HOME BASED NEWBORN CARE: COUNTRY SUCCESSES AND CHALLENGES

Mihret Hiluf (BSc, MPH) Director, AHPDPD FMoH Ethiopia NEWBORN 2013: Global Newborn Health Conference, Johannesburg April 17, 2013

Outline
Background Overview of HEP
Objectives HEWs Packages Service delivery modalities &

Organizational support

Achievements &

Challenges

Background
Geographic location=

Horn of Africa
Second most populous

nation in Africa
It covers 1,104,300 square

kilometers
Estimated total population

in 2013= 86 million.

Population growth rate = 2.6%

83.6% rural, 16.4% urban

Background
Predominately young with 47% < 15 years and 15.4% <5 years 9 Regions and 2 City Administrations, (more than 810 Districts)

EDHS 2011
Fertility rate = 4.8 births per woman Contraceptive prevalence rate: 29% Only 10% of births are attended by skilled personnel.

Background
300

Neonatal mortality rate Under 5 mortality rate MDG 4 Target

Mortality per 1000 live births

200

88
100

68

37
0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010* 2015

Over fifty percent of infant and forty percent of under five deaths in Ethiopia are neonatal Chronic Malnutrition has dropped from 47% to 44% Ethiopia could meet MDG 4 with accelerated progress (from the current rate of 4.4% annual reduction to 6%) and more focus on neonatal deaths Data sources: Updated from Opportunities for Africas Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 data

Background .
Major direct causes of newborn deaths are

- Preterm 37% - Intrapartum related complication (birth asphyxia) 28% - Severe infection 24%.
(Liu L. et al.2012 Global, Regional & National Causes of Child Mortality in 2000-2010).

25 to 45 % of all neonatal deaths occur in the first 24 hours,

with about three-quarters occurring in the first week

Background
Ethiopian Health Tier System

Specialized Hospital (3.5-5.0 million people) General Hospital (1-1.5 million people) Primary Hospital (60,000-100,000 people) Health Centre (15-25,000 people) Health Post (3-5,000 people)

Tertiary level health care

Secondary level health care

Primary level health care

PHCU
Woreda Health Office

One HC Five HPs 15-25,000 Pop.

100,000 Health Center 25,000

District Health office

Health Center Health Posts

5,000

Health Post A

Health Post B

Health Post C

Health Post D

Health Post E

Overview of HEP
Objective: to increase equitable access to essential promotive,

preventive and selected high impact curative health interventions targeting households at the community level.
Fundamental philosophy: if the right health knowledge and

skill is transferred, households can take responsibility for producing and maintaining their own health.
It promotes community involvement, ownership,

empowerment, skill multiplication and self-reliance to ensure sustainability.

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Overview of HEP HEWs

HEWs are 10th grade complete & one year certificate trained

community health workers. More than 95% are females. They are selected with participation of the rural community Paid by government. Two per 3,000-5,000 people at the village level Over 38,000 HEWs being deployed (over 34,000 in rural & 4,000 in Urban). More than 15,000 HPs were constructed and equipped with necessary materials. Supported by Community health development army.

Health Post
Health Post A
1,000 HHs 150 - 200 1 to 5 network Leaders 30 40 HDTs

Serves app 3 - 5,000

people (1,000 HHs) 2 HEWs 30 40 HDTs 150 - 200 1 to 5 network leaders

2 HEWs

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Overview of HEP Packages

Family Health (5)

Hygiene & EH (7)

16 Health Extension Packages

Disease Prevention & control (3)

Health Education

Community level activities : Addressing the three main causes of newborn deaths
Preterm birth complications Prevention of preterm birth & LBW (LLINs ) Clean & Safe delivery Promotion of Skilled attendance & EmONC Essential newborn care as part of PNC ICCM CKMC (Pilot in 10 districts) Intrapartum related (Birth Asphyxia) FANC Clean & Safe delivery Promotion of institutional delivery ENC as part of PNC ICCM Newborn infection

Antenatal management of maternal infections Clean & Safe delivery & promotion of SD ICCM ENC as part of PNC CBNC (Learning phase)

Platform: Health Services Extension Program (HSEP)

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Overview of HEP
Service Delivery Modalities
House Hold Out reach Health Post

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Overview of HEP
HEP Organizational Support Primary Health Care Unit (PHCU)
One HC with five Health Posts Technical & administrative support

Planning Implementation Monitoring Supply

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Achievements & Challenges

MNCH Component Coverage (%)

CPR** ANC* ANC 4+** Skilled delivery* Clean & Safe delivery* Percentage of deliveries of HIV-positive women who received a full course of ARV prophylaxis* PNC* PNC within 2 days** PAB** Exclusive breast feeding < 6months ** Health facilities providing IMNCI * HPs providing ICCM*
Source: * FMoH 2011/12 **EDHS 2011

29 89.1 19 20.4 13 26 44.5 7 48 52 68 77

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Thank You!