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12/10/2014Tigray Health Bureau Health Situation in Tigray State, Ethiopia and the Way Forward Government of the Regional State of Tigray Bureau of Health.

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Presentation on theme: "12/10/2014Tigray Health Bureau Health Situation in Tigray State, Ethiopia and the Way Forward Government of the Regional State of Tigray Bureau of Health."— Presentation transcript:

1 12/10/2014Tigray Health Bureau Health Situation in Tigray State, Ethiopia and the Way Forward Government of the Regional State of Tigray Bureau of Health Dublin, 7 July 2004

2 12/10/2014Tigray Health Bureau Introduction Background about Tigray Background about Tigray Health Situation in Tigray Health Situation in Tigray Health Sector strategic plan Health Sector strategic plan Health Extension Package Health Extension Package Concluding note Concluding note

3 12/10/2014Tigray Health Bureau General Background about Tigray Location = northern most part of Ethiopia Location = northern most part of Ethiopia Area = 60,000 km 2 Area = 60,000 km 2 6 Administrative zones, 36 rural districts and 11 urban districts 6 Administrative zones, 36 rural districts and 11 urban districts Population = 4 million; 83% is rural Population = 4 million; 83% is rural Population growth rate = 3% Population growth rate = 3% 95.9% Christians and 4.1% Muslim. 95.9% Christians and 4.1% Muslim. Primary school enrolment is 75% Primary school enrolment is 75% Gender composition = 49% female in 1 o schools and 45% in secondary schools Gender composition = 49% female in 1 o schools and 45% in secondary schools Health service coverage = 68% Health service coverage = 68% Infant mortality = 97/1000 live births Infant mortality = 97/1000 live births Under 5 year mortality = 101/1000 live births Under 5 year mortality = 101/1000 live births

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6 12/10/2014Tigray Health Bureau Health situation in Tigray

7 12/10/2014Tigray Health Bureau Top 10 new outpatient cases: hospitals and health centres Malaria Malaria ARI ARI Skin infection Skin infection Gastritis duodenitis Gastritis duodenitis Helminthiasis Helminthiasis Parasitic infection Parasitic infection Pneumonia, broncho Pneumonia, broncho Ameobiosis Ameobiosis Bronchitis, chronic Bronchitis, chronic Genitourinary Genitourinary

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9 12/10/2014Tigray Health Bureau RED INDICATORS 13% HIV prevalence in pregnant women at sentinel sites. (1994 E.C data, 1995 data on process.) 11 % Female admissions due to ABORTION: number 2 cause of female admission 20% Female admissions due to normal delivery: number 1 cause of female admissions 15%Deaths due to MALARIA, the number 1 cause of death 16%Admissions due to malaria, the number 1 cause of admission 13%New outpatient visits due to malaria, the number 1 cause of outpatient visits 11%Case fatality rate for respiratory TUBERCULOSIS MATERNAL MORTALITY ratio 90UNDER 5 DEATH rate

10 12/10/2014Tigray Health Bureau Number of health institutions by type

11 12/10/2014Tigray Health Bureau Hospitals within 20 km radius catchment area

12 12/10/2014Tigray Health Bureau Health Centers within 10 km radius catchment's area

13 12/10/2014Tigray Health Bureau Hospitals and Heath Centers

14 12/10/2014Tigray Health Bureau Clinics within 5 km radius catchment area

15 12/10/2014Tigray Health Bureau Health Posts within 5 km radius catchment area

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18 12/10/2014Tigray Health Bureau Maternal Services

19 12/10/2014Tigray Health Bureau Immunization coverage for under 1 year

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34 12/10/2014Tigray Health Bureau Our objectives had not always been clear and big enough to bring a meaningful change – lack of a long term vision Our objectives had not always been clear and big enough to bring a meaningful change – lack of a long term vision Our objectives had not always focused on the majority Our objectives had not always focused on the majority Our indicators had not always been measurable Our indicators had not always been measurable Our plans had not always come to action Our plans had not always come to action Our activities had not always been considered in line with costs – neglect of community resources Our activities had not always been considered in line with costs – neglect of community resources Our impact had not always been certain Our impact had not always been certain Background: Major Problems of the Health Sector

35 12/10/2014Tigray Health Bureau Strategic Plan

36 12/10/2014Tigray Health Bureau Our Vision We aspire to have a healthy and prosperous society with the best community based household level health system. We aspire to have a healthy and prosperous society with the best community based household level health system.

