OROMIA REGIONAL HEALTH BUREAU ANNUAL HEALTH SECTOR ...orhb.gov.et/attachments/article/27/Oromia Health... · 2011, efy october 2012 oromia regional health bureau. annual health sector

OROMIA REGIONAL HEALTH BUREAU, ANNUAL PERFORMANCE REPORT OF 2011 EFY

I

ANNUAL HEALTH SECTOR PERFORMANCE REPORT

2011, EFY

October 2012

OROMIA REGIONAL HEALTH BUREAU

ANNUAL HEALTH SECTOR PERFORMANCE REPORT

October 2012

OROMIA REGIONAL HEALTH BUREAU


LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VI

LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VI

Acronym . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIII

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X

REMARKS FROM DISEASE PREVENTION,HEALTH PROMOTION DIRECTOR AND DEPUTY BUREAU HEAD X IRemarks From Police, Plan, Budget and Monitoring and Evaluation Director . . . . . . . . . . . . . . . . . . .XII

Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII

1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 . HEALTH SERVICE DELIVERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 .1 Health extension program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 .1 .1 Rural Health Extension program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 .1 .2 Urban Health Extension Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2 .2 Hygiene and Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2 .3 Reproductive, Maternal, Neonatal, Child, Adolescents, and Youth Health Services . . . . . . . . . . . . . . . . . . . . 7

2 .3 .1 Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 .3 .2 Maternal Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2 .3 .3 Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2 .3 .4 Nutrition Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2 .4 Prevention and Control Of Communicable Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

2 .4 .1 HIV/AIDS Prevention and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

2 .4 .2 TB, TB/HIV, Drug Resistance TB and Leprosy Diseases Prevention and Control . . . . . . . . . . . . . . . . 24

2 .4 .2 .1 Tuberculosis (TB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

2 .4 .2 .2 Programmatic management Drug Resistance TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

2 .4 .2 .3 Leprosy Programmatic Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

2 .4 .2 .4 TB/HIV Collaborative Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

2 .4 .3 Malaria Prevention and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

2 .5 Neglected Tropical Diseases (NTDs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

2 .5 .1 Blinding Trachoma Elimination Program: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

2 .5 .2 Trachoma Mass Drug Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

2 .5 .3 Trachomatous Trichiasis (TT) Surgery Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2 .5 .4 Service expansion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2 .5 .5 Onchocerciasis/River Blindness: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2 .6 Public Emergency Management & Health Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

CONTENTS


3 QUALITY IMPROVEMENT AND ASSURANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

3 .1 Hospital and Health center reform Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

3 .2 Blood bank services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

3 .3 Clinical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

3 .4 Regulatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

4 LEADERSHIP AND GOVERNANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

4 .1 . Human Resource management and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

4 .2 . Evidence Based Decision Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

4 .3 . Gender Main-streaming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

5 HEALTH SYSTEM CAPACITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

5 .1 Health Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

5 .2 Pharmaceutical Supply and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

5 .3 Health Information System (HIS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

5 .4 Community Based Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

5 .5 Health financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

6 TRANSFORMATION AGENDAS PROGRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

6 .1 Woreda Transformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

6 .2 . Equity And Quality Of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

6 .3 . Compassionate Respectful And Caring Health Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

6 .4 . Information Revolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

7 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

8 . LOOKING FORWARDS TO 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64


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Table 1 .Showed that Constructions of WASH facilities in Health institutions last 5 years (2007-2011) Vs 2011 performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Table 2 .Performance of Sick Young Child treated for Sepsis by Zones and towns, 2011 EC(%) . . . . . . . . . . . . . . 14Table 3 .HIV testing service performance and positivity yield by Town of 2011 EFY . . . . . . . . . . . . . . . . . . . . . . 21Table 4 .Zonal and town ART initiation performance, 2011 EC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Table 5 .Viral load service provision and virally suppressed among HIV patients on ART in Oromia 2011 . . . . . . . . 22Table 6 .TB detection rate by age category in Oromia,2011EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Table 7 .Case Detection/Notification performance of zones and towns, 2011 EC . . . . . . . . . . . . . . . . . . . . . . . 25Table 8 .Showing number of kebeles with malaria elimination Phase by zone . . . . . . . . . . . . . . . . . . . . . . . . 30Table 9 .Measles CFR by zone, Oromia Region, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Table 10 .Performance of regulatory system of the region in 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Table 11 .Pre service and in-service training in Oromia region for 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . 44Table 12 .HealthNet Connectivity by Facility type and connection type . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Table 13 .Government allocation to the health sector2007 to 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Figure 1 .Showed that, WDA leader provided training for 1-5 members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Figure 2 .Showed house hold sanitation service level by zone, of 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Figure 3 .Showed % coverage of open defecation free kebeles by zone ,2011EFY . . . . . . . . . . . . . . . . . . . . . . . . 5Figure 4 .showed Trends of Open Defecation Free kebele by year, Oromia(%) . . . . . . . . . . . . . . . . . . . . . . . . . . 5Figure 5 .Regional institutional WaSH Coverage of 2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Figure 6 .Showing CAR and LAFP coverage by Zones ,2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Figure 7 .Figure 6 .Showing CAR and LAFP coverage by Towns ,2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Figure 8 .Method mix of contraceptive used in Oromia region by the year 20011 EFY(%), . . . . . . . . . . . . . . . . . . . 8Figure 9 .Teenage FP and comprehensive abortion care performance by zones 2011 . . . . . . . . . . . . . . . . . . . . . 9Figure 10 .Trends of skilled Birth attendant from 2008 to 2011 EFY, Oromia . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Figure 11 .Skilled birth attendant performance by zones, 2011 EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Figure 12 .Skilled birth attendant performance by Towns of 2011EFY(#) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Figure 13 .Pregnant women received ANC4 performance by zone of 2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . 11Figure 14 .Early PNC coverage by zone of 2011 EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Figure 15 .Performance of Early PNC visits by days in Oromia 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Figure 16 .Trends of Vaccination coverage, Oromia region, 2007 to 2011 EFY(%) . . . . . . . . . . . . . . . . . . . . . . . 13Figure 17 .Trend of Nutritional status in Oromia Region (%) (EDHS by years) . . . . . . . . . . . . . . . . . . . . . . . . . . 15Figure 18 .Trend of TFP Expansion in Oromia from 2003 to 2011 EFY(#) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Figure 19 .Trends of TFP admission in Oromia(#) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Figure 20 .Treatment outcome for therapeutic feeding program, Oromia 2011EFY(%) . . . . . . . . . . . . . . . . . . . . 16Figure 21 .GMP coverage by Zone , 2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Figure 22 .GMP coverage by Town,2011EFY (%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Figure 23 .Trend of Screening and GMP Coverage of Oromia (%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Figure 24 .Trend of VAS and De-Worming Coverage, Oromia(%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Figure 25 .Coverage of Vitamin A Supplementation by Zone& Town of Oromia, 2011(%) . . . . . . . . . . . . . . . . . . 18

LIST OF TABLES

LIST OF FIGURES


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Figure 26 .Coverage of IFA 90+ tablet supplementation to pregnant women by Zone in Oromia, 2011 . . . . . . . . . 18Figure 27 .HIV Testing through Social Networking among FCSW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Figure 28 .HIV Positivity yield (%) among different Population group, 2011 EC, Oromia . . . . . . . . . . . . . . . . . . . 20Figure 29 .HIV testing service performance and positivity yield by zones of 2011 EFY . . . . . . . . . . . . . . . . . . . . 20Figure 30 .Trends of HIV test service from 2007 -2011 EFY,Oromia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Figure 31 .HIV/AIDS Panel discussion with different stakeholders,Oromia,2011EFY . . . . . . . . . . . . . . . . . . . . . . 23Figure 32 .Trends of TB detection rate of oromia (2007 -2011EFY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Figure 33 .Trend of Treatment cure rate and success rate of PTB+,2010 by zone(%) . . . . . . . . . . . . . . . . . . . . . 26Figure 34 .Trends of Drug Resistance TB Patient enrolled to Treatment (2007 -2011EFY) in Oromia . . . . . . . . . . . . 26Figure 35 .Oromia Malaria Case Trends by year (2003-2011)(#) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Figure 36 . Oromia Malaria case trends in months over the last three years (2009-2011) . . . . . . . . . . . . . . . . . . 28Figure 37 . . Number of malaria deaths reduction(facility based) by year (2008-2011 E .C) . . . . . . . . . . . . . . . . . . 28Figure 38 .Oromia Long lasting impregnated nets (LLINs) distribution and replacement by year 2003-2011 E .C(#) . . 29Figure 39 .Showed Five Years Therapeutic Coverage of STH/SCH MDA in Oromia(#) . . . . . . . . . . . . . . . . . . . . . 31Figure 40 .Cholera Epidemiological curve by date of onset Oromia region, 2011 EFY(#) . . . . . . . . . . . . . . . . . . . 32 Measles Outbreak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Figure 41 . EHCRIG performance(%) of the region by zone, 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Figure 42 .Trends of blood unit collected in the region as of 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Figure 43 .Annual Performances of OPD Visit by age category, Oromia 2011EFY (%) . . . . . . . . . . . . . . . . . . . . . 38Figure 44 .Annual Performances of OPD Visit by Gender,Oromia 2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . . . . 39Figure 45 .Annual Performances of OPD Visit by age category,Oromia 2011EFY(%) . . . . . . . . . . . . . . . . . . . . . . 39Figure 46 . Annual Performances of OPD per capita by zone, 2011EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Figure 47 .Annual Performances of OPD percapita by town admin,2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Figure 48 .Annual Performances of Admission Rate by Zone of 2011 EFY (per 1000 population) . . . . . . . . . . . . . 40Figure 49 . Bed occupancy rate of 2011 by Zone and towns (%) . . . . . . . . . . . . . . . . . . . . . . . . . . 41Figure 50 .Average Length of Stay of 2011 by Zone(days) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Figure 51 .Trends of density of human capital in health sector as of 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . 44Figure 52 .Pictures of different workshops and awareness creation on Gender Main streaming/ sexual violence, 2011 EFY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Figure 53 .Closing program of women training on leadership and health reforms . . . . . . . . . . . . . . . . . . . . . . . 46Figure 54 .Trends of Health facilities expansion by year(number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Figure 55 .Ratio of Health center and health posts to population of the region,2011 . . . . . . . . . . . . . . . . . . . . . 47Figure 56 .Ratio of different types of hospitals to population of the region,2011 . . . . . . . . . . . . . . . . . . . . . . . . 48Figure 57 . Services Delivery monthly report completeness and timeliness, 2011(%) . . . . . . . . . . . . . . . . . . . . 52Figure 58 .Trends of allocated budget for the Woredas and share of WoHOs’ . . . . . . . . . . . . . . . . . . . . . . . . . 56Figure 59 . Trend of budget allocated for woreda Health office by line item . . . . . . . . . . . . . . . . . . . . . . . . . . 56Figure 60 .Shows regional average performance of EHCRIG by chapter, August, 2019, Oromia Region (%) . . . . . . . 57


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ACRONYM

AHSPR Annual Health Sector performance reportALOS Average Length of StayANC Antenatal CareAPTS Auoditable Pharmaceutical Transaction and serviceART Anti-Retrovirus Treatment BEmONC Basic emergency maternal and obstetric Newborn careBOR Bed Occupancy RateCASH Clean and Safe Health FacilityCBHI Community based Health InsuranceCBMP Capacity Building and Mentorship programCBT Competency based trainingCDR Case Detection RateCEmONC Comprehensive emergency maternal and obstetric Newborn careCHIS Community Health insurance SystemCMAM Community moderate acute malnutritionCPR Contraceptive Prevalence RateCVRS Civil and vital registration SystemDM Diabetic MallietusDOR Drop out rateEDHS Ethiopian demography health SurveyEHCRIG Ethiopian Health Center Reform Implementation Guidelines EHSTG Ethiopia Hospital Service Transformation GuidelineEPI Expanded Program of ImmunizationEPNC Early Postnatal CareFCSW Females Commercial Sex workersFP Family PlanningGMP Growth monitoring and promotionGTP2 Growth and transformational planHEP Health Extension ProgramHEW Health Extension WorkersHIS Health Information systemHIV Human Immunio virusHMIS Health Management information systemHSTP Health Sector transformational PlanIDPs Internally Displaced Population IRS Indoor Residual SprayLAFP Long acting family planning LLINs long-lasting insecticidal nets LNMP last normal menstrual period MDA Mass Drug AdministrationMDR-TB Multi-Drug resistance TBMEDHS Mini Ethiopian demographic health Survey


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MUAC Mid-upper Arm circumferenceNCD Non Communicable DiseaseNCoD National Disease classificationNTD Neglected tropical DiseaseODF open defecation freePHCG Primary Health Care Clinical GuidelinesPHCU Primary Health Care UnitPMT Performance Monitoring teamRDTs rapid diagnostic testsSaLTS Saving Lives through Safe Surgery SBA . . Skilled Birth Attendant SNS Social Networking Services TB TuberculosisTCR Treatment Success RateTFP Therapeutic Feeding Program TT Trachomatous TrichiasisWDA Women Developmental Army


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FOREWORD

The 2011 Health Sector Performance Report presents brief progress of agreed activities, outputs, performance of health sector and come up with strategies and recommendation on how to improve the health system . This report is produced at the time we have left with one year of our HSTP plan and it gives us vital inputs which indicates us were we are in our last 4 years .This prepared report will support the Regional Health Bureau to engage in effective health sector planning and decision-making going forwards .This report will be presented and distributed for different stakeholders on different meeting such as heath conference on which they express their interest on the

areas required support, reflect on the challenges they faced, and look forward to 2012 plan and last GTP2 to build on our shared successes . As such, I am confident that the report provides a comprehensive and genuine information of how the health sector has performed this 2011 EFY and will plan for the last annual plan of HSTP, 2012 EFY .The regional health bureau remains committed to improving the health of the community through prioritising evidence-based, cost-effective strategies and interventions such as Health extension program and community based health insurance . I strongly recognize the contribution of all actors in the health system to the achievements of our shared goals . This includes first and foremost the hard work of front-line health workers from doctors, nurses, and midwives, to health extension workers; but also the hard work of managers and technical staff across the region at health centers, hospitals, woredas, zonals and regional level; health development partners; civil society representatives; the private sector; and the community in the achievement of progress in the financial year 2011 .Without them, there would be no performance to report on, so this report is, more than anything, a reflection of their hard work .Under the Government’s leadership and particularly the leadership of the region, a strong, collaborative working relationship amongst all stakeholders will continue to be supported to improve the health of the community .I really again re-affirm my commitment as previous year to this year also . It is truly the most important report the region produces, and I am proud to share it with all of you . I encourage all of us to use its findings to inform future plans to improve health in region, so that together we can deliver a strong, resilient health system that meets the needs of our whole community .

