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

11/04/2311/04/23 Tigray Health BureauTigray 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


IntroductionIntroduction

• Background about TigrayBackground about Tigray

• Health Situation in TigrayHealth Situation in Tigray

• Health Sector strategic planHealth Sector strategic plan

• Health Extension PackageHealth Extension Package

• Concluding noteConcluding note


General Background about General Background about TigrayTigray• Location = northern most part of EthiopiaLocation = northern most part of Ethiopia• Area = 60,000 kmArea = 60,000 km22 • 6 Administrative zones, 36 rural districts and 11 urban districts6 Administrative zones, 36 rural districts and 11 urban districts• Population = 4 million; 83% is ruralPopulation = 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 1Gender composition = 49% female in 1oo schools and 45% in schools and 45% in

secondary schoolssecondary schools• Health service coverage = 68%Health service coverage = 68%• Infant mortality = 97/1000 live birthsInfant mortality = 97/1000 live births• Under 5 year mortality = 101/1000 live birthsUnder 5 year mortality = 101/1000 live births


Western Central

Southern

Eastern

Mekele

WELKAIT

KAFTA HUMERA

TSILEMTI

TAHTAY ADIYABO

SAMRE

OFLA

TSEGEDE

EROB

ENDERTA

ENTICHO

WUKRO

ABERGELE

ALAJE

RAYAAZEBO

ASEGEDE TSIMBELA

ADWA

LAELAY ADIYABO

HAWZEN

KOLA TEMBEN

WERIE LEHE

HINTALO WAJIRAT

MEREB LEHE

ALAMATA

MEDEBAY ZANA

DEGUA TEMBEN

NAEDER ADET

ATSBI WENBERTA

GULOMAHDA

SAESI TSAEDAEMBA

ENDAMEHONI

TAHTAY KORAROTAHTAY MAYCHEW

GANTA AFESHUMLAELAY MAYCHEW

Tigray

ETHIOPIA



Health situation in Health situation in TigrayTigray


Top 10 new outpatient cases: Top 10 new outpatient cases: hospitals and health centreshospitals and health centres• MalariaMalaria• ARIARI• Skin infectionSkin infection• Gastritis duodenitisGastritis duodenitis• HelminthiasisHelminthiasis• Parasitic infectionParasitic infection• Pneumonia, bronchoPneumonia, broncho• AmeobiosisAmeobiosis• Bronchitis, chronicBronchitis, chronic• GenitourinaryGenitourinary



RED INDICATORS13% 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 admission20% Female admissions due to normal delivery: number 1 cause of female admissions

15% Deaths due to MALARIA, the number 1 cause of death16% Admissions due to malaria, the number 1 cause of admission13% New outpatient visits due to malaria, the number 1 cause of outpatient visits

11% Case fatality rate for respiratory TUBERCULOSIS

504-756 MATERNAL MORTALITY ratio

90 UNDER 5 DEATH rate


Number of health institutions by typeNumber of health institutions by type

0

5

10

15

20

25

30

35

40

87 88 89 90 91 92 93 94 95 96

Year EC

Num

ber

0

20

40

60

80

100

120

140

160

180

Num

ber

Hospital HC HS HP


Hospitals within 20 km radius catchment area


Health Centers within 10 km radius catchment's area


Hospitals and Heath Centers


Clinics within 5 km radius catchment area


Health Posts within 5 km radius catchment area



Immunization Coverage

0%

20%

40%

60%

80%

100%

OPV3 DPT3 BCG MEASLES

0-11MONTS FULLY

IMMUNIZEDTT2 NON

PREGNANTTT2

PREGNANT


0

10

20

30

40

50

60

70

84 85 86 87 88 89 90 91 92 93 94 95

ANC Delivery PNC CPR TT2 preg TT2 Npreg

Maternal ServicesMaternal Services


0102030405060708090

100

84 85 86 87 88 89 90 91 92 93 94 95

BCG DPT3 Measles

Immunization coverage for Immunization coverage for under 1 yearunder 1 year


020406080

100120140160180200

84 85 86 87 88 89 90 91 92 93 94 95

Year EC

num

ber s

tatic

01002003004005006007008009001000

Num

ber o

utre

ach

Static Outreach


73.0%

12.1%

3.7%

60.8%

13.2%

2.6%

Clinical Suspect VCT Clients Blood Donors0.0%

20.0%

40.0%

60.0%

80.0%Year 94

Year 95

HIV Prevalence






CHW-Treated Malaria Patients

4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 6 8 10 12 2 4 68-0210-0212-022-034-0392 93 94 95 96 97 98 99 00 01 02

