Working in partnership Working in partnership Countdown for Child Survival in Countdown for Child Survival in

EthiopiaEthiopia

London London

13-14 December 200513-14 December 2005

Federal Ministry of Health of the Democratic Republic Federal Ministry of Health of the Democratic Republic of Ethiopiaof Ethiopia

OutlineOutline

• Background Background

• PartnershipPartnership

• HSDP III and areas of focusHSDP III and areas of focus

• The two acceleration vehiclesThe two acceleration vehicles

• Challenges and the way Challenges and the way forwardforward

• ConclusionConclusion

• Utilization of healthUtilization of health servicesservices: 0.36/person/ year (2004): 0.36/person/ year (2004)

• Per capita Health expenditurePer capita Health expenditure, all sources: US$ 5.60 , all sources: US$ 5.60 (2000)(2000)

• Projected population :Projected population :

77,4 million in 2005 (85 % 77,4 million in 2005 (85 % rural)rural)

• U5 mortalityU5 mortality : 140/1000 : 140/1000

• 29% of deaths in neonatal 29% of deaths in neonatal periodperiod

• MMR MMR : 871/100,000: 871/100,000

Neonatal, 25%

Malaria, 20%

Pneumonia, 28%

Diarrhea, 20%

AIDS, 1%

Measles, 4%

Other, 2%

What are Children Dying from?What are Children Dying from?

Malnutrition57%

HIV/AIDS11%

Experience of working in partnershipExperience of working in partnership

• First Global Child Survival Partnership First Global Child Survival Partnership mission in December 2003 to initiate mission in December 2003 to initiate discussion on Partnershipdiscussion on Partnership

• National Child Health situation analysis doneNational Child Health situation analysis done• First National Child Survival Partnership First National Child Survival Partnership

Conference held - April 22-24, 2004Conference held - April 22-24, 2004• National Child Survival Core Technical National Child Survival Core Technical

Working Group establishedWorking Group established• Child Survival strategy developed and Child Survival strategy developed and

endorsed November 2004.endorsed November 2004.

Strong partnership led by Strong partnership led by governmentgovernment

• Government commitment at all levelsGovernment commitment at all levels

• effective linkage of HSDP III with PASDEPeffective linkage of HSDP III with PASDEP

• Consensus among partners on HSDP IIIConsensus among partners on HSDP III– 13 partners Signed Code of Conduct on 13 partners Signed Code of Conduct on harmonizationharmonization

One Plan, One Budget, One Monitoring system One Plan, One Budget, One Monitoring system

(Harmonization) (Harmonization)

Institutionalization Institutionalization of the Child Survival Strategyof the Child Survival Strategy

• Incorporated in the third Health Sector Development Incorporated in the third Health Sector Development Program Program

• Central to the MDG based Plan for Accelerated and Central to the MDG based Plan for Accelerated and Sustainable Development Program (PASDEP)Sustainable Development Program (PASDEP)

• Improved harmonization and alignment of in-country Improved harmonization and alignment of in-country partnerspartners

• Health Extension Program identified as the principal Health Extension Program identified as the principal vehicle for delivery of essential Child Survival vehicle for delivery of essential Child Survival interventionsinterventions

• Community ownershipCommunity ownershipInstitutionalization is critical in translating vision into actionInstitutionalization is critical in translating vision into action

HSDP III prioritiesHSDP III priorities

•Focus AreasFocus Areas– Maternal Health; CPR 75% Maternal Health; CPR 75% – Child Health; DPT 3 = 90% Child Health; DPT 3 = 90% – HIV/AIDS prevention and controlHIV/AIDS prevention and control– Malaria prevention and controlMalaria prevention and control

•2 bednets/HH – all HHs in malarious areas2 bednets/HH – all HHs in malarious areas

Government commitment: Government commitment: No more “business as usual” No more “business as usual”

67

166200

149

108120

136

166200

149

0

75

150

225

1990 2000 2005 2010 2015

Year

Un

der

5 M

ort

ali

ty R

ate

MDG trend Current trend

HSDP III prioritiesHSDP III priorities

• Vehicles (the two lines of 1Vehicles (the two lines of 1o o health care)health care)– Health extension Program (HP)Health extension Program (HP)– Accelerated health center expansionAccelerated health center expansion

• SystemsSystems– Health Management and info System Health Management and info System

(HMIS)(HMIS)– Logistics management system (LMIS)Logistics management system (LMIS)– Finance SystemFinance System

Universal Primary Health Care by Universal Primary Health Care by 20082008

The two acceleration vehicles - strategiesThe two acceleration vehicles - strategies

1.1. Accelerated expansion of Health Posts – Accelerated expansion of Health Posts – 1 HP/village (Health Extension 1 HP/village (Health Extension Package) Package)

