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Optimizing the Health Extension Program
17-03-08	Page	1	
A collaborative effort to increase use of community based newborn care
(CBNC) and integrated community case management of childhood illness
(iCCM) services in Ethiopia
	
January,	2017
Outline
■ Background
■ Evolution of OHEP
■ Expected results
■ Learnings
■ Challenges
17-03-08	 Page	2
Background
17-03-08	 Page	3
Background
■  Ethiopia is one of the 12 Low Income Countries that achieved
MDG 4 target.
■  However, 184,000 under five deaths is happening each year.
More than 40% of these deaths happen in newborns.
■  Pneumonia, Diarrhea, Malaria and Malnutrition remain to be
the leading cause of deaths.
17-03-08	 Page	4
17-03-08	 Page	5	
ICCM is implemented at scale where over 30,000
HEWs are trained on competency based training
CBNC rolled-out as of 2013
ICCM quality of care as measured by consistency
between Assessment, Classification and Treatment is
over 80%
Utilization has been persistently low. E.g After two
years of implementation only 8% of Expected
Pneumonia cases and 1% of Diarrheal Disease were
treated at HP (Tadesse, 2014).
Evolution of OHEP
17-03-08	 Page	6
Evolution of OHEP
■  Given the low uptake of the services, FMOH identified the
need for innovative demand generation interventions.
■  To be sustainable these interventions needs to be integrated
in the existing structure.
■  FMOH and BMGF in collaboration with PATH and UNICEF
agreed to take up this challenge
■  Led by FMOH, BMGF, UNICEF and PATH designed this project
as a learning and a capacity building agenda for future scale-
up
17-03-08	 Page	7
Optimizing the Health Extension Program
Partners
■  BMGF- Funder
■  FMOH – Coordinator
■  PATH and UNICEF- Demand side
■  R4D and CHAI – Supply side (Amox DT, ORS and Zn)
■  LSHTM, EPHI and 4 Local Universities for external evaluation
17-03-08	 Page	8
Expected Results
17-03-08	 Page	9
Expected	Results		
Barriers	for	uptake	
idenEfied	
	
	
Theory	of	Change	
developed	
Short	
Term	
(Jul15-Feb	
16)	
Test	the	
evidence	
based	
intervenEons	
by	increasing	
uptake	of	
services	
Interme
diate	
(Feb	2016-
Jan	2018)	
SBCC	strategy	
for	uptake	of	
iCCM/CBNC	
developed	
Long-term	
(Feb-June	
2018)	
17-03-08	Page	10
17-03-08	
Page	11
17-03-08	Page	12	
Barriers	to	low	uElizaEon	
•  Misconcep*ons	and	myths	
related	to	childhood	illness	
and	disease	causa*on	
•  Lack	of	awareness	on	
iCCM/CBNC	services	
•  Preference	for	tradi*onal	
healers	or	home	remedies	
•  	Perceived	poor	quality	of	
services/capacity	of	HEWs
Barriers	to	low	uElizaEon	
•  Weak	iCCM/CBNC	program	
ownership	
•  Service	interrup*on		
(unscheduled	closure)	
•  Drug	stock-out	
•  Limited	skill	and	confidence,	
mainly	in	trea*ng	newborns	
	
17-03-08	Page	13
Developing	Theory	of	Change	
			
Ø  NaEonal	workshop	to	share	findings	of	barrier	analysis	and	to	
design	the	project	intervenEon		
	
17-03-08	Page	14
17-03-08	Page	15
GOAL: To contribute for the improvement of
Newborn and Child Health
Increased iCCM and CBNC service
utilization
Ensuring program
ownership and
accountability
Building Capacity to ensure
availability of quality iCCM/
CBNC services and
sustainable demand
generation activities
Community Education and
Mobilization to improve
care seeking and
household care and
practices for newborns and
children
17-03-08	 Page	16	
Project Objectives
PHCU/Kebele
Command Post
HDA
Community
Woreda:	ImplementaEon	focus	
Demand
generation
capacity
building
Support print and media materials:
Low lit. tools, Projecting Health, Radio
Increase depth of Knowledge
on illness causation and
service availability
Capacity building
Advocacy for
ownership
Level-1
CBDDM
Gap filling
training for
HEWs, PRRT, ISS
District	Health	Office/	District	
AdministraEon
Interventions
Community Education and
Mobilization
Capacity Building Ensuring ownership and
accountability
HP open house CBDDM and Level-1 training
for HDA
Advocate for the inclusion of
iCCM/CBNC indictors as
performance evaluation
Engaging traditional leaders,
schools, Ag. Extension
workers
Command post, PRT, HEWs Support the integration of
iCCM/CBNC in WBP, ISS and
RM
Projecting health, radio,
speaking book
Gap filling training for HEWs Advocate for the allocation of
budget to fill gaps in
commodities
Community meetings for
feedback on health services
Outreach kits for treating sick
children during home visits
Advocate for standard
schedule for HP
17-03-08	 Page	18
Key beneficiaries
Secondary
Ag. Extension workers, religious
and traditional leaders, School
community, HDA
Primary
Mothers/care
givers
17-03-08	 Page	19	
CreaEng	an	
enabling	
environment	
ImpacEng	depth	
of	knowledge,	
building	skills;	
changing	
percepEons
Engaging the Woreda from the outset
Ø  Plan Alignment Workshop
Ø  Engaged in woreda based planning ensuring iCCM/CBNC received due
attention and activities are included in the annual plan
17-03-08	 Page	20
Engaging religious/ traditional healers
17-03-08	 Page	21
Sensitization for Agriculture Extension Workers
17-03-08	 Page	22	
Ø  AEWs	have	interacEon	both	with	
women	and	men	--	serve	as	good	
channel	for	informaEon	on	child	health
Sensitization for school
community
17-03-08	 Page	23
Field testing the KCP
orientation guide
17-03-08	 Page	24
Learnings
17-03-08	 Page	25
Learnings
■  For the sustainability woreda need to be the focus and
interventions need to be aligned with the Woreda
transformation agenda.
■  Addressing ownership from the outset is critical.
■  Innovations that look at the family and the community within
the context of their society is important for success.
■  Integrating a monitoring and feedback approach helps to
generate evidence for possible scale-up.
■  Engaging the woreda administration for multi-sectoral
engagement and political commitment and accountability is
important.
■  Active leadership role of the FMOH and RHBs is critical for
successful implementation and scale-up.
■  The partnership helps in improving the tools and in having a
standardized approach
17-03-08	 Page	26
Challenges
■  Supply: drug stock-out
■  Competing priority by the public sector
■  Nationally rolled out trainings such as the
Level-I HDA training are delayed
■  Relevant data are not part of the HMIS (e.g
treated newborns)
■  FHG- translation is not yet completed
17-03-08	 Page	27
Thank you !
17-03-08	 Page	28

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