Ethiopia

Country Overview


Funding Began 2011

MCHIP Partners involved Lead Organization: Jhpiego, Partners: Save the Children and IIP

Key Partners in Country Federal Ministry of Health (FMOH), including the Urban Health Promotion and Disease Prevention, Agrarian Health Promotion and Disease Prevention, and Pastoralist Health Promotion and Disease Prevention units; FMOH-led national working groups, including Safe Motherhood/PMTCT Technical Working Group, Child Survival Technical Working Group, C-MNCH Technical Working Group, and Family Planning Technical Working Group; Regional Health Bureaus; World Health Organization/UNICEF/UNFPA; Ethiopian Midwives Association and Ethiopia Society of Obstetricians and Gynecologists; Integrated Family Health Program (IFHP)

Child Survival Health Grants Program Grantees
Save the Children (SC) – Standard grantee (2009-2012): The Innovation for Scale: Enhancing Ethiopia’s Health Extension Program in the Southern Nations and Nationalities People’s Region Project (SNNPR) has a goal to reduce under-five mortality by enhancing the existing government’s pro-poor strategy (HEP, or Health Extension Package) package to ensure increased efficiency, expanded coverage, and equitable access.

GOAL – New Partner grantee (2007-2011): The Sidama Child Survival Program in the two Woredas of Awassa Zuria and Boricha, Sidama Zone, Southern Nation, Nationalities and Peoples Region (SNNPR) is establishing Care Groups at the household level to expand the reach of the health system, improving community health worker (CHW) capacity to work at the community level, supporting health extension workers (HEWs) at health post and kebele levels, and training traditional birth attendants (TBAs) in Home Based Life-Saving Skills (HBLSS).

Click here to see Rapid CATCH and other select project data generated through small-sample household surveys conducted by CSHGP projects that ended between October and December 2011. (The Rapid CATCH is a tool that contains questionnaires, tabulation plans, and indicator definitions for a set of standard indicators that all grantees collect at baseline and endline.)

Technical Scope
  • MNH at facility and community level
  • Quality improvement 
  • Integrated MNH/PMTCT
  • Preservice education
  • Essential newborn care including resuscitation
  • Postpartum family planning
  • Community KMC

Scale/Coverage National Scale MCHIP will support roll out of the newborn resuscitation program (Helping Babies Breathe), support development of an accelerated midwifery program, identify promising practices in MNH, support the national MNCH Communication and Advocacy Plan, and help identify additional research on cultural barriers to accessing maternal care.

Targeted Geographic Focus
MCHIP is working in four regions: Amhara, Tigray, Southern Nations and Nationalities People (SNNP) and Oromia, which have been identified by USAID as priority regions. MCHIP works in close collaboration with a number of partners, including IFHP. MCHIP support is designed to build upon and/or expand activities implemented by the IFHP, thereby allowing greater coverage of selected interventions.
 

Integrated Approaches MCHIP will implement an integrated quality improvement approach focusing on MNH/postpartum family planning/PMTCT at the facility level. MCHIP will also expand integrated MNH and PMTCT services at selected sites. 
 
Collaboration MCHIP will expand and strengthen selected MNH interventions currently being implemented by the Integrated Family Health Program (IFHP), a comprehensive program addressing gaps in provision of community- and health facility-based reproductive health including FP and MNCH. MCHIP will work with IFHP to identify and support technical areas such as provision of basic emergency and obstetric care training, and immediate care of the newborn.

With core funding, MCHIP will also support activities implemented under the Urban Health Extension Program, focusing on conducting a study to better understand barriers to facility-based delivery in urban settings, as well as develop Ethiopian leaders who will be networked to other country teams working on similar urban health issues, including those around MNCH.
 