2.2. Accelerated expansion of Health Accelerated expansion of Health Centers – 1 HC/ 25,000 populationCenters – 1 HC/ 25,000 population

Health Extension ProgramHealth Extension Program

• Train > 30,000 Health extension workers – Train > 30,000 Health extension workers – 2HEWs / village of 5,000 population2HEWs / village of 5,000 population– 2800 deployed in 2004 and 7,100 will be deployed this 2800 deployed in 2004 and 7,100 will be deployed this

month = 9900 month = 9900

• Build 12,500 Health PostsBuild 12,500 Health Posts– 4148 built4148 built

““Households are the primary producers of Households are the primary producers of Health”Health”

HEP’s Major ComponentsHEP’s Major Components

• Family Health Family Health • Communicable Disease Prevention and Communicable Disease Prevention and

ControlControl• Hygiene and Environmental HealthHygiene and Environmental Health• First AidFirst Aid

There are 16 packages under the above 4 broad areasThere are 16 packages under the above 4 broad areas

Action Steps – HEP implementationAction Steps – HEP implementation

• Discuss with administrators and association leaders Discuss with administrators and association leaders and reach consensusand reach consensus

• Conduct base line survey Conduct base line survey • Select model families (30-45 households at once) on Select model families (30-45 households at once) on

voluntary basisvoluntary basis• Train selected households for 96 hoursTrain selected households for 96 hours• Graduate trained households in 2-3 months (Oath)Graduate trained households in 2-3 months (Oath)• Monitor progress after graduation (HEW and CHWs)Monitor progress after graduation (HEW and CHWs)• Enforce environmental law and penalize community Enforce environmental law and penalize community

members who practice otherwise (Social court)members who practice otherwise (Social court)

In many areas where HEP is being implemented, CPR is reaching up to 80%

Accelerated expansion of Health Accelerated expansion of Health Centers Centers

• Train 3,000 Health Officers in 3 YearsTrain 3,000 Health Officers in 3 Years– Up to 2000 HOs already enrolledUp to 2000 HOs already enrolled

• Upgrade 2167 clinics to health centers, build Upgrade 2167 clinics to health centers, build 563 new563 new– 619 HCs exsting, 443 will be upgraded this year619 HCs exsting, 443 will be upgraded this year

• We are on schedule in relation to the two We are on schedule in relation to the two acceleration targets set for 2008 acceleration targets set for 2008

US$ 3.1 Billion needed to reach child health US$ 3.1 Billion needed to reach child health MDGMDGWith estimated average annual allocation of US$ 307 With estimated average annual allocation of US$ 307

MillionMillion

Marginal Budgeting for Bottlenecks model: overall reduction of under-5 mortality

of 48% by 2010 and 61% by 2015

0.00

1.00

2.00

3.00

4.00

5.00

6.00

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per

Cap

ita

in U

S$

Total recurrent

Total investment

Key ChallengesKey Challenges

• Moving from strategy to accelerated Moving from strategy to accelerated implementationimplementation– Human Resource developmentHuman Resource development– System strengthening System strengthening – Expansion of health infrastructureExpansion of health infrastructure

• Resources for HEPResources for HEP

• Effectively broadening the National Effectively broadening the National Partnership to MNCHPartnership to MNCH

Sustainability Issues - Sustainability Issues -

• Organizing around priorities and Organizing around priorities and outcomes outcomes

• Integrated health systemIntegrated health system• Social mobilization with concrete Social mobilization with concrete

expectations from communities expectations from communities – Health financing (HI - tap own resources)Health financing (HI - tap own resources)

• Accelerate implementation (Scale-up) Accelerate implementation (Scale-up) expansion of health services – Piloting expansion of health services – Piloting only in exceptional situations - BBPonly in exceptional situations - BBP

ConclusionsConclusions• Government commitment Government commitment

– Set clear directions in PASDEP II and HSDP III child Set clear directions in PASDEP II and HSDP III child survival being a key focus area survival being a key focus area

– Prepared Child survival strategyPrepared Child survival strategy– Identified two acceleration vehicles for fast scale-Identified two acceleration vehicles for fast scale-

up up – Started implementing the two strategies and on Started implementing the two strategies and on

schedule in relation to set targets for 2008 schedule in relation to set targets for 2008 – Harmonization is taking shape (CoC)Harmonization is taking shape (CoC)

• Above all, we are ready to face any challenge Above all, we are ready to face any challenge and take any risk to reach our goals – we and take any risk to reach our goals – we value your partnership to realize our vision. value your partnership to realize our vision.

We are determined to win the fight.We are determined to win the fight.

11stst National Child Survival National Child Survival Partnership Conference, April 22-Partnership Conference, April 22-24, 200424, 2004

Together we Together we can make a can make a

difference for difference for the future of the future of our Globeour Globe

Thank youThank you