Month/Year Gregorian Calendar

0

10

20

30

40

50

60

70

80Number of patients (thousands)

0

20

40

60

80

100% CHWs reporting at least 1X/month

Number of Patients % CHWs reporting 1x/mo


Malaria Patients by Treatment Site

11 12 1 2 3 4 5 6 7 8 9 10

Month/ Year Ethiopian Calander

0

20

40

60

80

100

120Thousands

Outpatient Clinic CHW Inpatient

94 95








• Our objectives had not always been clear and Our objectives had not always been clear and big enough to bring a meaningful change – lack big enough to bring a meaningful change – lack of a long term visionof a long term vision

• Our objectives had not always focused on the Our objectives had not always focused on the majoritymajority

• Our indicators had not always been measurableOur indicators had not always been measurable• Our plans had not always come to actionOur plans had not always come to action• Our activities had not always been considered Our activities had not always been considered

in line with costs – neglect of community in line with costs – neglect of community resourcesresources

• Our impact had not always been certainOur impact had not always been certain

Background: Major Problems of the Background: Major Problems of the Health Sector Health Sector


Tigray Health BureauTigray Health Bureau

Strategic PlanStrategic Plan


Our VisionOur Vision

We aspire to have a healthy We aspire to have a healthy and prosperous society with and prosperous society with the best community based the best community based household level health household level health systemsystem..


Our GoalsOur Goals

1.1. Improve quality of health care Improve quality of health care servicesservices

2.2. Increase health services Increase health services coverage and utilizationcoverage and utilization

3.3. Implement best health Implement best health management practices management practices

4.4. Reduce morbidity and mortality.Reduce morbidity and mortality.


Objectives:Objectives: Goal 1: Improve quality of health Goal 1: Improve quality of health

care services.care services.

• Staff 80% health institutions per Staff 80% health institutions per national/regional standard by national/regional standard by 1998/2006GC1998/2006GC

• Equip all health institutions per national Equip all health institutions per national standard by 1998standard by 1998

• Improve and maintain the availability of Improve and maintain the availability of essential drug and supplies in all health essential drug and supplies in all health institutions to 75% of required amount by institutions to 75% of required amount by 1998.1998.

• Introduce an effective, efficient, and equitable Introduce an effective, efficient, and equitable heath care financing system in 1996. heath care financing system in 1996.

• Increase index of satisfaction of health Increase index of satisfaction of health services customers from 58% to 80% by 1998.services customers from 58% to 80% by 1998.


Goal 2: Increase health service Goal 2: Increase health service coverage ancoverage and d utilization.utilization.

• Increase health services coverage from 68% Increase health services coverage from 68% to 90% by 199to 90% by 1998 8 –– primary health care 100%. primary health care 100%.

• Sustain immunization coverage above 90% Sustain immunization coverage above 90% (DPT3) and reduce all antigen(DPT3) and reduce all antigen defaulter defaulter rates below 10% by the end of 1998.rates below 10% by the end of 1998.

• Expand health extension package to all Expand health extension package to all Tabias (villages) of Tigray by 1998.Tabias (villages) of Tigray by 1998.

• Increase health extension agent to Increase health extension agent to population ratio from 0 to 1:2500 by 1998.population ratio from 0 to 1:2500 by 1998.

• Increase proportion of households targeted Increase proportion of households targeted for using at least 1 ITN from 34%-100% by for using at least 1 ITN from 34%-100% by 1998.1998.


