ODA’s Practical Field Experience

SOMALI

OROMIA

SNNP

AMHARAAFAR

TIGRAY

GAMBELLA

BENISHANGUL-GUMUZ

DIRE-DAW AADDIS ABABA

EthiopiaOromia

N

50 0 50100150200250 Kilometers

Adiministrative Regions of Ethiopia

ODA a membership local CSO (>500,000 members); working : health, education, agriculture & rural water supply)

Oromia Development Association (ODA) initiated and run ICBRH /FP Program for 9 years; starting in 2000

The David and Lucile Packard Foundation supported the project

BALE

GUJI

BORENA

ARSIJIMMA

EaAST HARERGE

ILUBABOR

WEST ARSI

WEST SHEWA

WES

T

HARE

RGE

EAST

SHEWA

EAST

WEL

LEG

AWEST WELLEGAKELEM WELLEGA

NORTH SHEWA

HORO GUDURU

S/WEST SHEWA

OROMIA_ZONESODA-RH/FP PROJECT N

OROMIA DEVELOPMENT ASSOCIATIONRH/FP PROJECT SITES

To ensure the availability and accessibility of range of contraceptive choices

To fill in the gaps whenever short acting contraceptives run out of stock (Public sector)

Main source of incentives for CBRHA; besides recognition, provision of uniforms and training

To enable CBRHA continue to serve communities; even when the project phases out

Compensation for CBRHA has enabled project managers:

to undertake rigorous supervision, to standardize schedules, to implement the project rapidly and to maintain service quality

To make the client a more responsible contraceptive userTo use as a revolving fund to procure contraceptives To become less reliant on donors (to ensure sustainability)

The communities were consulted on the amount of user fee

Cost sharing was based on what clients could pay or are already paying for services they are receiving

Ability to pay was determined based on: research findings, participatory rural appraisal (PRA),

For those who could not pay; ◦

Referral to the near by public health facilities

◦

If the health facility was far from CBRHA service delivery point and the clients were very poor, services were provided free of charge

The fee collection system was made simpleRegistry books instead of receipts Minimal additional work for CBRHA

The price set was communicated to communities through community support committees

Sixty percent was paid for CBRHA & 40% was deposited in block account

Internal financial controls/ auditing carried out

1.

MOH assessment of CBRH program (2002-2003),

◦

76% of clients knew and were willing to pay for the services provided by CBRHA, While it was:◦

81% for Oromia region &

◦

90% in areas where ODA-CBRH program was operating

2. ODA project sites Experience: Project sites were divided into two◦

In East Wollega, clients were asked to pay 50% less ◦

In West Wollega clients paid the amount agreed

Finding◦

The number of clients could not increase◦

Even the number of clients decreased over time

More than 98% of 900,000 Clients had been paying

906

18,161

29,347

42,77039377

50044

36,4

47

36,4

75

30,5

41

23,9

20

25,5

89

3503

9

0

10,000

20,000

30,000

40,000

50,000

60,000

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

E.WollegaW.Wollega

1.71.925

4.5

6.1 6.28

6.8

0

1

2

3

4

5

6

7

8

Year 1 Year2 Year 3 Year 4 Year 5 Year 6

Ser

vice

Ch

arge

inB

irr

100%

Summary of User Service Charge Over Six Years in Summary of User Service Charge Over Six Years in Local CurrencyLocal Currency

As a result of the service charge the project was able to motivate community health agents to allocate their spare time to render services for their community

The money collected was used as a revolving fund to procure contraceptives through social marketing to ensure continuity of service whenever the public facility runs out of stock

Up to now 23 CBRHA Associations have been established and making use of the money collected as revolving fund for income generating activities and has continued to serve their communities after the project has closed out.

In countries with low health service coverage CBRHA model has been proved as the most successful approach to mobilize communities and to increase contraceptive uptake

Clients who pay fee for service are more likely to value the services they receive and demand high quality services

Advocacy for service charge and enhancing voluntary CBRH model approaches should be encouraged as part of ensuring contraceptive security efforts

The Packard Foundation

CBRHA & Communities

ODA staff

Conference organizers

Thank you!