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

Background Overview of HEP
Objectives HEWs Packages Service delivery modalities &

Organizational support

Achievements &


Geographic location=

Horn of Africa
Second most populous

nation in Africa
It covers 1,104,300 square

Estimated total population

in 2013= 86 million.

Population growth rate = 2.6%

83.6% rural, 16.4% urban

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.


Neonatal mortality rate Under 5 mortality rate MDG 4 Target

Mortality per 1000 live births




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 * 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

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

Woreda Health Office

One HC Five HPs 15-25,000 Pop.

100,000 Health Center 25,000

District Health office

Health Center Health Posts


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.


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


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)


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


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

Planning Implementation Monitoring Supply


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


Thank You!