HE Dr Dereje Duguma (MD, MPH)Oromia Regional Health Bureau Head


XI

REMARKS FROM DISEASE PREVENTION,HEALTH PROMOTION DI-RECTOR AND DEPUTY BUREAU HEAD

Currently our Regional Health Bureau is going to complete the its five year Health Sector Transformation Plan (HSTP), which is part of the broader country and regional Growth and Transformation Plan . Throughout this strategic plan period, we have strived to reverse the long standing health problems and maximally tried to full-fill the health care needs of our society .

Despite, we have made immense progress in decreasing maternal and

child mortality with strong commitment and concerted effort of political leaders, all health workforces, development partners and at large the community participation, still there is high morbidity and mortality from major infectious diseases (TB, HIV, Malaria, NTD etc…), non-communicable diseases, and trauma . Above all, quality and equity of the services provided for the community is still the biggest challenge . Hence, to address these existing and emerging challenges, our bureau is strongly working with special emphasis on the four transformation agendas . Namely; Woreda transformation, transformation in equity and quality of health care, Caring, Respectful and Compassionate health workforce and finally Information revolution which need yet great attention to achieve in the coming one year of HSTP period .

Our unlimited and joint effort towards improving the maternal, child health services and decreasing the burden imposed on our people due to communicable, non-communicable disease and trauma enabled us to cope up several challenges which we faced during the implementation of this fiscal year to render the fairly good health services and improve low utilization of preventive and curative health services .

To this end, once again, I would like to express my sincere appreciation to all leaders, health workforces at all levels and our development partners, for their unreserved efforts for the achievement of our joint plan .

Dr. Mengistu Bekele (MD, MPH)Oromia Regional Health

Bureau Deputy Bureau Head


XII

REMARKS FROM POLICE, PLAN, BUDGET AND MONITORING AND EVALUATION DIRECTOR

Producing information and disseminating it for all stakeholder is very important to improve information use culture, enhance evidence based decision making and improve quality and coverage of health service .Besides to this it also ensure accountability of the ORHB to the population, development partners and actors across the sector . End to this, the regional health bureau has prepared the 2011 EFY health sector annual performance report which briefly reports on core activities across the sector, as well as highlights whether those activities actually translated into improved outputs and health outcomes for the population . This allows us to take well understanding of what is working well, and what is not working well,

and to adjust our plans for future years accordingly . It is my pleasure therefore to present this report to you all – a full account of our activities and performance, and the challenges we faced in getting there . As well I encourage all health sector staffs and other stakeholders to use this report to understand the implementation status, gaps in HSTP implementation and working up on the gaps together to improve health status of the community . A sincere thank you to all those that contributed to these results


XIII

ACKNOWLEDGEMENT

Regional Health Bureau is grateful to acknowledge program directorates for their facilitation, coordination, availing important data and unreserved involvement for the preparation of this annual health sector performance report .

All health sector staffs, leaders at different levels deserve special appreciation for their active involvement in the planning and execution of the plan to achieve these results and moreover, regional health bureau appreciates all development partners in the health sector for their concerns and incredible support that has great input in achieving our targets .

Heart felt gratitude goes to members of regional PMT and other bureau’s expert such as Mr Abera Botore, Mr Lamessa Tadesse, Mr Asfaw Benti, Mr Dereje Bekele, Mr Awol Husen, Mr Heyo Garedo, Mr Taye Wondimu, Mr Birhanu Kenate, Mr Saiefe Redahgn, Mr Wegari Tessema, Mr Antensay Amare, Mr Zerihun Ayanew, Mr Kemerdin Shifawu for their unreserved contribution during the analysis, cleaning and write up of this report and to JSI-DUP project for financial and technical support for preparation and printing of this 2011 EFY AHSP report .

Our appreciations also goes to Bureau Senior Management for their guidance, invaluable comments during the whole phase of preparation of this annual health sector performance report .


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1. INTRODUCTION

To provide quality, equitable service and improve the health outcome of the community, the regional health bureau has been highly excelling on the health policy which is focusing on the disease prevention and health promotion . To realize this and increase the community benefits to high level; the health extension program packages which are community centred programs contributed to the achievement of MDG gaols of core programs . Similarly, the Regional Health Bureau has been implementing different health care quality reforms with ministry of health and supporting partners in all the health institutions found in the region for the achievement of the second health sector transformational plan and sustainable development goals(SDG) .

Furthermore, by the efforts and commitments of government health service access coverage has been improved . Currently, there are about 85 functional public hospitals, 1400 health centers, and 7090 health posts . Moreover, there are 23 other hospitals (5 University hospitals,4 other governmental organizations -OGO, 4 Non-governmental Organizations-NGO and 12 Private), and 5 NGO health centers and 3149 different types of private clinics, 45 pharmacies, 371 drug stores and 550 rural drug vendors functioning in the region . Thus, the region has a total of 108 hospitals and 1405 health centers where the potential health service coverage of the region in terms of health centers and Health posts were 93% and 94% for the year 2011 EFY respectively . With regard to human resource, there are more than 70,098 health work force density (49,220 health professionals and 20,878 supportive staffs) in sector as of 2011 EFY .

This Annual Performance Report represents the 4th year of the Health Sector Transformation Plan (HSTP) performance, and mainly highlights the four pillars of HSTP: (i) Health Service Delivery; (ii) Quality Improvement and Assurance; (iii) Leadership and Governance; and (iv) Health System Capacity with the progress status on the strategic objectives of the health sector under these four themes/pillar .

This 2011 EFY annual health sector performance report is produced from routine report collected via District health information system-DHIS2 triangulated with previous year report, EDHS, supportive supervision and review meeting reports . The process of development of the AHSP report was highly consultative, participatory and transparent .This report was initially written by different groups of some performance monitoring team(PMT) and coordinated by plan, budget and M&E directorate then reviewed jointly by all the members together, finally presented to and commented by senior Bureau management members, before being finalized .


2

2. HEALTH SERVICE DELIVERY

2.1 Health extension program

2.1.1 Rural Health Extension program

Under the framework of Primary Health Care, HEP was primarily designed to make essential Health Services accessible to every segment of society at their door-steps with the major objective of providing equitable promotive, preventive and high impact selected curative health services . More over, it improves the health seeking behaviour of the communities . To realize this, more than 13,000 HEWs are currently working in the rural kebele’s of the region .

The main strategy of health extension program was increasing the capacity of WDA leader to make model households through trainings on health extension packages .The program intended to transform all households into model household within short period of time based on expansion of best practice (Babal’isuu Muuxannoo Gaggaarii) and active participation of individual and families .

Since the initiation of the program, several remarkable achievements were registered through improving awareness of the community, availing services to accesses and enhancing services uptakes . Increasing access to high impact maternal and child health services, improvements in contraceptive prevalence rate, increase in institutional delivery, improvement in immunization coverage and increase in latrine coverage are some of major achievement of the program .

To further improve the quality and equitable access to the program, second-generation health extension program is started as key strategic activity . The program was implemented by upgrading HEWs to level IV through additional one year training, revision of the Health Extension Program Packages, renovation and expansion of health posts, equipping and supplying health posts with the necessary equipment and supplies, and enhance community engagement and shifting basic preventive and promotive services to the community level and institutionalization of the WDA platform through competence based training on the health extension program .

However, the achievements registered since the launching and development of HEP, there remains huge gaps to realize the ambitious plan set in the HSTP and the HEP performances became declined due to several factors .

In order to sustain the gains, enhance the efforts of the HEP, and expand its access and promoting participation of individuals, families, and communities in PHC through the strategy of WDA is very crucial . The WDA strategy has also helped to consolidate the gains of the HEP in terms of improving RMNCH and hygiene practices in Oromia regions .In order to strengthen the implementation of WDA strategy, the government have brought multiple signatory sectors together to train WDA leaders in the region . Though, the WDA strategy was assumed to improve HEP performance, the functionality of the WDA strategy has became declined in recent years . In our region 4,543,761 women were organized in 156, 067 teams and 803,890 one to five net-work were established . The percentage of active one-to-five net-work and one-to-thirty WDA leaders are very low . The implementation of WDA is limited and only 27 .4% of one-to-five leaders were reported to be active in participating in competency based training .


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To ensure the functionality and sustainability of WDA the existed HEP implementation document was revised, prepared and then WDA was revitalized . Regional Orientation on the revitalization documents was provided for political leaders, leaders of health sectors and Women & Child Affairs of all zones, towns & Woreda’s . A total of 2,232 leaders were participated on orientation . Revitalization orientation was cascaded to all kebeles . And then model women’s were assigned as leaders of 1-5/WDA, technical team from different sectors was established to follow & organize reports on the status of WDA under governance of steering committee . Similarly, revitalization for Towns & Pastoralist areas were considered .

Besides to this, to improve the capacity WDA leaders the competence based training (CBT) strategy was designed and started in the region . The concept of the WDA CBT training is delivering training to all women developmental army leaders on the Health Extension package programs and making them competent to the level of implementing the packages and becoming model and trainer for their 1-5 members . The training was modular approach which will be given for 52 hours in their vicinity close to their living environment and finally the trainees should receive examination of competency and certified by formal certificate of competency .

The women developmental Army leaders’ competency based training was part of the HEP optimization strategy and focuses on addressing different issues such as:-Mitigate the Skill gaps observed among the 1-5 leaders, motivate the WDA/1-5 leaders, and increase number of model households and with overall objective of ensuring Human resources pool for the Health Extension Program .

Figure 1.Showed that, WDA leader provided training for 1-5 members

Currently, more than 40,000 1-5 leader women received the training . But because of absence of assessors all CBT trained WDA leaders were remained uncertified . To overcome this challenge, the regional health Bureau has trained 100 level IV HEWs and 16 Supervisors on COC assessment methodology in collaboration with Oromia COC Center . After the training of HEWs and Zonal HEP focal persons on COC assessment methodology about 16,000 WDA leaders were assessed and about 14,288 (89%) passed the assessment and certified .


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2.1.2 Urban Health Extension Program

In urban settings, the community-based activities conducted by the urban health extension professionals through the urban HEP are linked to the health centers . Those professionals are nurses with additional training . The urban HEP has essential packages of interventions including hygiene and environmental sanitation, family health care, prevention and control of communicable, NCDs and injuries .

To more functioning the town HEP; family health team initiative was piloted in Jimma health center and expanded to 8 health centers (Jimma & Shashemene Towns) .

2.2 Hygiene and Environmental Health

Poor sanitation, lack of access to clean water supply and inadequate personal hygiene are responsible for 90% of diarrheal disease occurrence . An estimated 64,540 children could be saved every year by improving Water, Sanitation and Hygiene in the country . Millions of people are subjected to WASH-related diseases as a result of recurrent droughts and health emergencies resulting from poor sanitation and hygiene .

Latrine CoverageAs the 2011 report showed, the cumulative coverage of the house hold having improved sanitation services reached 49%, while unimproved sanitation 35% and household with no any type of latrine is 16% . The performance of each zones shown as the following figure(2) .

Oromia regional Health bureau, Annual performance report of 2011 EFY

5

As the 2011 report showed, the cumulative coverage of the house hold having improved sanitation

services reached 49%, while unimproved sanitation 35% and household with no any type of latrine is

16%. The performance of each zones shown as the following figure(2).

Figure 2.Showed house hold sanitation service level by zone, of 2011 EFY.

Open defecation free kebeles

Kebele declared open defecation free (ODF) at regional level accounts 32% (2229 kebeles) in 2011 EFY

Figure 3.Showed % coverage of open defecation free kebeles by zone ,2011EFY

Open defecation free kebele showed promising progress from 2006 to 2010 E.C but, in 2011 EC

assessment conducted in districts showed that ODF declined by two percent.This was due to most of the

51 50 47 46 4641 40 40 38 38 38 36

3227 26

18 18 17 16 14 14

0

10

20

30

40

50

60

West W

ellega

HGW Arsi

Borena IABBale

Kelem W

ellega

West Arsi

Buno Bedele

East

Shewa

Jimma

FSSZ

Oromia

West Guji

North Sh

ewa

East

Wellega

South W

est Sh

ewa

West Sh

ewa

Guji

East

Hararge

West Hara

rge



5




5

As the 2011 report showed, the cumulative coverage of the house hold having improved sanitation

services reached 49%, while unimproved sanitation 35% and household with no any type of latrine is

16%. The performance of each zones shown as the following figure(2).





