
Recruitment: Female high school graduates
Duration of training: 1 year
Venue of training: TVET Centers
Deployment : two HEWs per villages
Employment: per government scale
Accountability: accountable to the DHOs
Supervision : supervised by DHOs
Logistic supplies: provided by DHOs and Health
Centers
         Major HEP Categories
Family health
Communicable diseases prevention and
control
Hygiene and environmental health
Health education
                    Components
1.   HIV/AIDS
2.   Malaria
3.   Maternal Health
4.   Child Health
5.   Adolescent reproductive health
6.   Vaccination
7.   Nutrition
8.   Solid and liquid waste
                   Components
9.    Housing
10.   Latrine
11.   Insect control
12.   Food sanitation
13.   Water sanitation
14.   Personal hygiene
15.   First Aid
16.   Health education
                  Action Steps
Discuss with administrators and association leaders
m reach consensus
and
Conduct base line survey
Select model families (30-45 households at once) on
voluntary basis
Train selected households for 96 hours
Graduate trained households in 2-3 months (Oath)
Monitor progress after graduation (HEW and CHWs)
Enforce environmental law and penalize community
members who practice otherwise (Social court)
Complete (HH) and minimum package
Activities are harmonized with Education and Agriculture
  Achievements to date and challenges
Challenges
– 17,430 health extension workers trained and deployed until
  December 2007
– Over 7200 HEWs enrolled in January 2007
– > 6,800 Health Posts constructed to date
– Results from areas where HEWs are deployed are encouraging:
  immunization; contraceptive use; personal and environmental hygiene HCT;
  malaria etc..
Challenges
– Systems (shortage of supplies and weak support system)
– Structure (dedicated unit and Supportive supervision)
– Human resource (low confidence in some skills)
Progress 2000 to 2005: Child Health

Infant mortality 77/1000
from 97 in 2000
Under five mortality
123/1000 from 160 in
2000
DPT 3 coverage 80% from
38% in 2000
    EPI Coverage 2001 - 2006, Ethiopia

                 DPT1         G     DPT3                 Measles
    100                       A
    90                        V
    80                        I
    70                                              69             72
                                             66
    60
                               52
%




    50      51          51
    40
    30
    20
    10
     0
          2001      2002     2003          2004   2005        2006
                                    Year
 Distribution of zones by coverage category

 <50% DPT3 coverage   50 - 79% DPT3 coverage   >=80% DPT3 coverage

100%
            9          8
                                    23         21
80%                                                          29
           23
                      34
60%
                                    35         39
40%                                                          38
           46
20%                   39
                                    27         25            18
 0%
          2002        2003         2004        2005        2006
                   Trends in Child Health Impact Indicators
                         T REND IN INFANT MORT ALIT Y RAT E (IMR)
                                      (ET HIOPIA, DHS)
                   140
                            130

                   120


                   100
                                        97
RATE (PER 1,000)




                   80
                                                           77


                   60
                                                                             45
                   40
                                                                    Target in 2010 GC

                   20


                    0
                         1991-1995   1996-2000          2001-2005         2006-2010

                                                 YEAR
   Support provided from GAVI to Ethiopia 2002 to
                       2007
                                Injection
                       GAVI       safety    Fund for
Year                ISS fund     Support      new
                      (USD)        fund     Vaccines       HSS
ISS Investment 1
(2002)               964,000
ISS Investment 2
(2003)               964,000    3,091,000
ISS Investment 3
(2004)              1,928,000
Reward 1 for 2004
(2006-2007)         7,115,320                100,000
Reward 2 for 2005
                    2,298,000
Not received        approved
                                            34,727,400   23, 733,500
2007                                                      (76,500,000)
Additional children reached for DPT3 and GAVI- ISS
       Award since the start of GAVI support



    127,464            2,549,280

    114,896                                     2006
                       2,375,330
                                                2005
                                                2004
                                                2003
    403,754
                       7,115,320


    69,407
                             Number of children reached for DPT3 and
                                        GAVI- ISS Award
                                                DPT3     DPT1   ISS award

                                                                                                   $8,000,000
                            2,200,000

                            2,000,000             $7,115,320                                       $7,000,000

                            1,800,000
                                                                                                   $6,000,000
                            1,600,000
no of children vaccinated




                            1,400,000                                                              $5,000,000

                            1,200,000
                                                                                                   $4,000,000
                            1,000,000
                                                                                                   $3,000,000
                             800,000
                                                                                      $2,549,280
                                                                      $2,375,330
                             600,000                                                               $2,000,000

                             400,000
                                                                                                   $1,000,000
                             200,000

                                   0                                                               $0
                                        2003   2004               2005             2006
                                          ART Site Expansion
                  300
                            Total        Hospitals        Health C                        260
                  250
                                                                                212
Number of sites




                                                            192
                  200

                  150                                                                             143
                                                              115              115
                  100                                                                         117
                                                64                                107
                  50                32                         77

                        3
                   0
                        5           06        6            6                  6              t)
                      d0         tQ         Q0           Q0                 Q0         g abi
                    En        1s       2n d          3rd             4t h            Me
                                                                              Q 07 (
                                                                       2n d
A year ago 85% of the ART
patients were male (fee based)
                                           Children
                                             4%
Hospitals filled with male patients
                                                      Male
Today with free ART program                           46%
females exceeded the male patients    Female
b/c it is freely available for         50%
economically poor and vulnerable
women and their children
                       Malaria
10 million households in malarious area in 2 years, by
August 2007 20 million ITNs required
So far, 15.8 million ITNs distributed and remaining ITNs
are secured and in the pipeline
Gap to be filled with ITNs already on procurement
Early diagnosis and treatment by HEWs
Social mobilization for malaria picking
IRS coverage increasing
MAC campaign
Yearly Malaria Epidemics Recorded, ETHIOPIA (July 2000 – June 2006)
       REMARK: no data incorporated from Benishangul Gumuz and Dire Dawa Regional States for the year 2005 - 2006