37 12/10/2014Tigray Health Bureau Our Goals 1. Improve quality of health care services 2. Increase health services coverage and utilization 3. Implement best health management practices 4. Reduce morbidity and mortality.

38 12/10/2014Tigray Health Bureau Objectives: Goal 1: Improve quality of health care services. Staff 80% health institutions per national/regional standard by 1998/2006GC Staff 80% health institutions per national/regional standard by 1998/2006GC Equip all health institutions per national standard by 1998 Equip all health institutions per national standard by 1998 Improve and maintain the availability of essential drug and supplies in all health institutions to 75% of required amount by Improve and maintain the availability of essential drug and supplies in all health institutions to 75% of required amount by Introduce an effective, efficient, and equitable heath care financing system in Introduce an effective, efficient, and equitable heath care financing system in Increase index of satisfaction of health services customers from 58% to 80% by Increase index of satisfaction of health services customers from 58% to 80% by 1998.

39 12/10/2014Tigray Health Bureau Goal 2: Increase health service coverage and utilization. Increase health services coverage from 68% to 90% by 1998 – primary health care 100%. Increase health services coverage from 68% to 90% by 1998 – primary health care 100%. Sustain immunization coverage above 90% (DPT3) and reduce all antigen defaulter rates below 10% by the end of Sustain immunization coverage above 90% (DPT3) and reduce all antigen defaulter rates below 10% by the end of Expand health extension package to all Tabias (villages) of Tigray by Expand health extension package to all Tabias (villages) of Tigray by Increase health extension agent to population ratio from 0 to 1:2500 by Increase health extension agent to population ratio from 0 to 1:2500 by Increase proportion of households targeted for using at least 1 ITN from 34%-100% by Increase proportion of households targeted for using at least 1 ITN from 34%-100% by 1998.

40 12/10/2014Tigray Health Bureau Goal 3: Implement best health management practice and information system Introduce and maintain best practice management system (strategic planning and management system) civil service reform. Introduce and maintain best practice management system (strategic planning and management system) civil service reform. Introduce autonomous management system in all hospitals by Introduce autonomous management system in all hospitals by Expand drug revolving fund scheme to all hospitals, health centers and nucleus health centers by Expand drug revolving fund scheme to all hospitals, health centers and nucleus health centers by Strengthen simple and modern information system starting from Strengthen simple and modern information system starting from Network (wide area network) all levels of the health system by the end of Network (wide area network) all levels of the health system by the end of 1998.

41 12/10/2014Tigray Health Bureau Goal 4: Reduce morbidity and mortality Reduce maternal mortality rate from 756 to 400 per 100,000 live births by Reduce maternal mortality rate from 756 to 400 per 100,000 live births by Reduce under 5 mortality from 101/1000 to 90/1000 live births by Reduce under 5 mortality from 101/1000 to 90/1000 live births by Reduce infant mortality from 97 to 85 per 1000 live births by 1998 Reduce infant mortality from 97 to 85 per 1000 live births by 1998 Reduce fertility rate from 5.8 to 5 children per woman Reduce fertility rate from 5.8 to 5 children per woman Halt the spread of HIV infection at 7% by Halt the spread of HIV infection at 7% by Reduce malaria prevalence by 25% by Reduce malaria prevalence by 25% by Eliminate Leprosy from 0.6/10,000 to 0.3/10,000 Eliminate Leprosy from 0.6/10,000 to 0.3/10,000 Eliminate measles by Eliminate measles by Eradicate Polio and achieve certification criteria by 1998 Eradicate Polio and achieve certification criteria by 1998

42 12/10/2014Tigray Health Bureau Major activities from the strategic plan Focus on rural majority Health extension service Health extension service –Train and deploy 1200 health extension agents in 2 years –Construct 437 health posts (HPs) in 2 years –Establish community pharmacies in 600 HP (rural villages) –Provide health extension service in ALL (600) rural villages –Maintain child immunization over 90% Upgrade 122 clinics to Health Centres in 3 years Upgrade 122 clinics to Health Centres in 3 years –Equip ALL –Train 122 health officers and 600 nurses –Build additional blocks (expansion) –Establish special pharmacy in 122 Nucleus health centres in 2 years Improve quality of service in all hospitals Improve quality of service in all hospitals –Introduce Quality Assurance standards, Equip and staff

43 Tigray Health Bureau12/10/2014 Health Extension Package

44 12/10/2014Tigray Health Bureau Vision To create healthy family through the introduction of preventive and promotive health service at household level. To create healthy family through the introduction of preventive and promotive health service at household level.