Open defecation free kebele showed promising progress from 2006 to 2010 E.C but, in 2011 EC

assessment conducted in districts showed that ODF declined by two percent.This was due to most of the

51 50 47 46 4641 40 40 38 38 38 36

3227 26

18 18 17 16 14 14

0

10

20

30

40

50

60

West W

ellega

HGW Arsi

Borena IABBale

Kelem W

ellega

West Arsi

Buno Bedele

East

Shewa

Jimma

FSSZ

Oromia

West Guji

North Sh

ewa

East

Wellega

South W

est Sh

ewa

West Sh

ewa

Guji

East

Hararge

West Hara

rge


Open defecation free kebele showed promising progress from 2006 to 2010 E .C but, in 2011 EC assessment conducted in districts showed that ODF declined by two percent .This was due to most of the latrines constructed were unimproved and on average 101,800 latrine collapse/filled per quarter . In order to overcome this problems regional health bureau had plan to expand sanitation marketing centers . To realize this, this year concrete latrine slab of different sizes 20,167, hand washing facilities 8,420, Shower facility 228 and smokeless stove 3,154 were produced and distributed to households . To expand the sanitation market initiative a total of 18 Sanitation market centers are established of which 16 are constructed separately and 2 are found in Health center compound without having separate house . 91 artesian are deployed in 18 centers with current attrition rate of 4(4 .4%) . A total of 401,645 ETB was gained by artesian this year . Regarding menstrual hygiene management services at school community a total of 3,895 (78%) targeted female students got modes in 2011EFY .


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latrines constructed were unimproved and on average 101,800 latrine collapse/filled per quarter. In

order to overcome this problems regional health bureau had plan to expand sanitation marketing

centers. To realize this, this year concrete latrine slab of different sizes 20,167, hand washing facilities

8,420, Shower facility 228 and smokeless stove 3,154 were produced and distributed to households. To

expand the sanitation market initiative a total of 18 Sanitation market centers are established of which

16 are constructed separately and 2 are found in Health center compound without having separate

house. 91 artesian are deployed in 18 centers with current attrition rate of 4(4.4%). A total of 401,645

ETB was gained by artesian this year. Regarding menstrual hygiene management services at school

community a total of 3,895 (78%) targeted female students got modes in 2011EFY.

Figure 4.showed Trends of Open Defecation Free kebele by year, Oromia(%).

House hold having temporary solid waste management pit 33% and temporary liquid waste

management pit 14%. Similarly, in Oromia house hold having good housing condition accounts for 35%

and with water treatment and safe storage accounts 60%.

One WaSH National Program Consolidated WaSH Account (OWNP-CWA)

One WaSH National Program (OWNP) is a five year program covering the period from July 2013 to June

2019. The Program’s Development objective is to improve the health and well-being of communities in

rural and urban areas in an equitable manner with sustainable water supply and sanitation access and

the adoption of good hygiene practices.

17

2832 34 32

0

10

20

30

40

2007 2008 2009 2010 2011

PERC

ENTA

GE

Figure 4.showed Trends of Open Defecation Free kebele by year, Oromia(%).

House hold having temporary solid waste management pit 33% and temporary liquid waste management pit 14% . Similarly, in Oromia house hold having good housing condition accounts for 35% and with water treatment and safe storage accounts 60% .


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One WaSH National Program Consolidated WaSH Account (OWNP-CWA)

One WaSH National Program (OWNP) is a five year program covering the period from July 2013 to June 2019 . The Program’s Development objective is to improve the health and well-being of communities in rural and urban areas in an equitable manner with sustainable water supply and sanitation access and the adoption of good hygiene practices .

Table 1.Showed that Constructions of WASH facilities in Health institutions last 5 years (2007-2011) Vs 2011 performance.

S.No construction typeplan 5 years (2007-2011)

Performance of 5 years

(2007-2011)

2011 performance (Completed)

%from 5 years

plan

1 Construction of new improved Health facility latrines 493 643 344 130

2 Construction of incinerator at Health facility 230 164 104 75

3 Construction of placenta pit at Health facility 231 157 109 68

4Construction of new water supply facilities at health facilities

280 505 408 175

5 Construction of Public latrine at small towns 36 32 18 89

6 Construction of Communal latrine 32 29 26 91

7 Construction of ash pit 0 55 55

8 construction of demonstration latrine 0 77 0

Total construction 1032 1577 121

OWNP CWA starts in 2007, most of the projects constructed and completed in 2011, this is due to special attention was given by health sector leaders and experts from the region up to woreda levels .

With contribution of OWNP currently our health facilities having water facility has been reached 93%, 62% and 12% by Hospital, health center and Health post respectively as shown on the figure(5) .

93 97 95 97

6862

86 87 85

1212

62

2 1 00

20

40

60

80

100

120

with water facility With Latrine With Incinerator With Placenta pit With Ash pit

HospitalHealth CenterHealth post

Figure 5.Regional institutional WaSH Coverage of 2011EFY(%)

From Institutional WaSH coverage Share of OWNP CWA (rural) indicates that latrine 12, Water for HI 31, Incinerator 12 P .pit 12 and ash pit 31 . In addition to this Logistic purchasing and distribution was undertaken . Accordingly, 161 motor bikes purchased and distributed for 140 program supported rural and 21 small towns supported by Urban WASH .Similarly 28 water quality test kits purchased and distributed to 20 zonal health offices for water quality monitoring .


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2.3 Reproductive, Maternal, Neonatal, Child, Adolescents, and Youth Health Services

2.3.1 Reproductive Health

Family planning

The Region has been working careful on family planning services to make accessible at all primary healthcare delivery points and other outlets . In recent years, the uptake of FP service has shown encouraging improvement . In Oromia, the contraceptive Prevalence Rate (CPR) among currently married women increased from 6 .6 in EDHS 2000 to 39 in MEDHS 2019 in the region . From this the current contraceptive prevalence rate of 9% and unmet need of 30% among teenage girls (15-19) are among the lowest in sub-Saharan Africa . This is due to low access to adolescent and youth friendly services including family planning in this age group compared to older women .By considering this disparity the region try to expands youth friendly service at least in one Health Center of each Woreda .

According to 2011 routine HMIS data, the regional contraceptives acceptance rate (CAR) and LAFP is 72% and 21 % respectively . As depicted in the following table, the coverage of CAR is low in Bale 46 percent and LAFP low in West Guji and Borena (each account 11percent) and high in North Shoa CAR 98 percent and West Wallega LAFP 38% . Disparity of coverage amongst the Zones may be due to leader ship commitment/attention, poor community mobilization, poor client counselling at health facility, dependency on short-term FP methods and poor FP supply chain management system . Substantial variation seen between Towns and Zones because the actual population they are serving were much more greater than the number of population on which they planned .

Figure 6.Showing CAR and LAFP coverage by Zones ,2011EFY(%)

Moreover, over the last 5 years the RHB has made unreserved efforts to expand access to family planning information, counselling services and method mix mainly through the health extension program . Long acting family planning methods have been emphasized in the last five years evidenced by accessing implants and IUCD to community level by capacitate HEWs . Even though, there is improvement on expansion of method mix still performed below regional target . This might be due to poor counselling, shortage of FP supply, HEW trained on IUCD not fully start providing services and poor post training follow up .


8


11

Figure 7.Figure 6.Showing CAR and LAFP coverage by Towns ,2011EFY(%) .

Figure 8.Method mix of contraceptive used in Oromia region by the year 20011 EFY(%),

Other option to increase FP uptake is integration of family planning in all outpatient and inpatient

clinics specially in under 5 OPD, EPI and Maternal clinic. As a result Women’s used Immediate Post-

partum contraception is 42,366(5.1% of all delivery) as a region which is extremely low or poorly

recorded. Of the post-partum women discharged with family planning the highest postpartum

IUCD3%Implants

26%

injectables53%

Oral Contraceptives15%

Parmanent methods0%

Other Methods3%

Other3%

IUCD Implants injectables Oral Contraceptives Parmanent methods Other Methods

Figure 7.Figure 6.Showing CAR and LAFP coverage by Towns ,2011EFY(%)


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Figure 7.Figure 6.Showing CAR and LAFP coverage by Towns ,2011EFY(%) .


Other option to increase FP uptake is integration of family planning in all outpatient and inpatient

clinics specially in under 5 OPD, EPI and Maternal clinic. As a result Women’s used Immediate Post-

partum contraception is 42,366(5.1% of all delivery) as a region which is extremely low or poorly

recorded. Of the post-partum women discharged with family planning the highest postpartum

IUCD3%Implants

26%

injectables53%

Oral Contraceptives15%

Parmanent methods0%

Other Methods3%

Other3%

IUCD Implants injectables Oral Contraceptives Parmanent methods Other Methods


Other option to increase FP uptake is integration of family planning in all outpatient and inpatient clinics specially in under 5 OPD, EPI and Maternal clinic . As a result Women’s used Immediate Post-partum contraception is 42,366(5 .1% of all delivery) as a region which is extremely low or poorly recorded . Of the post-partum women discharged with family planning the highest postpartum contraception was in Adama 34 .3 percent from Towns and FSZ 11 .7% from Zones and the lowest in B/Gurecha, Galen and L/T/L/Dadi (each accounts 0 percent) from Towns and Borena 1,4% from Zones .

Comprehensive Abortion care

Abortion is the termination of pregnancy before fetal viability, which is conventionally taken to be less than 28 weeks from the last normal menstrual period (LNMP) . If the LNMP is not known, a birth weight of less than 1000gm is considered as abortion . This year, of the 99,958(76%) abortions were performed, out of this about 65,203 (65%) were safe voluntary pregnancy terminations and the rests were post abortion care . The percentage of safe abortions ranged between 19 percent in W/Guji to 72 percent in I/A/Bora . This may be due to the services not expanded to all Health Facilities, poor commitment of trained Health Workers and low community awareness on availability of the services . From the total age group received family planning and comprehensive abortion care service the teenage (10-19 years) group used FP service and get abortion in the region were 442,791(9%) and 23,028(23%) respectively . This may show early initiation of sexual intercourse or early marriage . On other hand Abortion services high in towns where the University or colleague available which needs attention .


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Figure 9.Teenage FP and comprehensive abortion care performance by zones 2011

2.3.2 Maternal Health

Skilled Birth Attendant (SBA)

The presence of skilled attendants at births and availability of emergency obstetric care have been shown to greatly reduce maternal deaths due to obstetric complications . It has been identified as the single most important intervention and global benchmark indicator to monitor progress towards the goal of maternal mortality reduction . In response, the Oromia regional government is committed to bring significant change in improving the utilization of high impact maternal, newborn and child health services . Based on this; various initiatives have been performed and encouraging results are obtained so far in the region . Some of the initiatives: - Social mobilization and community participation through “Women development Army”, Pregnant women conferences, Purchase of additional ambulances through community participation . Improving Health Facilities Readiness, Creating home like environment, Improving the competence clinical care providers at HC level by providing training like BEmONC, working to improve infrastructure problems in HCs like water and electric, Expansion of high impact life saving interventions (BEmONC & CEmONC),Continuous Monitoring and supervision and timely feedback . In Oromia, Skilled Birth attendant (SBA) improved from 4.9 in EDHS 2000 to 43.7 in EMDHS 2019 in the region .


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2.3.2. Maternal Health

Skilled Birth Attendant (SBA)

The presence of skilled attendants at births and availability of emergency obstetric care have been

shown to greatly reduce maternal deaths due to obstetric complications. It has been identified as the

single most important intervention and global benchmark indicator to monitor progress towards the

goal of maternal mortality reduction.

In response, the Oromia regional government is committed to bring significant change in improving the

utilization of high impact maternal, newborn and child health services. Based on this; various initiatives

have been performed and encouraging results are obtained so far in the region. Some of the initiatives: -

Social mobilization and community participation through “Women development Army”, Pregnant

women conferences, Purchase of additional ambulances through community participation. Improving

Health Facilities Readiness, Creating home like environment, Improving the competence clinical care

providers at HC level by providing training like BEmONC, working to improve infrastructure problems in

HCs like water and electric, Expansion of high impact life saving interventions (BEmONC &

CEmONC),Continuous Monitoring and supervision and timely feedback. In Oromia, Skilled Birth

attendant (SBA) improved from 4.9 in EDHS 2000 to 43.7 in EMDHS 2019 in the region.

Figure 10.Trends of skilled Birth attendant from 2008 to 2011 EFY, Oromia

2011 EFY report showed that the regional skilled Birth attendant performance is 60% which is below the

target (90%). This may be due to irregular community mobilization (WDA and PMC), Government

structure and community instability, low Health worker commitment and problems related to

ambulance (budget for fuel, long stay at service in some woreda) and problems recording and reporting.

According to the report the lowest performance is in W/Guji 34% and the highest in E/Hararge 72 %.

%80 %74%59 % 60

0

20

40

60

80

100

2008Y 2009Y 2010Y 2011Y

Figure 10.Trends of skilled Birth attendant from 2008 to 2011 EFY, Oromia

2011 EFY report showed that the regional skilled Birth attendant performance is 60% which is below the target (90%) . This may be due to irregular community mobilization (WDA and PMC), Government structure and community instability, low Health worker commitment and problems related to ambulance (budget for fuel, long stay at service in some woreda) and problems recording and reporting . According to the report the lowest performance is in W/Guji 34% and the highest in E/Hararge 72 % .


