Bringing Family Planning to Every Doorstep The Ethiopia Experience Meeting the FP Demand to Achieve MDGs: Vision 2015

BACKGROUND Total Pop. = 76.9 million Population Growth Rate = 2.6% Rural Population = 83% Pop. Under 15 = 44% TFR = 6.4, 5.9, 5.4 (1990, 2000, 2005) Unmet Need = 34% CPR = 13.6% modern methods CPR 4 regions = 29.3%(L10k Project) MMR= 673/100,000 * DHS 2005, Census 2007

Ethiopian Population (Past, Present, Future)

Trend in Current Use of Modern Contraceptive Methods by Married Women of Reproductive Age, L10K Areas by Region,

Acceleration to reach MDG 4

CONCLUSION: Cannot do business as usual!

Health Extension Program (HEP) 33,000 health extension workers (98% female) with one year of training, paid by government (2/5000 people) Supported by voluntary community health workers, the HEP: Empowers caretakers and produce model families, and communities Institutionalizes and standardizes “village” health care delivery linked to PHCU Increases access and utilization of promotional, preventive, and essential curative care services Reduces opportunity cost for families; enhances participation.

Family Health (5) Disease Prevention & Control (3) Hygiene & Environmental Health (7) Health Education & Communication (1) MCH FP Immunization Nutrition Adolescent Health HIV/TB Malaria First AID Personal Hygiene Water and sanitation Food hygiene Latrine Solid & liquid waste disposal Housing construction Insects & Rodents control HEP Components of HEP 16 HEP Packages

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Case Story Kuhar Michael Health Post in Amhara Region Prior to the HEP less than 50 Injectable users from the nearby HC Took 1-4 hours to reach to HC Additional travel costs More waiting time at HC In 2 years time injectable users in the HP increased to 398 within maximum of 30 minutes reach to clients Limited opportunity costs and waiting time

Implanon Insertion by HEWs TOT for 350 providers Rollout Training for 1189 HEWs 67% USAID supported

Lessons Learned Access to FP (particularly injectables and Implants) has increased by bringing services closer to the people Task shifting through training and deployment of HEWs Wide scale coverage brings national impact HEP promotes women’s empowerment Promising practice: use of model families Public-private partnerships

Challenges Huge unmet need for FP requiring more resources Training of all HEWs in the health post in the provision of Implanon Sustainability of supplies of commodities and consumables (particularly Implanon) New HEP supervisory structure needs more support Constraints with the monitoring and evaluation system

Way Forward Career development for HEWs (more discussion at HRH section) Scale up training and service provision in LAFP Multi-sectoral (health, education, youth, women’s affairs ministries) support for Adolescent and Youth Reproductive Health

Way Forward (continued..) Strengthen YFS within the HEP Strengthen HEW supervision through support of the HEW supervisor (Transport, training, better remuneration) Strengthen backup support from the HC to HP using the principle of the PHCU. Strengthen public-private partnerships