Working in partnership Countdown for Child Survival in Ethiopia London December 2005 Federal Ministry of Health of the Democratic Republic of Ethiopia

Outline Background Background Partnership Partnership HSDP III and areas of focus HSDP III and areas of focus The two acceleration vehicles The two acceleration vehicles Challenges and the way forward Challenges and the way forward Conclusion Conclusion

Utilization of health services: 0.36/person/ year (2004) Utilization of health services: 0.36/person/ year (2004) Per capita Health expenditure, all sources: US$ 5.60 (2000) Per capita Health expenditure, all sources: US$ 5.60 (2000) Projected population : Projected population : 77,4 million in 2005 (85 % rural) U5 mortality : 140/1000 U5 mortality : 140/ % of deaths in neonatal period 29% of deaths in neonatal period MMR : 871/100,000 MMR : 871/100,000

Neonatal, 25% Malaria, 20% Pneumonia, 28% Diarrhea, 20% AIDS, 1% Measles, 4% Other, 2% What are Children Dying from? Malnutrition 57% HIV/AIDS 11%

Experience of working in partnership First Global Child Survival Partnership mission in December 2003 to initiate discussion on Partnership First Global Child Survival Partnership mission in December 2003 to initiate discussion on Partnership National Child Health situation analysis done National Child Health situation analysis done First National Child Survival Partnership Conference held - April 22-24, 2004 First National Child Survival Partnership Conference held - April 22-24, 2004 National Child Survival Core Technical Working Group established National Child Survival Core Technical Working Group established Child Survival strategy developed and endorsed November Child Survival strategy developed and endorsed November 2004.

Strong partnership led by government Government commitment at all levels Government commitment at all levels effective linkage of HSDP III with PASDEP effective linkage of HSDP III with PASDEP Consensus among partners on HSDP III Consensus among partners on HSDP III – 13 partners Signed Code of Conduct on harmonization One Plan, One Budget, One Monitoring system (Harmonization)

Institutionalization of the Child Survival Strategy Incorporated in the third Health Sector Development Program Incorporated in the third Health Sector Development Program Central to the MDG based Plan for Accelerated and Sustainable Development Program (PASDEP) Central to the MDG based Plan for Accelerated and Sustainable Development Program (PASDEP) Improved harmonization and alignment of in-country partners Improved harmonization and alignment of in-country partners Health Extension Program identified as the principal vehicle for delivery of essential Child Survival interventions Health Extension Program identified as the principal vehicle for delivery of essential Child Survival interventions Community ownership Community ownership Institutionalization is critical in translating vision into action

HSDP III priorities Focus Areas Focus Areas –Maternal Health; CPR 75% –Child Health; DPT 3 = 90% –HIV/AIDS prevention and control –Malaria prevention and control 2 bednets/HH – all HHs in malarious areas 2 bednets/HH – all HHs in malarious areas

Government commitment: No more “business as usual”

HSDP III priorities Vehicles (the two lines of 1 o health care) Vehicles (the two lines of 1 o health care) –Health extension Program (HP) –Accelerated health center expansion Systems Systems –Health Management and info System (HMIS) –Logistics management system (LMIS) –Finance System

Universal Primary Health Care by 2008 The two acceleration vehicles - strategies 1. Accelerated expansion of Health Posts – 1 HP/village (Health Extension Package) 2. Accelerated expansion of Health Centers – 1 HC/ 25,000 population

Health Extension Program Train > 30,000 Health extension workers – 2HEWs / village of 5,000 population Train > 30,000 Health extension workers – 2HEWs / village of 5,000 population – 2800 deployed in 2004 and 7,100 will be deployed this month = 9900 Build 12,500 Health Posts Build 12,500 Health Posts – 4148 built “Households are the primary producers of Health”

HEP’s Major Components Family Health Family Health Communicable Disease Prevention and Control Communicable Disease Prevention and Control Hygiene and Environmental Health Hygiene and Environmental Health First Aid First Aid There are 16 packages under the above 4 broad areas

Action Steps – HEP implementation Discuss with administrators and association leaders and reach consensus Discuss with administrators and association leaders and reach consensus Conduct base line survey Conduct base line survey Select model families (30-45 households at once) on voluntary basis Select model families (30-45 households at once) on voluntary basis Train selected households for 96 hours Train 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 members who practice otherwise (Social court) Enforce environmental law and penalize community members who practice otherwise (Social court)

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

Accelerated expansion of Health Centers Train 3,000 Health Officers in 3 Years Train 3,000 Health Officers in 3 Years – Up to 2000 HOs already enrolled Upgrade 2167 clinics to health centers, build 563 new Upgrade 2167 clinics to health centers, build 563 new – 619 HCs exsting, 443 will be upgraded this year We are on schedule in relation to the two acceleration targets set for 2008 We are on schedule in relation to the two acceleration targets set for 2008

US$ 3.1 Billion needed to reach child health MDG With estimated average annual allocation of US$ 307 Million Marginal Budgeting for Bottlenecks model: overall reduction of under-5 mortality of 48% by 2010 and 61% by 2015

Key Challenges Moving from strategy to accelerated implementation Moving from strategy to accelerated implementation –Human Resource development –System strengthening –Expansion of health infrastructure Resources for HEP Resources for HEP Effectively broadening the National Partnership to MNCH Effectively broadening the National Partnership to MNCH

Sustainability Issues - Organizing around priorities and outcomes Organizing around priorities and outcomes Integrated health system Integrated health system Social mobilization with concrete expectations from communities Social mobilization with concrete expectations from communities –Health financing (HI - tap own resources) Accelerate implementation (Scale-up) expansion of health services – Piloting only in exceptional situations - BBP Accelerate implementation (Scale-up) expansion of health services – Piloting only in exceptional situations - BBP

Conclusions Government commitment Government commitment –Set clear directions in PASDEP II and HSDP III child survival being a key focus area –Prepared Child survival strategy –Identified two acceleration vehicles for fast scale-up –Started implementing the two strategies and on schedule in relation to set targets for 2008 –Harmonization is taking shape (CoC) Above all, we are ready to face any challenge and take any risk to reach our goals – we value your partnership to realize our vision. Above all, we are ready to face any challenge and take any risk to reach our goals – we value your partnership to realize our vision. We are determined to win the fight.

1 st National Child Survival Partnership Conference, April 22-24, 2004

Together we can make a difference for the future of our Globe Thank you