10

Figure 11.Skilled birth attendant performance by zones, 2011 EFY(%)

In figure 10 some towns SBA coverage is above 100% which may be due to population present actually vary with population provided by BOFEC, choosing to deliver in the hospitals of these cities or receive high referral from other Hospitals .

Figure 12.Skilled birth attendant performance by Towns of 2011EFY(#)

Caesarean section

In 2011 EFY among 1,312,768 expected births, 3% were delivered by caesarean section . This caesarean rate is below the 5 percent minimum recommended by the UN . When we see this rate by zones the lowest in E/Shoa, Arsi, Jimma, E/Hararge, FSZ, N/Shoa, W/Guji and W/Arsi (each account 1 percent) and the highest in west wollega (5%) . Similarly it varied widely by Towns, with the highest in Asella (51%), followed by Jimma Town (26%) . It is possible that women in the surrounding town areas contributed to the high caesarean delivery rates in choosing to deliver in the hospitals of these cities or receive high referral from other Hospitals . This rate from highest to lowest in towns are Asella (52%) Jimma T (26%), Modjo (24%), Adama (24%), Shashamanne (23%), Bishoftu (23%), Robe (21%), Nakamte(20%),Batu (18%), Sebeata(6%) and the rest towns(0%) .


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Antenatal care (ANC)

The quality of antenatal care (ANC) can be measured by the qualifications of the provider, the number and frequency of ANC visits . Antenatal care quality can also be monitored through the package of services received and the kinds of information given to women during their visits . These services raise awareness of the danger signs during pregnancy, delivery, and the postnatal period . They also improve the health-seeking behaviour of the client; orient the client to birth preparedness issues, and provide basic preventive and therapeutic care . Nonetheless, the utilization of quality of ANC service low but promising move is noted in the past four years . Mini-EDHS 2019 reported that ANC follow up with at least one visit and four plus visits as 71% and 41% respectively from EDHS 2016 which is 51 and 22% respectively . On other hand, routine HMIS data, ANC first is 100% and ANC4 is 67% . Regionally, proportion of pregnant women received ANC (at least four plus visits) was 67% with high variation across zones .

Figure 13.Pregnant women received ANC4 performance by zone of 2011EFY(%)

Towns ANC4 performance with range of 12% in B/Gurecha to 391% in Dukem . Maximizing coverage of measures focused on contacts alone is insufficient to reduce maternal, newborn and child mortality . To move towards elimination of preventable causes of maternal and newborn deaths, increased coverage of recommended contacts should be accompanied by increased focus on content of services Looking in to key service packages delivered in the focused ANC platform, according to routine HMIS data 2011 report showed Screening of syphilis for pregnant women is 43% which is yet very low .

Postnatal Care (PNC)

A large proportion of maternal and neonatal deaths occur during the 48 hours after delivery, and these first two days following delivery are critical for monitoring complications arising from the delivery . Thus, postnatal care is important for both the mother and the child not only to treat complications arising from the delivery, but also to provide the mother with important information on how to care for herself and her child .

The postnatal period is a critical phase in the lives of mothers and newborn babies . Most of the maternal and new born deaths occur during this time . Therefore, postnatal care is one of the high impact interventions planned in HSTP 2 with a target to reach 100% by the year 2012 . EDHS 2011 reported PNC coverage is 9% and MEDHS 2019 shows 26 .1% which is three-fold improvement . According to 2011 EFY routine report showed early PNC within 7 days coverage rate is 80% in the region . This coverage of PNC high in B/Badelle Zone 107 % and lowest in W/Guji Zone 52% .


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16

Towns ANC4 performance with range of 12% in B/Gurecha to 391% in Dukem. Maximizing coverage of

measures focused on contacts alone is insufficient to reduce maternal, newborn and child mortality. To

move towards elimination of preventable causes of maternal and newborn deaths, increased coverage

of recommended contacts should be accompanied by increased focus on content of services Looking in

to key service packages delivered in the focused ANC platform, according to routine HMIS data 2011

report showed Screening of syphilis for pregnant women is 43% which is yet very low.

Postnatal Care (PNC)

A large proportion of maternal and neonatal deaths occur during the 48 hours after delivery, and these

first two days following delivery are critical for monitoring complications arising from the delivery. Thus,

postnatal care is important for both the mother and the child not only to treat complications arising

from the delivery, but also to provide the mother with important information on how to care for herself

and her child.

The postnatal period is a critical phase in the lives of mothers and newborn babies. Most of the maternal

and new born deaths occur during this time. Therefore, postnatal care is one of the high impact

interventions planned in HSTP 2 with a target to reach 100% by the year 2012. EDHS 2011 reported PNC

coverage is 9% and MEDHS 2019 shows 26.1% which is three-fold improvement. According to 2011 EFY

routine report showed early PNC within 7 days coverage rate is 80% in the region. This coverage of PNC

high in B/Badelle Zone 107 % and lowest in W/Guji Zone 52%.

Figure 14.Early PNC coverage by zone of 2011 EFY(%)

10799 99 95 93 89 89

82 80 76 75 75 74 74 73 69 6760 58 57 52

0

20

40

60

80

100

120

B/Bed

ele

Borena

W/Hara

rge

E/Welle

ga Bale

E/Shewa

Guji

E/Hara

rge

OromiyaJim

ma

W/Arsi

H/G/W

elleg

a

S/W/Sh

ewa

K/Welle

ga

W/ Well

ega

N/Shewa

W/Shew

a Arsi

I/A/B

ora FSZ

W/Guji

Figure 14.Early PNC coverage by zone of 2011 EFY(%)

To further improve the uptake of PNC service that is provided by skilled care providers; the Regional Health Bureau has initiated different innovative actions in all health centers which is currently expanded as a country is staying all delivered mothers at least for twenty-four hours in the same facility at maternity waiting area .


17

To further improve the uptake of PNC service that is provided by skilled care providers; the Regional

Health Bureau has initiated different innovative actions in all health centers which is currently expanded

as a country is staying all delivered mothers at least for twenty-four hours in the same facility at

maternity waiting area.

Figure 15.Performance of Early PNC visits by days in Oromia 2011

2.3.3. Child Health

Approximately three million babies are born in Ethiopia each year and 81,000 to 90,000 babies are dying

in Ethiopia each year. National Infant mortality rate is at 48/1000 LB, child mortality is at 20/1000 LB and

under 5 years mortality rate is at 67/1000 LB (EDHS 2016). Newborn mortality rate (NMR) has been

stagnant over the past five to ten years; Neonatal mortality accounting for 42% of the under5 mortality.

It is estimated that 25% to 45% of all neonatal deaths occur in the first 24 hours, with about three-

quarters occurring in the first week after birth. Three causes account for about 90% of newborn deaths.

These are severe infections 24%, intra-partum related complications (birth asphyxia) 28%, and preterm

birth complications 37%. Pneumonia (18%) and diarrhoea (9%) are the major cause of mortality in under

5 children too(2014 WHO/CHERG).

In Oromia the under-five mortality has declined to 64 in 2013 from 204 in 1990 among 1000 live births.

The achievements registered in child health is by large is attributable to large scale implementation of

promotive, preventive and curative primary health care interventions alongside a positive trend of

socio-economic changes. Among key child survival interventions that have been implemented successful

and contributed to achievement includes IMNCI, ICCM, expanded program for immunization (EPI),

Nutrition, control of malaria and other infectious diseases which are implemented in an integrated

manner both at primary health care unit and community level. 6428 health posts in the region have

Early PNC within one days, 57

Early PNC within 1-2 days, 6



Figure 15.Performance of Early PNC visits by days in Oromia 2011

2.3.3 Child Health

Approximately three million babies are born in Ethiopia each year and 81,000 to 90,000 babies are dying in Ethiopia each year . National Infant mortality rate is at 48/1000 LB, child mortality is at 20/1000 LB and under 5 years mortality rate is at 67/1000 LB (EDHS 2016) . Newborn mortality rate (NMR) has been stagnant over the past five to ten years; Neonatal mortality accounting for 42% of the under5 mortality . It is estimated that 25% to 45% of all neonatal deaths occur in the first 24 hours, with about three-quarters occurring in the first week after birth . Three causes account for about 90% of newborn deaths . These are severe infections 24%, intra-partum related complications (birth asphyxia) 28%, and preterm birth complications 37% . Pneumonia (18%) and diarrhoea (9%) are the major cause of mortality in under 5 children too(2014 WHO/CHERG) .

In Oromia the under-five mortality has declined to 64 in 2013 from 204 in 1990 among 1000 live births . The achievements registered in child health is by large is attributable to large scale implementation of promotive, preventive and curative primary health care interventions alongside a positive trend of socio-economic changes . Among key child survival interventions that have been implemented successful and contributed to achievement includes IMNCI, ICCM, expanded program for immunization (EPI), Nutrition, control of malaria and other infectious diseases which are implemented in an integrated manner both at primary health care unit and community level . 6428 health posts in the region have been rendering curative service for uncomplicated common causes of childhood illness including pneumonia, diarrhea, malaria


13

and uncomplicated sever acute malnutrition with aims of improving access to unreached segment of the population . moreover, Promotive and preventive services are also integrated with curative service to reduced missed opportunity . On other hand recently introduced community based newborn care is expected to improve the newborn health . A number of initiatives are ongoing to tackle the challenges including availing newborn corners at health centres, establishing neonatal intensive care units in 79 hospitals and more recently, community based newborn care by HEWs . The results of all these concerted efforts are to be seen in the foreseeable future

Immunization service (EPI)Immunization is one of the most cost-effective public health interventions for reducing child morbidity and mortality . Accordingly, routine expanded programme on immunization (EPI) that initially targeted six vaccine preventable diseases has been upgraded to ten targeted childhood disease starting from the first years of HSDP IV .

Over the last five years, encouraging achievements were reported in the area of child immunization . The improvement in EPI is attributed to the improved access and social mobilization through women development army . The coverage of Penta-3 in 2011 at regional level is 102%, but there is variation of performance across Zones . Highest coverage is reported from Borena Zone (133%) and Guji Zone (117%) while low coverage reported from W/Wollega (71%), S/W/shoa (77%), and I/A/B Zone (78%) . MEDHS 2019 result showed that the coverage of Penta3 for Oromia is 53,6% good progress from EDHS 2016 which is 39 .9% . The coverage of measles in 2011 at regional level is reported 94%, but there is significant variation Zones . High coverage is reported from Borena Zone (120%) and low coverage is from W/Wollega (68%) and S/W shoa Zone (71%) .

Similarly 2011 routine report shaowed that fully immunized Children coverage is 1,074,399 (88%) in Oromia . At Zonal level there is high coverage from Borena Zone (115%) and low coverage was from W/Wollega Zone (65%) and from S/W Shoa Zone (66%) . MEDHS 2019 result showed that the coverage of Penta3 for Oromia is 29% have progress from EDHS 2016 which is 24 .7% .


19

Figure 16.Trends of Vaccination coverage, Oromia region, 2007 to 2011 EFY(%)

All-tough the coverage is interesting; Penta1 to Penta3 DOR in some zones like North Shoa (16%), West

Guji(14%), W/Shoa Guji (13%), Horo Guduru Wollega (13%) and W/Hararghe (12%) need attention. The

regional average Penta1 to Penta 3 was 9%. Similarly, the DOR of Penta 1 to Measles 1 was high which is

16%.This was vary from 9% in B/Bedele and W/Wollega to 24% in west Guji.

Sick Young infants treated for sepsis: The implementation of community based newborn care (CBNC) has

brought the identification of sick young infants with very sever Diseases at community level. Health

extension workers trained in CBNC are supposed to provide antibiotic treatment for possible severe

bacterial infection among neonates when referral is not possible & can treat newborns with local

bacterial infection (LBI) at health post level. At health centers, health care providers are supposed to

treat neonates with very severe disease according to the IMNCI guideline. This shows the proportion of

neonatal sepsis (very severe disease & LBI) cases who received treatment at all levels of the health

system. It measures the demand for neonatal sepsis (very severe disease) and utilization of health

services.Among the Estimated number of Sick young infant 0-2 months with sepsis or VSD of this year

about 64% them were received treatment at Health center and Health posts. This highest (123%) was in

Buno Bedele and the lowest (27%) north Shoa as shown in the table

101 102 100 91 101

97 98 95 85 94

91 94 91 82 88

0

100

200

300

2007 2008 2009 2010 2011

Perc

ent

Penta 3 Measles Fully vaccinated

Figure 16.Trends of Vaccination coverage, Oromia region, 2007 to 2011 EFY(%)

All-tough the coverage is interesting; Penta1 to Penta3 DOR in some zones like North Shoa (16%), West Guji(14%), W/Shoa Guji (13%), Horo Guduru Wollega (13%) and W/Hararghe (12%) need attention . The regional average Penta1 to Penta 3 was 9% . Similarly, the DOR of Penta 1 to Measles 1 was high which is 16% .This was vary from 9% in B/Bedele and W/Wollega to 24% in west Guji .