Goal Goal 3: Implement best health 3: Implement best health management practicemanagement practice andand

information systeminformation system• Introduce and maintain best practice Introduce and maintain best practice

management system (strategicmanagement system (strategic planning planning and management system) civil service and management system) civil service reform.reform.

• Introduce autonomous management Introduce autonomous management system in all hospitals by 1998.system in all hospitals by 1998.

• Expand drug revolving fund scheme to Expand drug revolving fund scheme to all hospitals, health centers and nucleus all hospitals, health centers and nucleus health centers by 1998.health centers by 1998.

• Strengthen simple and modern Strengthen simple and modern information system starting from 1996.information system starting from 1996.

• Network (wide area network) all levels Network (wide area network) all levels of the health system by the end of 1998.of the health system by the end of 1998.


Goal 4: Reduce morbidity and Goal 4: Reduce morbidity and mortalitymortality

• Reduce maternal mortality rate from 756 to 400 Reduce maternal mortality rate from 756 to 400 per 100,000 live births by 1998.per 100,000 live births by 1998.

• Reduce under 5 mortality from 101/1000 to Reduce under 5 mortality from 101/1000 to 90/1000 live births by 199890/1000 live births by 1998..

• Reduce infant mortality from 97 to 85 per 1000 Reduce infant mortality from 97 to 85 per 1000 live births by 1998live births by 1998

• Reduce fertility rate from 5.8 to 5 children per Reduce fertility rate from 5.8 to 5 children per womanwoman

• Halt the spread of HIV infection at 7% by 1998. Halt the spread of HIV infection at 7% by 1998. • Reduce malaria prevalence by 25% by 1998.Reduce malaria prevalence by 25% by 1998.• Eliminate Leprosy from 0.6/10,000 to 0.3/10,000Eliminate Leprosy from 0.6/10,000 to 0.3/10,000• Eliminate measles by 1998.Eliminate measles by 1998.• Eradicate Polio and achieve certification criteria Eradicate Polio and achieve certification criteria

byby 19981998


Major activities from the strategic Major activities from the strategic planplan

Focus on rural majorityFocus on rural majority• Health extension service Health extension service

– Train and deploy 1200 health extension agents in 2 yearsTrain and deploy 1200 health extension agents in 2 years– Construct 437 health posts (HPs) in 2 yearsConstruct 437 health posts (HPs) in 2 years– Establish community pharmacies in 600 HP (rural villages)Establish community pharmacies in 600 HP (rural villages)– Provide health extension service in ALL (600) rural villagesProvide health extension service in ALL (600) rural villages– Maintain child immunization over 90%Maintain child immunization over 90%

• Upgrade 122 clinics to Health Centres in 3 yearsUpgrade 122 clinics to Health Centres in 3 years– Equip ALL Equip ALL – Train 122 health officers and 600 nursesTrain 122 health officers and 600 nurses– Build additional blocks (expansion)Build additional blocks (expansion)– Establish special pharmacy in 122 Nucleus health centres in 2 Establish special pharmacy in 122 Nucleus health centres in 2

yearsyears• Improve quality of service in all hospitalsImprove quality of service in all hospitals

– Introduce Quality Assurance standards, Equip and staffIntroduce Quality Assurance standards, Equip and staff

Tigray Health BureauTigray Health Bureau11/04/2311/04/23

Health Health Extension Extension PackagePackage


VisionVision

•To create healthy family To create healthy family through the introduction of through the introduction of preventive and promotive preventive and promotive health service at household health service at household level.level.


ObjectiveObjective

•Decrease morbidity and Decrease morbidity and mortality in Tigray by the mortality in Tigray by the implementation of health implementation of health extension package at extension package at household levelhousehold level


Specific ObjectivesSpecific Objectives

• Introduce the program in all Tabias of Introduce the program in all Tabias of Tigray by the year 2005Tigray by the year 2005

• Train and assign two extension Train and assign two extension workers in each Tabia (village) by the workers in each Tabia (village) by the end of 2005end of 2005

• Construct one health post in each Construct one health post in each Tabia, a total of 437 in two yearsTabia, a total of 437 in two years

• Continue training CHWsContinue training CHWs


Health extension package as a Health extension package as a strategy:strategy:

• Is a major shift by our government to Is a major shift by our government to address precursors of ill-healthaddress precursors of ill-health

• Is part and parcel of food security programIs part and parcel of food security program

• The components address major health The components address major health problems problems

• It brings meaningful increase in service It brings meaningful increase in service coverage in rural areas reaching the rural coverage in rural areas reaching the rural majoritymajority

• It is the best strategy to reach MDGsIt is the best strategy to reach MDGs


General StrategiesGeneral Strategies

• Capacity building - community and district Capacity building - community and district levelslevels

• Social mobilization and community Social mobilization and community empowerment: (sustainability and impact)empowerment: (sustainability and impact)

• Resource mobilization - focus on community Resource mobilization - focus on community resources – appropriate technologyresources – appropriate technology

• Inter-sectoral collaboration: (at all levels)Inter-sectoral collaboration: (at all levels)• Adapting strategy to local situations: (no global Adapting strategy to local situations: (no global

treatment) treatment) • Operational research for continuous Operational research for continuous

improvementimprovement


Strategies for Implementing HEP Strategies for Implementing HEP at household levelat household level

• Select model families (30-45 Select model families (30-45 households)households)

• Train model families for 96 hoursin 2 –4 Train model families for 96 hoursin 2 –4 months and Graduate trained HHs months and Graduate trained HHs (Oath)(Oath)

• Enhance inter-sectoral collaborationEnhance inter-sectoral collaboration

• Monitor progress after graduation Monitor progress after graduation • Enforce environmental bill and penalize Enforce environmental bill and penalize

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


COMPONENTSCOMPONENTS

1.1. Family planningFamily planning2.2. Maternal healthMaternal health3.3. VaccinationVaccination4.4. Adolescent reproductive healthAdolescent reproductive health5.5. Nutrition Nutrition 6.6. Solid and liquid wasteSolid and liquid waste7.7. HousingHousing8.8. Child healthChild health


COMPONENTSCOMPONENTS9.9. HIV/AIDS and TBHIV/AIDS and TB10.10.MalariaMalaria11.11.First aidFirst aid12.12.Insect and rodent controlInsect and rodent control13.13.Food sanitationFood sanitation14.14.Water sanitationWater sanitation15.15.Personal hygienePersonal hygiene16.16.Latrine construction.Latrine construction.


Progress on implementation of HEP:Progress on implementation of HEP:

• 36,000 families enrolled in one year using 36,000 families enrolled in one year using existing health workersexisting health workers

• Preliminary data showed better health Preliminary data showed better health condition in HEP families compared to non-condition in HEP families compared to non-HEP families HEP families

• 400 health extension workers are on training, 400 health extension workers are on training, 800 will be trained by mid 2005 (total 800 will be trained by mid 2005 (total coverage)coverage)

• 200 HPs of the 437 constructed, remaining 200 HPs of the 437 constructed, remaining 237 will be completed by mid 2005.237 will be completed by mid 2005.

• Progress so far indicates that HEP will be Progress so far indicates that HEP will be implemented in all villages by 2005 implemented in all villages by 2005


Experiences gained from Experiences gained from healthy family sites:healthy family sites:

• Practical approaches workPractical approaches work• Trickling down effect from involved to Trickling down effect from involved to

non-involved farmersnon-involved farmers• Effective social mobilization and Effective social mobilization and

community empowermentcommunity empowerment• Extension is Low cost but with high Extension is Low cost but with high

impact impact • Activities mainly address to precursors Activities mainly address to precursors

of ill-health of ill-health


As you have seen it from my As you have seen it from my presentation, our targets are very high presentation, our targets are very high and if met could bring meaningful and if met could bring meaningful improvement in our health system. improvement in our health system.

We are determined to achieve these We are determined to achieve these targets, and we believe we will targets, and we believe we will

The trick is “the tale of the tigers tail”The trick is “the tale of the tigers tail”

“ “Never let it go”Never let it go”


I am sure we will make it I am sure we will make it however great the challenges however great the challenges

may be.may be.


Thank YouThank You

Documents

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