45 12/10/2014Tigray Health Bureau Objective Decrease morbidity and mortality in Tigray by the implementation of health extension package at household level Decrease morbidity and mortality in Tigray by the implementation of health extension package at household level

46 12/10/2014Tigray Health Bureau Specific Objectives Introduce the program in all Tabias of Tigray by the year 2005 Introduce the program in all Tabias of Tigray by the year 2005 Train and assign two extension workers in each Tabia (village) by the end of 2005 Train and assign two extension workers in each Tabia (village) by the end of 2005 Construct one health post in each Tabia, a total of 437 in two years Construct one health post in each Tabia, a total of 437 in two years Continue training CHWs Continue training CHWs

47 12/10/2014Tigray Health Bureau Health extension package as a strategy: Is a major shift by our government to address precursors of ill-health Is a major shift by our government to address precursors of ill-health Is part and parcel of food security program Is part and parcel of food security program The components address major health problems The components address major health problems It brings meaningful increase in service coverage in rural areas reaching the rural majority It brings meaningful increase in service coverage in rural areas reaching the rural majority It is the best strategy to reach MDGs It is the best strategy to reach MDGs

48 12/10/2014Tigray Health Bureau General Strategies Capacity building - community and district levels Capacity building - community and district levels Social mobilization and community empowerment: (sustainability and impact) Social mobilization and community empowerment: (sustainability and impact) Resource mobilization - focus on community resources – appropriate technology Resource mobilization - focus on community resources – appropriate technology Inter-sectoral collaboration: (at all levels) Inter-sectoral collaboration: (at all levels) Adapting strategy to local situations: (no global treatment) Adapting strategy to local situations: (no global treatment) Operational research for continuous improvement Operational research for continuous improvement

49 12/10/2014Tigray Health Bureau Strategies for Implementing HEP at household level Select model families (30-45 households) Select model families (30-45 households) Train model families for 96 hoursin 2 –4 months and Graduate trained HHs (Oath) Train model families for 96 hoursin 2 –4 months and Graduate trained HHs (Oath) Enhance inter-sectoral collaboration Enhance inter-sectoral collaboration Monitor progress after graduation Monitor progress after graduation Enforce environmental bill and penalize community members who practice otherwise (Social court) Enforce environmental bill and penalize community members who practice otherwise (Social court)

50 12/10/2014Tigray Health Bureau COMPONENTS 1. Family planning 2. Maternal health 3. Vaccination 4. Adolescent reproductive health 5. Nutrition 6. Solid and liquid waste 7. Housing 8. Child health

51 12/10/2014Tigray Health Bureau COMPONENTS 9. HIV/AIDS and TB 10. Malaria 11. First aid 12. Insect and rodent control 13. Food sanitation 14. Water sanitation 15. Personal hygiene 16. Latrine construction.

52 12/10/2014Tigray Health Bureau Progress on implementation of HEP: 36,000 families enrolled in one year using existing health workers 36,000 families enrolled in one year using existing health workers Preliminary data showed better health condition in HEP families compared to non-HEP families Preliminary data showed better health condition in HEP families compared to non-HEP families 400 health extension workers are on training, 800 will be trained by mid 2005 (total coverage) 400 health extension workers are on training, 800 will be trained by mid 2005 (total coverage) 200 HPs of the 437 constructed, remaining 237 will be completed by mid HPs of the 437 constructed, remaining 237 will be completed by mid Progress so far indicates that HEP will be implemented in all villages by 2005 Progress so far indicates that HEP will be implemented in all villages by 2005

53 12/10/2014Tigray Health Bureau Experiences gained from healthy family sites: Practical approaches work Practical approaches work Trickling down effect from involved to non-involved farmers Trickling down effect from involved to non-involved farmers Effective social mobilization and community empowerment Effective social mobilization and community empowerment Extension is Low cost but with high impact Extension is Low cost but with high impact Activities mainly address to precursors of ill-health Activities mainly address to precursors of ill-health

54 12/10/2014Tigray Health Bureau As you have seen it from my presentation, our targets are very high and if met could bring meaningful improvement in our health system. We are determined to achieve these targets, and we believe we will The trick is “the tale of the tigers tail” “Never let it go” “Never let it go”

55 12/10/2014Tigray Health Bureau I am sure we will make it however great the challenges may be.

56 12/10/2014Tigray Health Bureau Thank You


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