14

Sick Young infants treated for sepsis: The implementation of community based newborn care (CBNC) has brought the identification of sick young infants with very sever Diseases at community level . Health extension workers trained in CBNC are supposed to provide antibiotic treatment for possible severe bacterial infection among neonates when referral is not possible & can treat newborns with local bacterial infection (LBI) at health post level . At health centers, health care providers are supposed to treat neonates with very severe disease according to the IMNCI guideline . This shows the proportion of neonatal sepsis (very severe disease & LBI) cases who received treatment at all levels of the health system . It measures the demand for neonatal sepsis (very severe disease) and utilization of health services .Among the Estimated number of Sick young infant 0-2 months with sepsis or VSD of this year about 64% them were received treatment at Health center and Health posts . This highest (123%) was in Buno Bedele and the lowest (27%) north Shoa as shown in the table

Table 2.Performance of Sick Young Child treated for Sepsis by Zones and towns, 2011 EC(%)

Zones % treated for Sepsis Towns % treated for Sepsis

North Shoa 27 Dukem 0

West Guji 29 Sululta 0

FSOZ 37 Bishan Gurracha 1

SWS 40 Ambo 12

Arsi 40 Robe 23

IAB 49 L/T/L/dadhi 27

E/Hararghe 51 Batu 27

Bale 59 Jimma 41

E/Shoa 59 Gelan 45

H/G/Wollega 62 Woliso 48

W/Shoa 63 Burayou 54

Borena 63 Holeta 60

Oromia 64 Bishoftu 61

W/Arsi 66 Oromia 64

W/Hararghe 67 Asella 71

Jimma 74 Sebeta 118

W/Wollega 86 Nekemte 129

E/Wollega 86 Adama 145

Guji 96 Mojo 234

K/Wollega 103 Shashemene 313

Bunno Bedele 123

2.3.4 Nutrition Program

Worldwide, malnutrition is an underlying cause in the deaths of more than 3 .5 million children under the age of 5 each year (Lancet nutrition series, 2008/ 13) . The nutritional status of children in Oromia region has improved within the last decade; for example stunting prevalence decreased from 47% in 2005 to 35 .5% in 2019 (EDHS) , but the improvement of stunting is not satisfactory to achieve HSTP target by 2020 and need maximum attention by all actors working on stunting reduction .


15


21

2.3.4. Nutrition Program

Worldwide, malnutrition is an underlying cause in the deaths of more than 3.5 million children under

the age of 5 each year (Lancet nutrition series, 2008/ 13). The nutritional status of children in Oromia

region has improved within the last decade; for example stunting prevalence decreased from 47% in

2005 to 35.5% in 2019 (EDHS) , but the improvement of stunting is not satisfactory to achieve HSTP

target by 2020 and need maximum attention by all actors working on stunting reduction.

Figure 17.Trend of Nutritional status in Oromia Region (%) (EDHS by years).

To achieve the targets of those nutritional status community based approach Nutrition services through

routine program that played a key role in child survival and mortality reduction carried out in the

Region. These are

A. Therapeutic Feeding Program (TFP) expansion:- Service coverage expansion of CMAM program was

successful in Oromia region each year since the beginning of CMAM program in 2000 EFY in drought

affected vulnerable zones.

Figure 18.Trend of TFP Expansion in Oromia from 2003 to 2011 EFY(#)

Community Based Management of Acute Malnutrition Program

5247

41 37.5 36.5 35.526

42.434.4

26 22.2 22.516.1 1310.4 9.6 9.6 6.8 10.64.7 4.9

EDHS-2000 EDHS-2005 EDHS0-2011 EDHS-2014 EDHS-2016 EDHS-19 HSTP TARGET

percent

STUNTING UNDERWEIGHT WASTING

3187 33084189

5295 5398 5604 57246493 6679

204 225 414 520 545 688 788 881 937

0

2000

4000

6000

8000

2003 2004 2005 2006 2007 2008 2009 2010 2011

NUMBER

YEAR

Number of OTP Number of SC


To achieve the targets of those nutritional status community based approach Nutrition services through routine program that played a key role in child survival and mortality reduction carried out in the Region . These are

A. Therapeutic Feeding Program (TFP) expansion:- Service coverage expansion of CMAM program was successful in Oromia region each year since the beginning of CMAM program in 2000 EFY in drought affected vulnerable zones .


21

2.3.4. Nutrition Program

Worldwide, malnutrition is an underlying cause in the deaths of more than 3.5 million children under

the age of 5 each year (Lancet nutrition series, 2008/ 13). The nutritional status of children in Oromia

region has improved within the last decade; for example stunting prevalence decreased from 47% in

2005 to 35.5% in 2019 (EDHS) , but the improvement of stunting is not satisfactory to achieve HSTP

target by 2020 and need maximum attention by all actors working on stunting reduction.


To achieve the targets of those nutritional status community based approach Nutrition services through

routine program that played a key role in child survival and mortality reduction carried out in the

Region. These are

A. Therapeutic Feeding Program (TFP) expansion:- Service coverage expansion of CMAM program was

successful in Oromia region each year since the beginning of CMAM program in 2000 EFY in drought

affected vulnerable zones.



5247

41 37.5 36.5 35.526

42.434.4

26 22.2 22.516.1 1310.4 9.6 9.6 6.8 10.64.7 4.9

EDHS-2000 EDHS-2005 EDHS0-2011 EDHS-2014 EDHS-2016 EDHS-19 HSTP TARGET

percent

STUNTING UNDERWEIGHT WASTING

3187 33084189

5295 5398 5604 57246493 6679

204 225 414 520 545 688 788 881 937

0

2000

4000

6000

8000

2003 2004 2005 2006 2007 2008 2009 2010 2011

NUMBER

YEAR

Number of OTP Number of SC



CMAM program has high impact on the reduction of mortality among children less than five years of age and the program is intensively implemented in the region since 2000 EFY .


22

CMAM program has high impact on the reduction of mortality among children less than five years of age

and the program is intensively implemented in the region since 2000 EFY.

Figure 19.Trends of TFP admission in Oromia(#)

Since 2007 EFY to date, a total of 696,937 under five children were admitted and benefited from TFP

program. In 2011 alone a total of 142,424 SAM children were admitted and of these 139,516 (89%) were

declared to be cured. The case load was high in 2008 due to serious drought and in 2011 secondary to

the effect of continuous drought and high number of IDPs occurred in the region. The performance

indicators for therapeutic feeding program are acceptable when compared to the sphere standard. Cure

rate, defaulter rate and death rate respectively were 89%, 2% and 1%.

Figure 20.Treatment outcome for therapeutic feeding program, Oromia 2011EFY(%)

Growth Monitoring and Promotion (GMP) Participation

128,502

178,485

119,245 128,281142,424

0

50,000

100,000

150,000

200,000

2007 2008 2009 2010 2011

NUMBER

YEAR

89%, 89%

2%, 2%1%, 1%2%, 2%

1%, 1%

2%, 2%

3%, 3%

6%, 6%

Cure Rate

Defaulter rate

Death rate

MT rate

NR rate

T out rate

Unknown rate


Since 2007 EFY to date, a total of 696,937 under five children were admitted and benefited from TFP program . In 2011 alone a total of 142,424 SAM children were admitted and of these 139,516 (89%) were declared to be cured . The case load was high in 2008 due to serious drought and in 2011 secondary to the effect of continuous drought and high number of IDPs occurred in the region . The performance indicators for therapeutic feeding program are acceptable when compared to the sphere standard . Cure rate, defaulter rate and death rate respectively were 89%, 2% and 1% .


16


22

CMAM program has high impact on the reduction of mortality among children less than five years of age

and the program is intensively implemented in the region since 2000 EFY.


Since 2007 EFY to date, a total of 696,937 under five children were admitted and benefited from TFP

program. In 2011 alone a total of 142,424 SAM children were admitted and of these 139,516 (89%) were

declared to be cured. The case load was high in 2008 due to serious drought and in 2011 secondary to

the effect of continuous drought and high number of IDPs occurred in the region. The performance

indicators for therapeutic feeding program are acceptable when compared to the sphere standard. Cure

rate, defaulter rate and death rate respectively were 89%, 2% and 1%.


Growth Monitoring and Promotion (GMP) Participation

128,502

178,485

119,245 128,281142,424

0

50,000

100,000

150,000

200,000

2007 2008 2009 2010 2011

NUMBER

YEAR

89%, 89%

2%, 2%1%, 1%2%, 2%

1%, 1%

2%, 2%

3%, 3%

6%, 6%

Cure Rate

Defaulter rate

Death rate

MT rate

NR rate

T out rate

Unknown rate


Growth Monitoring and Promotion (GMP) Participation Monthly growth monitoring is conducted for infant and young children less than 2 years of age each month . It is one of the main activities targeting 1000 days to prevent both acute and chronic malnutrition by monitoring the nutritional status of children during each visit .

Figure 21.GMP coverage by Zone , 2011EFY(%)

Figure 22.GMP coverage by Town,2011EFY (%)

A total of 877, 280 (41%) of children in average were participated on monthly GMP session to be weighed and monitored for their nutritional status in the region . The performance is low when compared to the expected HSTP target level of 85% and only 20% of Zones and Towns reported to have better performances . Very high GMP rate >100 could be either due to data quality or denominator difference .


17


24

Figure 23.Trend of Screening and GMP Coverage of Oromia (%) Child Nutritional Screening:-

Nutritional screening is conducting each month in children age less than five years to identify and manage

acutely malnourished children as early as possible to prevent morbidity and mortality in the community

A total of 2,189,178 (38.6%) children age less than 5 years were screened for acute malnutrition in 2011.

Of these MAM and SAM respectively were 5% and 0.7%. High MAM children were reported from Guji

Zone (11%), Bale zone (9%) and West Guji Zone (8%).

Vitamin A and De-Worming tablet supplementation

To reduce morbidity, mortality and disability in children below 5 years due to micronutrient deficiency,

high impact and cost effective community based interventions like supplementation of Vitamin A and

provision of De-Worming tablet is conducted in all woredas and towns of Oromia.

Figure 24.Trend of VAS and De-Worming Coverage, Oromia(%)

96.4%87.0%

77.0%

51.0%

39.0%

47.0%62.0% 59.0% 60.0% 41.0%

2007 2008 2009 2010 2011

percent

U5 screening Coverage GMP rate

97.30%71%

79%72%

69%98.30%

82% 82%

54%64%

2007 2008 2009 2010 2011

Percent

VAS coverage Deworming

Figure 23.Trend of Screening and GMP Coverage of Oromia (%)

Child Nutritional Screening:-

Nutritional screening is conducting each month in children age less than five years to identify and manage acutely malnourished children as early as possible to prevent morbidity and mortality in the community

A total of 2,189,178 (38 .6%) children age less than 5 years were screened for acute malnutrition in 2011 . Of these MAM and SAM respectively were 5% and 0 .7% . High MAM children were reported from Guji Zone (11%), Bale zone (9%) and West Guji Zone (8%) .


To reduce morbidity, mortality and disability in children below 5 years due to micronutrient deficiency, high impact and cost effective community based interventions like supplementation of Vitamin A and provision of De-Worming tablet is conducted in all woredas and towns of Oromia .


24

Figure 23.Trend of Screening and GMP Coverage of Oromia (%) Child Nutritional Screening:-

Nutritional screening is conducting each month in children age less than five years to identify and manage

acutely malnourished children as early as possible to prevent morbidity and mortality in the community

A total of 2,189,178 (38.6%) children age less than 5 years were screened for acute malnutrition in 2011.

Of these MAM and SAM respectively were 5% and 0.7%. High MAM children were reported from Guji

Zone (11%), Bale zone (9%) and West Guji Zone (8%).


To reduce morbidity, mortality and disability in children below 5 years due to micronutrient deficiency,

high impact and cost effective community based interventions like supplementation of Vitamin A and

provision of De-Worming tablet is conducted in all woredas and towns of Oromia.


96.4%87.0%

77.0%

51.0%

39.0%

47.0%62.0% 59.0% 60.0% 41.0%

2007 2008 2009 2010 2011

percent

U5 screening Coverage GMP rate

97.30%71%

79%72%

69%98.30%

82% 82%

54%64%

2007 2008 2009 2010 2011

Percent

VAS coverage Deworming


The trend of most important nutrition intervention has shown decrement in 2010 and 2011 when compared to the previous years of 2008 and 2009 . The decrement is very critical especially for GMP and Screening performances . Shifting from campaign to routine community based implementation need maximum support to sustain the coverage at community by strengthening HEP to implement routine program effectively to achieve better performance .


18

Figure 25.Coverage of Vitamin A Supplementation by Zone& Town of Oromia, 2011(%)

The bi-annual deliveries of high impact child survival intervention services (supplementation of Vitamin A for children 6 to 59 months and De-worming for children 2 to 5 years) provided in the community . Accordingly, 3,878,762 (68%) of children age 6-59 months were supplemented with vitamin A, while 2,792,629 (69%) of children age 2-5 years have received De-Worming during 2011 . According to the Result of MEDHS 2019 report only 45 .6% of children were supplemented with Vitamin A supplementation .

Maternal Nutritional Screening and Iron Folic Acid (IFA) provision

Maternal screening performance:-A total of 589,392 (45%) PLMs were screened for malnutrition and out of these 141,454 (24%) were found to have MUAC < 23cm .