                       2,500



                       2,000
 Number of Villages




                       1,500



                       1,000                                                                            2
                                                                                                       R = 0.0027



                         500



                           0
                               July 00 - June   July 01 - June   July 02 - June   July 03 - June   July 04 - June   July 05 - June
                                     01               02               03               04               05               06
                                                                 year                   Number of Epidemic Affected Villages

                                                                                        Linear (Number of Epidemic Affected
                      Source: data collected from Regional Health Bureaus, FMOH
                                                                                        Villages)
        Health Human Resource
 Health extension workers 17,400 (58% of the
 required 30,000)
 Physicians (including HOs) =2,790
 (Ratio=1:26,906)
 Health Officers (trained in 5 years)=776
 Nurses (senior and junior) =17,845
(Ratio=1:4,207)
     Harmonization and Alignment
Code of conduct was signed in September 2005
between Government and health partners
GAVI signed the code of conduct recently and the
first contributor to the MDG PPF
Establishment of TA Health Pool Fund
Revised HSDP Harmonization Manual (HHM) endorsed in
April 2007 (One Plan, One budget and one report)
Procurement of consulting firm for HSDP resource
mapping underway
         Logistic Master Plan

Assessment of the Health Commodity
Supply System
Selected option “Drug revolving fund”
managed by PHARMID
Total funding required amounts slightly
over 110 million USD in 4years
First year implementation started in
2007
                        HMIS
National HMIS reform under way, based on:
 common set of indicators
 standardized procedures
 focus on information use for decision making
 Involving all the stakeholders
 Based on regional and woreda experiences and best
 practices and BPR Principles
 Assessment conducted, indicators selected tools and
 formats developed ready for pilot testing
                        Health Financing Status
Funds flow in 3 channels to the health sector
Block grants to regional states, allocation to sectors based
on priorities at district level
Low per capita total health expenditure
 – US$5.6 in 2000
 – In 2004 total health expenditure increased to US$7.8 per
   capita(3rd NHA)
Domestic revenue (23% of GDP) and government
expenditures (29 % of GDP) higher than average SSA .
HSDP envisages establishment of Health Insurance
(social and community) country experiences consolidated, options of implementing HI being
developed, design phase begins once the appropriate option is selected
HSDP Financing GAP (preliminary data)
                                                      Scenario 3
                                      HSDP III Cost Estimates and Financing Gap
                            4500



                            3600
    Amount in Million US$




                            2700



                            1800



                             900



                               0
                                          Available finance                        Estimated cost


                             Government   Global Fund    Bilaterals and multilaterals   GAVI   Estimated cost
                                        0
                                            50
                                                 100
                                                             150
                                                                       200
                                                                                  250
                                                                                              300
                                                                                                    350
                                                                                                          400
              Family Health Services



                            HIV & TB



                              Malaria



                Other communicable
                                                                                                          HIV




            Hygiene and environment



                            Curative



      Physical access, transportation
                                                                                                                                                              PEPFAR)




      Human resources development



Strengthening pharmaceuticals sector



                            IEC BCC



                  HMIS/management



                Health care financing



                        Crosscutting
                                                                                                                Ethiopia: Donor Pledges 2005-2010 by HSDP3 component and sub-component (including PBS, Global Fund and
                                                                                                                                                                                                                         Funding Distribution by Programs



                                                              2008-9
                                                                       2007-8
                                                                                2006-7
                                                                                         2005-6




                                                   2009-10
           GAVI HSS Contribution to HSDP
Three main areas for GAVI HSS support
all focusing on strengthening health systems functions at district
level and below and still not exclusive.
    1. Health workforce mobilization, distribution and
       motivation
    2. Supply, distribution and maintenance systems and
       infrastructure for PHC
    3. Organization and management of health services at
       the district level and below
–   GAVI HSS a potential support to filling the critical gap in HSDP
–   GAVI HSS promotes harmonization by channelling the fund through
    MDG PPF
            HSDP Governance
Central Joint Steering Committee: chaired by
Minister of Health
Federal MOH-Health Population Nutrition donors
consultative forum: Co-chaired by State Minister of
Health and head of HPN
Joint Core Central Committee: chaired by Planning
Programming Department of MOH
Joint Review Mission /Annual Review Meeting
Mid term and final evaluation of HSDP
                   Challenges
High turn over of skilled health professionals – brain
drain
Ineffectiveness of HMIS in supporting planning, decision
making, and monitoring and evaluation process.
Weak logistic and medical equipment maintenance and
management system.
harmonization and alignment manual finalized getting
into action is a huge challenge.
Speed and Volume are picking but there is still a huge
challenge in Quality.
Underfunding of key areas such as health systems
                      gaps still large form child health, malaria and
                          health systems even for Scenario 1
                            Funding Gap per HSDP3 component
               2000




               1500
Thousand US$




               1000




                500




                  0

                        Family Health            Malaria        Health System          HIV & TB
                          Services

                                    Scenario 1     Scenario 2   Scenario 3      Funding
                                                                         Source: Health Care Financing Study
                The way forward
high production and retention with focus on low and mid-
level professionals
Focus on health systems strengthening – identify new
sources
Accelerate HMIS and LMIS reform
Ensure implementation of the newly endorsed
Harmonization manual – build partner confidence
Keep the balance on quality while maintaining high speed
and big volume
Accelerate Resource mobilization reform to tap both
domestic and international resources

								
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