Improving access to Diarrhea and Pneumonia treatment in Ethiopia. September, 2014

Transcription

1 Improving access to Diarrhea and Pneumonia treatment in Ethiopia September, 2014

2 Outline Background Status of iccm Lessons learnt Way forward Page 2

3 BACKGROUND Total Population: 91.2 mill. (2014)* 83% of the population is rural and 43% less than 15 yrs. Health Problems: Primarily preventable communicable and nutritional disorders 40% of U-5 are stunted (Emini DHS, 2014) Maternal Mortality Ratio: 676 per 100,000LB (EDHS, 2011) Lifetime risk of maternal death 1 in 28 SBA and early PNC are still low at 15% and 12% respectively. CPR among married women is 42% (Emini DHS, 2014). Under-five Mortality Rate: 68 per 1,000 LB (UN, 2012) Ethiopia achieved MDG 4 three years ahead of schedule. But there remains regional and socio-economic disparities. Neonatal mortality accounts for 43% of U-5 deaths, Source: *Populations and housing census CSA 2007 Page 3

4 Causes of under five mortality Page 4

5 Percentage Prevalence and care seeking: ARI, EDHS % ARI % ARI 2 wks B survey 7.3% ARI 2 wks B survey 2 wks B survey ARI Care seeking antibiotic % 25% 27% sought care sought care sought care 7% antibiotic 7% antibiotic Urban Rural National Page 5

6 Percentage Prevalence of DD and ORT 2 weeks prior to survey, EDHS % DD 11% DD 13.4% DD Diarrhea Care seeking ORT % ORT 22.8% 30.7% ORT ORT Rural Urban National Page 6

7 Health service delivery System Specialized Hospital Avg 440 staff Serves milll Tertiary level care General hospital 234 staff Serves million Secondary level care HC Avg. 20 staff Serves 40,000 Primary hospital Avg. 53 Staff Serves 60, ,000 Heath center Avg. 53 Staff Serves 25,000-35,000 Heath Post 2-3 HEWS Serves 3,000-5,000 Primary level care Page 7 Urban Rural

8 Page 8 Health Extension Program Piloted in 2003, launched in packages organized under four program areas: Hygiene and environmental sanitation (7), Disease prevention and control (4), Family health services (5), Health Education and Communication 2 government salaried HEWs, female high school graduates with 1year intensive theoretical and practical training on 16 health service packages, are deployed in each Kebele and stationed at HP (20/80 vs 50/50) Roles of HEWs expanded over time to include selected MNCH services (OTP, clean delivery &ENC, CBN, iccm, C-BNC) Process of upgrading HEWs to Level IV (diploma) is underway Health Post Health Extension Workers

9 Integrated Community Case Management Pneumonia Malaria Page 9 Diarrhea Malnutrition

10 Key Milestone date 2010 Q Q1-Q Q date 2014 Q1 Policy breakthrough that allowed HEWs to treat pneumonia with antibiotic Implementation plan for the four big regions developed Roll-out of iccm in the four big regions Policy breakthrough that enabled HEWs to treat newborn sepsis Implementation plan and rolling out iccm to pastoralist regions Change in treatment guideline of pneumonia from cotrimoxazole to amoxicillin DT CBNC Phase I Implementation in 5 zones Page 10

11 ICCM Current Status Is being expanded to emerging/pastoralist areas Close to 30,000 (88%) HEWs trained on competency based case management 4,670 HWs equipped with supervisory skill and 3,350 HWs trained on IMNCI and supervisory skill Close to 4.6 mill. Under five children received life saving care through iccm as of June 2013 Media messages developed and broadcasted on importance of Zinc Notification on the dose and importance of Zinc passed to all heath facilities by FMOH CBNC Phase I initiated to be scaled up nationally by 2015 Page 11

12 As of 2010 key progress was made to create enabling environment National Scale-up plan endorsed Achieved Implementation plan developed in 2011 OTC status secured for Zinc Achieved FMHACA approved OTC for Zinc in 2014 Amoxicillin as 1 st line treatment Coordination mechanism in place Achieved Guideline updated in 2014 Achieved Strong coordination mechanism under the leadership of MOH in place Mapping of partners Achieved Developed and updated by UNICEF Vaccines Achieved PCV and Rota virus vaccine already introduced Page 12

13 LESSONS LEARNT Government leadership and political commitment is key Skill based training, post training follow-up, supervision, performance review and clinical mentoring and emphasis to use job aids helped to improve/maintain QoC Introduction of iccm has further improved motivation of HEWs and boosted the HEP Coordinated and harmonized partnership is important Integrated approach helped to achieve more and mobilize resources from different funding source Page 13

14 Challenges Low utilization Short half life of zinc (expiring in the importation and transportation process) Weak supply chain management system HMIS Page 14

15 Way forward Scale-up iccm in the remaining districts of the pastoralists Scale up the CBNC in all the regions Ensure the inclusion of critical indicators in the revised HMIS and speed-up the roll-out Strengthen the supply chain management Continue to broadcast TV/radio messages on Zn Explore opportunities for local production of zinc Page 15 Strengthen the public private partnership

16 Key stakeholders MOH UNICEF USAID WHO Integrated Family Health Project JSI-L10K Save the Children International Rescue Committee AMREF Ethiopian Pediatric Society Micronutrient initiative Supply chain for CCM (SC4CCM) PATH Pharmaceuticals Fund and Supply Agency Food Medicine Heath care Administration and Control Agency (FMHACA) Page 16

17 Thank you Page 17