Performance of Iron Folic Acid (IFA) provision for Pregnant Women:-IFA provision for pregnant mothers has multiple advantages for the mothers as well as for their children . It prevents maternal anemia and decrease maternal mortality 20

to bleeding during pregnancy, delivery and post delivery period . It is also prevent low birth weight, stunting and neural tube defect in neonate if pregnant women take IFA tablet correctly and timely during pregnancy (WHO 2010) . Accordingly, a total of 1,200,685 (91 .5%) Pregnant women were provided with IFA90+ tablet in 2011 . Though, administrative report coverage is good, MEDHS 2019 result showed that only 15% of pregnant women were reported to take IFA90+ in Oromia .


26

Maternal Nutritional Screening and Iron Folic Acid (IFA) provision

Maternal screening performance:-A total of 589,392 (45%) PLMs were screened for malnutrition and

out of these 141,454 (24%) were found to have MUAC < 23cm.

Performance of Iron Folic Acid (IFA) provision for Pregnant Women:-IFA provision for pregnant

mothers has multiple advantages for the mothers as well as for their children. It prevents maternal

anemia and decrease maternal mortality 20 to bleeding during pregnancy, delivery and post delivery

period. It is also prevent low birth weight, stunting and neural tube defect in neonate if pregnant

women take IFA tablet correctly and timely during pregnancy (WHO 2010). Accordingly, a total of

1,200,685 (91.5%) Pregnant women were provided with IFA90+ tablet in 2011. Though, administrative

report coverage is good, MEDHS 2019 result showed that only 15% of pregnant women were reported

to take IFA90+ in Oromia.

Figure 26.Coverage of IFA 90+ tablet supplementation to pregnant women by Zone in Oromia, 2011

142%

121%108%107%103%100%97% 96% 92% 91% 89% 88% 88% 83%

76% 72%65% 64% 62%

43% 38%

0%

20%

40%

60%

80%

100%

120%

140%

160%

West Hara

rge

Borena Z

East

Hararge

East

Shewa

Bale Z

East

Wellega

West W

ellega

North Sh

ewa

Guji Z

OROMIA

West Guji

West Sh

ewa

Arsi Z

Jimma Z

Kelem W

ellega

West Arsi

Horo Gudru W

South W

est Sh

Finifin

e Zu

Buno Bedele Z

Ilu Aba B

ora

Figure 26.Coverage of IFA 90+ tablet supplementation to pregnant women by Zone in Oromia, 2011


19

2.4 Prevention and Control Of Communicable Diseases

2.4.1 HIV/AIDS Prevention and Control

HIV/AIDS is one of the major public health important communicable disease . Oromia regional health bureau in collaboration with key stakeholders and partners like CDC, is taking different measures to avert problems due to HIV/AIDS . The region has undertaken different activities including building technical capacity of health workers, task shifting from high level health professional to mid-level workers, service decentralization to primary health care units and expanding ART services near to community to mitigate the problem of HIV/AIDS epidemic . By doing so, remarkable progresses were made so far in expanding access to HIV prevention, treatment, care and support services in the region .Considering the new strategic plan of the country, which focuses on targeted HIV interventions, has set targets, to achieve the platform to ending AIDS, by 2030 . The three 90s targets are: -

v90% of people living with HIV will know their sero status;

v90% of those diagnosed with HIV infection will receive ART, and

v90% of ART-treated patients will have sustained viral suppression

A. HIV Testing and counselling Service(1st 90)

In order to achieve 1st 90 targets, new approaches and strategies have been being implemented in addition to existing strategies . For example: - Intensifying risk-based testing to pick up many HIV positives to initiate ART using risk assessment tool, Social Networking Services (SNS) primarily focused on key population groups like female commercial sex workers, etc .

Buufata FayyaaKattaa (Bishooftuu)

Figure 27.HIV Testing through Social Networking among FCSW.


20

During 2011 EFY, a total of 3,323,122 testing service was provided as a region and the annual testing performance was 63 .9% from this 13,207 HIV positives clients were identified and the regional average positivity yield was 0 .40% accordingly, the highest positivity yield was reported among partners of PLHV population category .

Figure 28.HIV Positivity yield (%) among different Population group, 2011 EC, Oromia

Figure 29.HIV testing service performance and positivity yield by zones of 2011 EFY


21

Table 3.HIV testing service performance and positivity yield by Town of 2011 EFY

Towns 12 months planTotal HTS Done Newly

PositivesPositivity Proportion (Yield

by %) No. %

Mojo 15,800 29,204 184 .8 287 0 .98Dukem 6,572 10,711 163 .0 111 1 .04Sebeta 26,326 37,787 143 .5 237 0 .63Asella 56,169 69,158 123 .1 416 0 .60Burayu 21,503 26,109 121 .4 203 0 .78Batu 21,184 25,632 121 .0 155 0 .60Gelan 3,449 4,038 117 .1 17 0 .42Robe 26,349 30,287 114 .9 111 0 .37Jimma T 64,118 64,496 100 .6 466 0 .72Bishoftu 93,255 86,982 93 .3 624 0 .72Bi/Guracha 3,337 2,913 87 .3 7 0 .24Laga Tafo 17,339 15,052 86 .8 77 0 .51Adama 115,799 100,069 86 .4 1,327 1 .33Nekemte 78,933 60,506 76 .7 329 0 .54Shashemene 136,136 104,227 76 .6 789 0 .76Ambo 29,592 19,677 66 .5 151 0 .77Holota 20,939 13,058 62 .4 147 1 .13Sululta 6,600 3,682 55 .8 48 1 .30Woliso 39,331 20,143 51 .2 78 0 .39

ORHB 5,196,509 3,323,122 63.9 13,207 0.40


30

Towns 12 months

plan

Total HTS Done Newly

Positives

Positivity Proportion (Yield by

%) No. %

Sululta 6,600 3,682 55.8 48 1.30 Woliso 39,331 20,143 51.2 78 0.39 ORHB 5,196,509 3,323,122 63.9 13,207 0.40

Figure 30.Trends of HIV test service from 2007 -2011 EFY,Oromia B. Anti-Retroviral Treatment (ART) service (Second 90)

In Oromia, currently over 348 health facilities are providing Anti-Retroviral Treatment (ART) service

while 980 are providing PMTCT services. During the reporting period out of 13,207 newly identified HIV

positive clients, only 10,859 (82.2%) were linked and started on ART (Table). Second Line ARV drug has

been decentralized in 71 selected health centers in order to make the service to be accessible. According

to DATIM report as of end of June, 2011 EC, there were 113,181 clients were currently on ART. The

newly WHO recommended ARV drug called Dolutogravile is currently being provided in all ART sites in

the region for naïve ART patients and changing of the newly drug for existing patients is on good track.

34817643031233

2690648 3138880

3323122

1533310946

13743 1399713207

99%

99%

100%

100%

100%

2007 2008 2009 2010 2011

HIV test (#) Positive(#)

Figure 30.Trends of HIV test service from 2007 -2011 EFY,Oromia

B. Anti-Retroviral Treatment (ART) service (Second 90)

In Oromia, currently over 348 health facilities are providing Anti-Retroviral Treatment (ART) service while 980 are providing PMTCT services . During the reporting period out of 13,207 newly identified HIV positive clients, only 10,859 (82 .2%) were linked and started on ART (Table) . Second Line ARV drug has been decentralized in 71 selected health centers in order to make the service to be accessible . According to DATIM report as of end of June, 2011 EC, there were 113,181 clients were currently on ART . The newly WHO recommended ARV drug called Dolutogravile is currently being provided in all ART sites in the region for naïve ART patients and changing of the newly drug for existing patients is on good track .


22

Table 4.Zonal and town ART initiation performance, 2011 EC

Zones Total HIV Positive(#)

Newly started on ART(#)

Left unlinked(#) Towns Newly

Positives(#)

Newly started on

ART(#)

Left unlinked(#)

W/Shewa 921 1,015 -94 Adama 1,327 904 423

Guji 692 664 28 Bishoftu 624 439 185

Arsi 636 561 75 Shashemene 789 375 414

E/Shewa 845 522 323 Asella 416 364 52

N/Shewa 429 431 -2 Jimma T 466 343 123

Borena 430 376 54 Mojo 287 266 21

Bale 526 356 170 Nekemte 329 242 87

Jimma 298 309 -11 Sebeta 237 185 52

W/Guji 400 307 93 Burayu 203 184 19

S/W/Shewa 288 269 19 Batu 155 160 -5

W/Hararge 356 252 104 Holota 147 140 7

FSOSZ 299 250 49 Dukem 111 106 5

E/Wellega 224 238 -14 Robe 111 94 17

W/Arsi 306 232 74 Ambo 151 93 58

W/Wellega 233 226 7 Woliso 78 84 -6

Iluababora 226 203 23 Laga Tafo 77 77 0

HGW 200 191 9 Sululta 48 47 1

E/Hararge 136 132 4 Gelan 17 17 0

Bu/Bedele 103 114 -11 Bi/Guracha 7 8 -1

Ke/Wolega 79 83 -4 ORHB 13,207 10,859 2,348

C. Viral Load services (Third 90)

Routine Monitoring of Treatment response is one of key component of clinical care service for HIV patients on ART and as good attention is given for this service, there is a good progression from time to time . Based on this, the viral load service has been provided for 75% of PLHIV clients on ART and among these, 91% have achieved viral suppression rate .

Table 5.Viral load service provision and virally suppressed among HIV patients on ART in Oromia 2011

Period Currently on ART (#) Viral load test (#) <1000 copy/ml (#)

Q1_2011 107,684 62,132 55,522

Q2_2011 112,287 67,566 60,806

Q3_2011 112,435 72,834 66,282

Q4_2011 113,181 85,317 77,474

D. Prevention of Mother to Child Transmission (PMTCT) service.

Prevention of HIV transmission from mother to child is a key intervention and one of basic strategy in HIV/AIDS prevention and control . Based on this regional health bureau has expanded PMTCT service to 980 health facilities in the region . During the 2011 EFY, a total of 1,137,099 (93 .4%) Pregnant women have been tested for HIV from eligible 1,215,578 set for the year, and testing coverage as a region is on good track . From expected 8,560 (69 .2%) HIV positives, 5,923 HIV Positive mothers were identified . Accordingly, 3,287 women


23

with known HIV positive status attending ANC, delivery and postpartum for new pregnancy linked from Pre ART and ART . During the year, 2,125 women get pregnant while on ART and it indicates family planning should be integrated in chronic HIV care service in strong manner in order to prevent unintended pregnancy in HIV positive mothers as it is one of the 4 prongs in PMTCT . A total of 1,896 HIV positive women have given birth at health institution, strong and qualified counselling should be done to encourage institutional delivery in order to ensure of HIV free child birth . As part of PMTCT package, testing and counseling of partners of HIV positive mothers has been implemented in PMTCT point of care . Based on this, 70,553 partners have been tested during the year .

From Expected 8,560 infants, 3,136 (36 .6%) HIV exposed infants have received ARV prophylaxis for 6 and 12 weeks, and at the same time, 2,584 (30 .2%) have been started on co-trimoxazole prophylaxis within two months of birth . In addition, 4,380 HIV exposed infants have received a virological HIV test within 0 - 12 Months of birth, consequently, 2,256 children have got Antibody test service at 18 months . DBS testing services by GenXpert has been started at selected Genxpert sites (hospitals) to shorten long Turnaround Time (TAT) . PMTCT Optimization action plan was developed and NVP with AZT doulas prophylaxis implementation is in pipe line .

E. Social Mobilization on HIV/AIDS

During 2011 EFY, mass and panel discussion has been conducted with Aba Gedas, Community leaders, Religious leaders, etc . World AIDS day also celebrated as a nation at Dukem town in collaboration with ORHB and National HIV/AIDS Prevention and Control Office . Based on the regulation to strengthen HIV/AIDS main streaming and multi sectoral response, during the budget year, and as a regional plan has been set to collect 132,000,000 birr and only 60,000,000 birr has been collected at different sector .

Figure 31.HIV/AIDS Panel discussion with different stakeholders,Oromia,2011EFY


24

2.4.2 TB, TB/HIV, Drug Resistance TB and Leprosy Diseases Prevention and Control

2.4.2.1 Tuberculosis (TB)

TB Case DetectionTuberculosis (TB) is a major public health problem throughout the world . Ethiopia is among the 30 High TB, HIV and MDR-TB Burden Countries, that accounted for 80% of all estimated TB cases worldwide, with annual estimated TB incidence of 164/100,000 populations and death rate of 24 per 100,000 populations for 2017 . According to the 2018 global TB report 2 .7% of new TB cases and 14% of previously treated TB cases are estimated to have multi drug resistant TB (MDR TB) (FMoH, 2019, WHO, 2018) .

In Oromia during 2011 EFY, a total of 62,048 all forms of TB cases have been planned to be detected from 37,831,920 total population and only 42,837(69%) all forms of TB cases were detected . The overall annual detection rate performance as Oromia region was 69 .0 %, which is equivalent to 113 per 100,000 population and this notification rate is somehow far from 164 per 100,000 which was set as a target for the year . The notification rate per 100,000 relatives to population size varied among towns and zones . The maximum number of all forms of TB case was reported from E/Hararge, but the highest performance relative to its target was reported from Guji zone among 20 zones while the maximum case notification per 100,000 was reported from W/Guji which is 176 per 100,000 people . Gaps between the estimated number of new cases and the number actually reported during the year as a region were 19,220 .

Private Health facilities contribution for the overall case detection was 11 .5% (4,941) which is increased by two folds of previous year while a total of 7,580 (17 .7%) diagnosed TB cases referred initially from the community by health extension workers and this performance is getting lower compared to previous years’ experience and it needs attention at all levels .