Major Results to Date

  • Orientated the Federal Ministry of Health (FMOH) and targeted Regional Health Bureaus (RHBs) to the MCHIP program objectives, and collaborated on site selection and program approaches. A total of 21 health facilities – 5 hospitals and 15 health centers – were selected as project sites for MCHIP for Year One.
  • Introduced a performance and quality improvement (PQI) process, Standards-Based Management and Recognition (SBM-R), to improve the quality of MNCH services provided in the 21 facilities. The workshops and baseline assessments helped the facility staff, managers and providers to understand MNCH performance standards and to identify gaps in provision of MNCH services in their facilities. In response to identified performance gaps, two training courses in basic emergency obstetric and newborn care (BEmONC) were conducted to improve the knowledge, skill and attitude of 32 skilled providers to provide quality essential MNH care.
  • Completed a literature review on cultural barriers affecting women’s utilization of health services and optimal health practices in Ethiopia; the report has been drafted and is being finalized. In the following program year, findings of the review will be shared with the FMOH and partners to provide guidance on how to ensure culturally sensitive and women friendly MNH services.
  • Facilitated the establishment of a core committee to select promising practices in MNH under the auspices of the FMOH. The MNH Promising Practices working document and selection criteria were developed by the core committee (MCHIP is the secretariat of this committee). Partners have been invited to send in their promising practice nominations, and once the promising practices are identified in Year Two, MCHIP will work with the FMoH to identify the appropriate implementation mechanism for scale-up of the selected practices.
  • Assessed and selected 18 facilities to implement Kangaroo Mother Care (KMC) in four regions (Amhara, SNNP, Oromia and Tigray regions), and commenced training providers on KMC as an integral part of the BEmONC training. The protocol developed for evaluating the feasibility of Community-based Kangaroo Mother Care (CKMC) was submitted to Johns Hopkins University and the Ethiopian Health and Nutrition Research Institute (EHNRI) IRBs for ethical approval; provisional approval was obtained from JHU. Additionally, a training module on CKMC for Health Extension Workers (HEWs) was prepared and the necessary equipment and supplies for establishing CKMC are being procured.
  • Ethiopia hosted the MCHIP “Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care,” focusing on prevention and management of postpartum hemorrhage, pre-eclampsia and newborn asphyxia, in Addis Ababa for over 300 participants from different MCHIP implementing countries from February 21-25, 2011.
  • A discussion on efforts to rollout HBB in Ethiopia was initiated with FMOH and partners. The integration of HBB into different MNCH training packages by the FMOH and partners is underway. MCHIP is supporting the FMOH in developing the national HBB implementation plan which will be an integral part of the National Child Health Program. MCHIP will continue to work with the FMOH and partners (including UNICEF) in the rollout of HBB nationally, as well as support an evaluation where appropriate.
  • In its support to the Ethiopian Midwifery Association (EMA), MCHIP supported the association to build its capacity to better manage its organization’s operational functions. The workshop resulted in the finalization of the association’s Human Resource and Financial manual.
  • During the EMA Annual General Assembly the “Midwife of the Year” award was presented to a midwife selected by the selection panel. The selected midwife was recognized for the tremendous work she is doing in a remote and often extremely harsh work conditions in Somali region and it is anticipated that this will be an annual award that recognizes the invaluable efforts midwives make throughout the country in saving lives and will inspire and motivate many other midwives.
  • Over 300 midwives were orientated to the White Ribbon Alliance during the Association’s Annual General Assembly meeting organized in September 2011. One of MCHIPs project goals is to revitalize the White Ribbon Alliance in Ethiopia, and this activity increased the awareness of the need for and importance of the Alliance for MNH advocacy in the country; 
  • Supported five health science colleges (Amhara and SNNP Regions) to improve the quality of pre-service midwifery education. A PQI process was introduced to define standards and identify gaps in midwifery education. Additionally MCHIP signed a sub-agreement with SNNPR RHB to provide financial assistance to three health science colleges.
  • Provided support to the FMOH to adapt the Accelerated Midwifery Education curriculum. The curriculum aims to address the country’s huge need for midwives by training diploma level trained nurses in one year. MCHIP seconded a staff to the FMOH during the adaptation of the curriculum and development of core competencies, and sponsored a national 3-day curriculum review workshop in Adama.

Country Profile

Select Health and Demographic Data for Ethiopia
GDP per capita (USD) 344.42
Total Population 82,824,732
Maternal Health
Maternal Mortality Ratio (deaths/100,000 live births) 470
Percent of maternal deaths due to HIV -
Skilled birth attendant coverage 5.8
Antenatal care, 4+ visits 12.2
Newborn Health
Neonatal mortality rate (deaths/1,000 live births) 39.3
Infant mortality rate (deaths/1,000 live births) 77
Child Health
Under-five mortality (deaths/1,000 live births) 123.5
Treatment for acute respiratory infection 18.7
Oral rehydration therapy for treatment of diarrhea 33.3
Immunizations
Diphtheria-pertussis-tetanus vaccine coverage (3 doses) 79
Percent of districts with >80% DPT3 coverage 55
DPT3 coverage equity ratio (wealthiest:poorest quintile) 1.87
Family Planning
Modern contraceptive prevalence rate 13.9
Total fertility rate 5.4
Malaria
Vulnerable populations who slept under an insecticide-treated net (ITN) the previous night* 1.5
Pregnant women receiving 2 doses intermittent preventive treatment for malaria 0.3
Children with fever treated with antimalarials within 24 hours 0.7
HIV
HIV Prevalence, adult 2.1
ART coverage, adult 29
Health Systems
Density of physicians (per 1,000 population) 0.02
Density of nurses & midwives (per 1,000 population) 0.24
Total Health Expenditure per capita (USD) 14.68
Sources: Demographic information and health systems, World Bank; Newborn health, child health, DPT3 equity ratio, family planning, SBA, malaria, and ANC4, Ethiopia 2005 Demographic and Health Survey; DPT3 coverage and percent districts >80%, MMR, ART coverage and maternal deaths due to HIV, WHO; HIV prevalence, UNAIDS 2008 Epidemic Update
*Calculated from DHS data as number of pregnant women and number of children under five who slept under an ITN the previous night divided by the total number of pregnant women and children under five.