TB cases were detected in all age and sex groups, thus, 87 .7% were adults while 13 .3 % were children with fewer than 15 years of age . The overall case proportion in men was 55 .4% which was greater than in women .

Table 6.TB detection rate by age category in Oromia,2011EFY

Age category M F %(Cumulative)

0-4 770 572 3 .13%>=65 1257 475 4 .04%55-64 1650 968 6 .11%5-14 1836 2088 9 .16%44-54 2350 1791 9 .67%35-44 3764 3012 15 .82%25-34 5752 5137 25 .42%15-24 6365 5050 26 .65%Grand Total 23744 19093 100%


25

Table 7.Case Detection/Notification performance of zones and towns, 2011 EC

Zones 2011 Target

Case Detected CDR per 100,000 Towns 2011

TargetCase Detected CDR per

100,000No. % No. %Guji 2,414 2,908 120 .5 198 Dukem 20 96 480 .0 769

W/Guji 2,032 2,176 107 .1 176 Shashemene 270 658 243 .7 399

Borena 878 840 95 .7 157 Sululta 40 97 242 .5 396

Bale 2,985 2,331 78 .1 128 Lega Tafo 34 82 241 .2 388

Ke/Wellega 1,788 1,384 77 .4 127 Mojo 92 177 192 .4 318

E/Shewa 2,572 1,771 68 .9 113 Robe 120 211 175 .8 290

E/Hararge 6,160 4,004 65 .0 107 Jimma T 326 565 173 .3 285

W/Arsi 4,404 2,795 63 .5 104 Sebeta 260 429 165 .0 270

S/W/Shewa 1,990 1,213 61 .0 100 Nekemte 202 321 158 .9 260

Arsi 5,844 3,556 60 .8 100 Asalla 182 267 146 .7 242

W/Hararge 4,234 2,568 60 .7 99 Burayu 168 242 144 .0 236

W/Wellega 3,072 1,717 55 .9 92 Holota 74 106 143 .2 236

E/Wellega 2,594 1,420 54 .7 90 Gelan 24 34 141 .7 225

W/Shewa 4,298 2,329 54 .2 89 Batu 130 181 139 .2 230

Jimma 5,576 2,988 53 .6 88 Bishoft 274 379 138 .3 227

FSOSZ 1,102 580 52 .6 85 Adama 634 852 134 .4 221

Ilu Aba Bora 1,576 820 52 .0 85 Woliso 102 111 108 .8 179

N/Shewa 2,688 1,264 47 .0 77 Ambo 154 119 77 .3 126

HGW 1,312 616 47 .0 77 Bi/Guracha 84 28 33 .3 55

Bu/Bedele 1,338 602 45 .0 74 ORHB 62,048 42,837 69 .0 113

ORHB 62,048 42,837 69 .0 113

The detection rate performance is getting better from the previous year which was 65 % . Performances among zones and towns are varied . Key affected population focussed case finding like implementation of regular TB screening at school, Prison, mining areas have contributed for better performance of TB case finding this year . In addition, distribution of additional 40 GenXpert machines played to detect TB case especially bacteriological confirmed TB cases in the region .


36

Figure 32.Trends of TB detection rate of oromia (2007 -2011EFY) Treatment outcomes

Regional TSR and Cure rate for bacteriologically confirmed PTB+ were 95.7 % & 86.1% respectively.

Among the zones, the highest treatment success rates were reported from W/Wollega and all of zones

performed more than 90%, but the lowest cure rate was reported from Jimma town which is 59.8%.

Number of cohort new TB cases (all forms) successfully treated and provided with treatment adherence

support by the community in the same period of the previous EFY were 9,746 (23.5%). For whom

treatment outcome was evaluated, a total of 607 were lost to follow up, while 420 (69.2%) were

Pulmunary TB cases. Among 199 bacteriologically confirmed TB cases, 52 LTFU cases were reported

from W/Guji followed by Kelem Wellega which was 33 LTFU cases. If left untraced they would remain as

infectious to the community. The main reason for lost to follow up must be ascertained and active

patient tracing must be implemented to minimize risk of transmission to the community. Additionally,

from TB case cohort registered, a total of 903 (2.23 %) have been reportedto be died.

Figure 33.Trend of Treatment cure rate and success rate of PTB+,2010 by zone(%)

65.0 66.264.0 65.0 69.0

60.0

65.0

70.0

2007 2008 2009 2010 2011

Case

Det

ectio

n in

%

Years in EC

96 95 96

91 90

86

80

85

90

95

100

2009 2010 2011

Sucess Rate (%) Cure Rate(%)

Figure 32.Trends of TB detection rate of oromia (2007 -2011EFY)

Treatment outcomes Regional TSR and Cure rate for bacteriologically confirmed PTB+ were 95 .7 % & 86 .1% respectively . Among the zones, the highest treatment success rates were reported from W/Wollega and all of zones performed more than 90%, but the lowest cure rate was reported from Jimma town which is 59 .8% . Number of cohort new TB cases (all forms) successfully treated and provided with treatment adherence support by the community in the same period of the previous EFY were 9,746 (23 .5%) . For whom treatment outcome was evaluated, a


26

total of 607 were lost to follow up, while 420 (69 .2%) were Pulmunary TB cases . Among 199 bacteriologically confirmed TB cases, 52 LTFU cases were reported from W/Guji followed by Kelem Wellega which was 33 LTFU cases . If left untraced they would remain as infectious to the community . The main reason for lost to follow up must be ascertained and active patient tracing must be implemented to minimize risk of transmission to the community . Additionally, from TB case cohort registered, a total of 903 (2 .23 %) have been reported to be died .


36

Figure 32.Trends of TB detection rate of oromia (2007 -2011EFY) Treatment outcomes

Regional TSR and Cure rate for bacteriologically confirmed PTB+ were 95.7 % & 86.1% respectively.

Among the zones, the highest treatment success rates were reported from W/Wollega and all of zones

performed more than 90%, but the lowest cure rate was reported from Jimma town which is 59.8%.

Number of cohort new TB cases (all forms) successfully treated and provided with treatment adherence

support by the community in the same period of the previous EFY were 9,746 (23.5%). For whom

treatment outcome was evaluated, a total of 607 were lost to follow up, while 420 (69.2%) were

Pulmunary TB cases. Among 199 bacteriologically confirmed TB cases, 52 LTFU cases were reported

from W/Guji followed by Kelem Wellega which was 33 LTFU cases. If left untraced they would remain as

infectious to the community. The main reason for lost to follow up must be ascertained and active

patient tracing must be implemented to minimize risk of transmission to the community. Additionally,

from TB case cohort registered, a total of 903 (2.23 %) have been reportedto be died.


65.0 66.264.0 65.0 69.0

60.0

65.0

70.0

2007 2008 2009 2010 2011

Case

Det

ectio

n in

%

Years in EC

96 95 96

91 90

86

80

85

90

95

100

2009 2010 2011

Sucess Rate (%) Cure Rate(%)


2.4.2.2 Programmatic management Drug Resistance TB

Today, DR- TB threatens TB prevention and control remains a major public health concern . ORHB in collaboration with different stakeholders and partners, has done a lot to prevent and control DR-TB . One of achievements is expansion of DR- TB treatment initiating center . To ensure treatment service accessible; Promptly; next to Nekemte; in 2005 the RHB made service expansion to 21 in 2010 EC . Additional 4 treatment initiating centers are under construction and will start service in 2012 EC .

Accordingly; of 396 DR-TB cases have been planned to detect during the reporting period a total of 167(42%) DR- TB cases were detected from the eligible for DST and sent for GenXpert site . Among 167 cases detected, 154 were put on second line treatment . In contrast to the global plan to stop TB in which greater than (50%) of the estimated DR-TB cases would be detected & notified; the region is expected to exert more efforts on the DR-TB cases detection in the coming fiscal year of 2012 .


37

2.4.2.2. Programmatic management Drug Resistance TB

Today, DR- TB threatens TB prevention and control remains a major public health concern. ORHB in

collaboration with different stakeholders and partners, has done a lot to prevent and control DR-TB.

One of achievements is expansion of DR- TB treatment initiating center. To ensure treatment service

accessible; Promptly; next to Nekemte; in 2005 the RHB made service expansion to 21 in 2010 EC.

Additional 4 treatment initiating centers are under construction and will start service in 2012 EC.

Accordingly; of 396 DR-TB cases have been planned to detect during the reporting period a total of

167(42%) DR- TB cases were detected from the eligible for DST and sent for GenXpert site. Among 167

cases detected, 154 were put on second line treatment. In contrast to the global plan to stop TB in

which greater than (50%) of the estimated DR-TB cases would be detected & notified; the region is

expected to exert more efforts on the DR-TB cases detection in the coming fiscal year of 2012.

Figure 34.Trends of Drug Resistance TB Patient enrolled to Treatment (2007 -2011EFY) in Oromia

The disaggregation of confirmed drug resistance TB cases by their patterns of resistance type: 127(76%);

35(21%); 4(2%); and 1(1%) were confirmed RR; MDR; Pre-XDR and XDR-TB cases respectively. Similarly,

of the total 127 RR-TB cases confirmed, Age less than 15 years of age were 13(10%). Moreover; age

greater than 15 years of age accounted about 114(90%). The overall sex disaggregation among 127 RR-

TB cases were identified: Male covered about 57(45%) and Female were covered about 70(55%).

However; there were about 35 Confirmed MDR-TB cases detected during the reporting period with the

proportion of 21% from the confirmed all DR-TB cases. Among confirmed MDR-TB cases age less than 15

years constituted about 8(23%); the rest 27(77%) were confirmed MDR-TB cases age greater than 15yrs

of age. In the intervening time males 15; and females 20 were detected with the proportion of 43% and

57% respectively.

Figure 34.Trends of Drug Resistance TB Patient enrolled to Treatment (2007 -2011EFY) in Oromia

The disaggregation of confirmed drug resistance TB cases by their patterns of resistance type: 127(76%); 35(21%); 4(2%); and 1(1%) were confirmed RR; MDR; Pre-XDR and XDR-TB cases respectively . Similarly, of the total 127 RR-TB cases confirmed, Age less than 15 years of age were 13(10%) . Moreover; age greater than 15 years of age accounted about 114(90%) . The overall sex disaggregation among 127 RR-TB cases were identified: Male covered about 57(45%) and Female were covered about 70(55%) .


27

However; there were about 35 Confirmed MDR-TB cases detected during the reporting period with the proportion of 21% from the confirmed all DR-TB cases . Among confirmed MDR-TB cases age less than 15 years constituted about 8(23%); the rest 27(77%) were confirmed MDR-TB cases age greater than 15yrs of age . In the intervening time males 15; and females 20 were detected with the proportion of 43% and 57% respectively .

Accordingly of 167 DR-TB cases detected 154 were enrolled that constituted about 92% . The global plan to stop TB enrollment would be 100% of confirmed DR-TB cases will start SLD treatment accordingly .

However; the Regional 2011 EFY/2018-19 24 months cohort evaluation showed that of the total 152 cohort of DR-TB cases started on long term second-line anti-TB treatment regimen 24 months earlier:110(72%) were cured; and 9(6%) were completed with the TSR of 109 (72%) . Among these 22 cases were died with the rate of 14% . Besides; the unfavourable treatment out -come registered 1(1%) was failed; 7(5%) were lost to follow up; and 3(2%) were not evaluated .

2.4.2.3 Leprosy Programmatic Management

During 2011 EC, the overall regional Leprosy Case detection was 67 .8%, which means a total of 1,540 new leprosy cases were identified and among these, 1,004 and 534 were diagnosed as Multi Bacillary & Pauci Bacillary types of leprosy respectively . In addition, 180 relapses cases were detected and if these cases were added to the total case detection, the annual regional Leprosy case detection performance would have been 75 .8% (1,720/2,270) .

Proportion of Grade II disability among newly diagnosed cases as Oromia region was 11 .8 % . The highest number of Grade II disability reported from Jimma zone (40 cases) followed by E/Hararge (30) .The average regional treatment completion rate was 92 .4% is seems good as a region . But, as there were not cases registered in a cohort before 18 months, 14 towns did not have any report concerning treatment outcome with leprosy case

2.4.2.4 TB/HIV Collaborative Activities

Among 42,837 TB patients detected and registered in to cohort, average regional proportion of TB patients with documented HIV test result during 2011 EC was 85 .4% and the average regional TB- HIV co infection is nearly 4 .9% . Total number of previously known HIV positive TB patients who are on ART in the reporting period was 3,074 .

2.4.3 Malaria Prevention and Control

Oromia has registered a remarkable progress in malaria control in the last decade . The region has achieved high coverage of interventions, both preventive and curative . Furthermore, the health services have been markedly expanded with commitment of the government for establishing a strong community based health service, the health extension program (HEP) . Health extension workers (HEWs) have been providing almost all anti-malaria interventions in all malarious areas .

Starting from the year 2003 there was a great reduction of malaria morbidity and mortality has seen in


28

Oromia . This reduction is achieved mainly as a result of government commitment on expansion of health facilities, trained man power, availability of malaria diagnostic tools at health post level, accessibility of effective malaria medications and anti-malarial drugs . Universal coverage of globally recommended vector control interventions (LLINs, IRS) have also played a tremendous roles in reduction of malaria case burden in the region as shown in the figure below .


39

community based health service, the health extension program (HEP). Health extension workers (HEWs)

have been providing almost all anti-malaria interventions in all malarious areas.


Oromia. This reduction is achieved mainly as a result of government commitment on expansion of

health facilities, trained man power, availability of malaria diagnostic tools at health post level,

accessibility of effective malaria medications and anti-malarial drugs. Universal coverage of globally

recommended vector control interventions (LLINs, IRS) have also played a tremendous roles in reduction

of malaria case burden in the region as shown in the figure below.

Figure 35.Oromia Malaria Case Trends by year (2003-2011)(#)

Figure 36. Oromia Malaria case trends in months over the last three years (2009-2011)

Number of deaths due to malaria decreased significantly as shown in the figure 33 below. To reduce

morbidity and mortality caused by the disease, several interventions guided by subsequent strategies

0

20000

40000

60000

80000

July

Aug…

Sept…

Octo…

Nove…

Dece…

Janu…

Febr…

March Ap

rilMay

June

2011 2010 2009



39

community based health service, the health extension program (HEP). Health extension workers (HEWs)

have been providing almost all anti-malaria interventions in all malarious areas.


Oromia. This reduction is achieved mainly as a result of government commitment on expansion of

health facilities, trained man power, availability of malaria diagnostic tools at health post level,

accessibility of effective malaria medications and anti-malarial drugs. Universal coverage of globally

recommended vector control interventions (LLINs, IRS) have also played a tremendous roles in reduction

of malaria case burden in the region as shown in the figure below.



Number of deaths due to malaria decreased significantly as shown in the figure 33 below. To reduce

morbidity and mortality caused by the disease, several interventions guided by subsequent strategies

0

20000

40000

60000

80000

July

Aug…

Sept…

Octo…

Nove…

Dece…

Janu…

Febr…

March Ap

rilMay

June

2011 2010 2009


Number of deaths due to malaria decreased significantly as shown in the figure 33 below . To reduce morbidity and mortality caused by the disease, several interventions guided by subsequent strategies and assisted by financial and technical inputs from local and national governments, as well as national and international partners, have been put in place .

Among major scale-up efforts began in 2004/2005 with the introduction of artemisinin-based combination therapy (ACT) as the first line treatment, expanded use of rapid diagnostic tests (RDTs) as well as stepping up of vector control and prevention through the wide distribution of long-lasting insecticidal nets (LLINs) backed by targeted indoor residual spraying (IRS) of houses .


40

and assisted by financial and technical inputs from local and national governments, as well as national

and international partners, have been put in place.

Among major scale-up efforts began in 2004/2005 with the introduction of artemisinin-based

combination therapy (ACT) as the first line treatment, expanded use of rapid diagnostic tests (RDTs) as

well as stepping up of vector control and prevention through the wide distribution of long-lasting

insecticidal nets (LLINs) backed by targeted indoor residual spraying (IRS) of houses.

Figure 37.. Number of malaria deaths reduction(facility based) by year (2008-2011 E.C)

Indoor Residual Spray Performance (IRS)

Based on Kebele based malaria stratification and previous history of malaria cases targeted Indoor

Residual Spray Operation have been conducted in malaria epidemic prone areas of the region. The Unit

Structures Sprayed has been decreased from 2,356,952 to 1125839 by year 2008 to 2011 respectively.

This is because as malaria cases were decreasing from year to year the regional health bureau preferred

to target unit structure sprayed only in epidemic prone areas of the region.

Long Lasting Impregnated Nets (LLINs) Distribution and Utilization

It is believed that LLINs played a very important role in achievements recorded in the reduction of cases

and deaths due to malaria. Moreover, mass distribution of LLINs has a significant role on reaching a high

coverage within short period of time. LLINs distribution through mass campaign, besides helping to

achieve high coverage in a very short time period, provides immediate large scale protection to entire

communities. As the estimated life span of LLINs is three years, LLIN distributions have been conducted

every three years for a targeted village/Kebele. LLINs are distributed free of charge to all population

groups living in malaria risk areas of the region.

55 57

37

30

20

40

60

2008 2009 2010 2011

Figure 37.. Number of malaria deaths reduction(facility based) by year (2008-2011 E.C)


29

Indoor Residual Spray Performance (IRS)

Based on Kebele based malaria stratification and previous history of malaria cases targeted Indoor Residual Spray Operation have been conducted in malaria epidemic prone areas of the region . The Unit Structures Sprayed has been decreased from 2,356,952 to 1125839 by year 2008 to 2011 respectively . This is because as malaria cases were decreasing from year to year the regional health bureau preferred to target unit structure sprayed only in epidemic prone areas of the region .

Long Lasting Impregnated Nets (LLINs) Distribution and UtilizationIt is believed that LLINs played a very important role in achievements recorded in the reduction of cases and deaths due to malaria . Moreover, mass distribution of LLINs has a significant role on reaching a high coverage within short period of time . LLINs distribution through mass campaign, besides helping to achieve

high coverage in a very short time period, provides immediate large scale protection to entire communities . As the estimated life span of LLINs is three years, LLIN distributions have been conducted every three years for a targeted village/Kebele . LLINs are distributed free of charge to all population groups living in malaria risk areas of the region .

1,532,8192,500,000

1,282,000

4,826,972

1,750,307

10,231,129

4,404,072 3,065,638

5,000,000

2,564,000

9,653,944

3,500,614

20,462,258

7,838,937

0

5,00 0,000

10,0 00,00 0

15,0 00,00 0

20,0 00,00 0

25,0 00,00 0

200 2 200 3 200 4 200 5 200 6 200 7 200 8 200 9 201 0 201 1

LLINs distribution Population Protected

Figure 38.Oromia Long lasting impregnated nets (LLINs) distribution and replacement by year 2003-2011 E.C(#).

Malaria Elimination Activities

Malaria elimination activities were started during the year 2009 E .C in 3 zones and 68 districts of Oromia Region . Malaria Elimination have four phases and Oromia region started the optimization phase by the end of 2009 E .C . Starting from that, the region were strongly working to realize malaria elimination by doing sensitization workshop at different level, capacity building for health workers and health extension worker, provide 125 microscopy for health facilities, installed on PCR machine, conducting regular supportive supervision and review meeting at all levels .

As it was stated in table below, number of malaria free kebeles’ was increased over the last one and half years (2010-2011) and this figures comes by data vérification and validation done by ORHB in collaboration with ACIPH . So, the région is on the right track to realize malaria élimination in 3 zones by 2013/2014 E .C to acheive malaria free Ethiopia by 2030 G .C . Malaria elimination Phase by zone


30

Table 8.Showing number of kebeles with malaria elimination Phase by zone

ZoneTotal

kebele

Optimization Phase Pre-elimination Phase Elimination Phase

# of kebele with (API >5) # of kebele with (API 1-5) # of kebele with (API >0<1)

# of Kebele with (Zero cases)

E/Hararghe 554 62(11%) 90 112 290(52 .3%)

W/ Hararghe 494 12(2 .4%) 109 141 232(47%)

Arsi 570 42(7 .3%) 70 108 350(61 .4%)

Total 1,618 116(7%) 269 361 872(53.9%)

2.5 Neglected Tropical Diseases (NTDs)

2.5.1 Blinding Trachoma Elimination Program:

Trachoma is one of the public health problems which predominant in developing countries . It is a disease of poor community where there is poor access to safe water and sanitation . It contributes around 13% of blindness in the world which only second to cataract Globally, it distributed in 37 countries and is responsible for the blindness or visual impairment of about 1 .9 million people . Ethiopia one of the most trachoma affected country worldwide which accounts about 30% of the global burden of active trachoma . The national average prevalence of active trachoma (TF) is 25 .4%, ranging from 0 .2% to 73 .4% and the prevalence of blinding trachoma – trachomatous trichiasis (TT), stands at 4%, and varies from 0 .2% to 12% among people aged 15 years and over Oromia shares about 10% of the global burden of active trachoma and the prevalence active trachoma (TF) in children aged 1-9 years: 29 .8% (Ranges from 5 .8% (Kellem Wollega) to 48 .2% (H/G/Wollega)) while prevalence of trachomatous Trichiasis (TT): 1 .1% (Ranges from 0 .5% (Kellem Wollega and Guji) to 1 .8% (Arsi) . Currently trachoma is endemic in 318 districts in Oromia

2.5.2 Trachoma Mass Drug Administration

One of the major components of SAFE strategy, anti-biotic mass drug Administration (MDA) has been affected from the time when the trachoma identified as one of public health problem in the region targeting very few districts (10 districts) to clear infection and also to suppress transmission of active trachoma in trachoma endemic districts . Up until now, through scaling up all 270 trachoma endemic districts in 20 zones have been addressed . As a result of mass drug administration (MDA) scale up, annually more than 20 million eligible people of the region living in endemic areas were able to be treated to suppress and reduce transmission of active trachoma . The minimum therapeutic coverage for trachoma recommended by WHO is 80%, whereas the trend of therapeutic coverage of the region is much better above the minimum required threshold I .e 92%, 93%, 94%, 94% and 94% staring from 2007 to 2011 respectively . In Oromia 270 district

were geographically covered by Trachoma program interventions .


31

2.5.3 Trachomatous Trichiasis (TT) Surgery Progress

Regarding the Trichiasis, the regional TT backlog accounts about 200,000 and UIG - 146,373 . TT surgery services have been provided in different facilities through static, out reaches, mini CAMPS/Intensified out reaches and integration with other case like facility-based cataract surgeries . Using these as strategies to conduct TT surgery; a total of 131, 215 individuals have got TT-surgery services in oromia from the above backlog .

2.5.4 Service expansion

During the budget year of 2007EC, only 27 districts were under STH/SCH intervention to impact STH/SCH where currently the number of districts reached its highest of 290 for STH mass drug administration for school age children 5-14 years . Regionally, all endemic districts for SHC are covered with MDA as per the WHO implementation standards .


43

2.5.3. Trachomatous Trichiasis (TT) Surgery Progress

Regarding the Trichiasis, the regional TT backlog accounts about 200,000 and UIG - 146,373. TT surgery

services have been provided in different facilities through static, out reaches, mini CAMPS/Intensified

out reaches and integration with other case like facility-based cataract surgeries. Using these as

strategies to conduct TT surgery; a total of 131, 215 individuals have got TT-surgery services in oromia

from the above backlog.

2.5.4. Service expansion During the budget year of 2007EC, only 27 districts were under STH/SCH intervention to impact STH/SCH

where currently the number of districts reached its highest of 290 for STH mass drug administration for

school age children 5-14 years. Regionally, all endemic districts for SHC are covered with MDA as per the

WHO implementation standards.

Figure 39.Showed Five Years Therapeutic Coverage of STH/SCH MDA in Oromia(#)

2.5.5. Onchocerciasis/River Blindness:

Onchocerchiasis is mainly endemic in 136 districts of H/G/Welega, E/Welega, K/welega, W/Welega,

E/Hararge, Jimma, I/A/Bor, B/Bedele and S/W/Shoa zones.

Based on disease mapping conducted in 2011, 23 districts have been identified as endemic districts

requiring mass drug distribution for Onchocerciasis/OV. Theraputic coverage from 81% in 2007

increased to 83% in 2011 and woredas affected by onchocerciasis increased from 100 woredas in 2007

to 136 woredas in 2011. Geographically all woredas were covered.

Figure 39.Showed Five Years Therapeutic Coverage of STH/SCH MDA in Oromia(#)

2.5.5 Onchocerciasis/River Blindness:

Onchocerchiasis is mainly endemic in 136 districts of H/G/Welega, E/Welega, K/welega, W/Welega, E/Hararge, Jimma, I/A/Bor, B/Bedele and S/W/Shoa zones .

Based on disease mapping conducted in 2011, 23 districts have been identified as endemic districts requiring mass drug distribution for Onchocerciasis/OV . Theraputic coverage from 81% in 2007 increased to 83% in 2011 and woredas affected by onchocerciasis increased from 100 woredas in 2007 to 136 woredas in 2011 . Geographically all woredas were covered .

2.6 Public Emergency Management & Health Research

The Oromia Regional Health Bureau Public Health Emergency Management & Health Research Directorate has been dedicating considerable resources to the response to Public Health Emergencies: from epidemics of diseases to widespread malnutrition resulting from drought and other health events . The region is also exposed to potential man-made disasters like conflicts and resulting displacement of population and related health and social problems with various degree of impact in the health sector . This year different


32

Coordination platforms are being used to coordinate different Events and Emergency responses this includes: Disaster Risk Management Technical Working Group, Health and nutrition task force (At least two Partners were present their performance on Health and nutrition task force meeting), One health Task Force, AWD technical working group, WASH Task force, Events/ Festival coordination team ( Kulubi Gebreil, Irrecha, Dire Sheik Hussien and others), Different partners were mobilized through the coordination plat forms for emergency responses and Joint Regional EPRP is being prepared and updated every 6 months

Completeness and timeliness

Regional surveillance report completeness and timeliness of government health facilities were 86% and 79% respectively . Report completeness of all zones and towns were above the target, except East Hararghe and West Guji which accounts 79% and 65% respectively . In addition Sebeta, Burayu, Modjo and Bishan Guracha Town annual completeness was 79%,75%, 72% and 66% respectively were towns below national target . Regarding the annual timeliness all zones and towns reported above the national target except Nine zones like Bale [77%] followed by Borena [73%], S/W/Shewa [74%], Horro Guduru Wollega [67%], Arsi [77%], E/Wollega [69%], North Shewa [75%], E/Hararghe [65%] and West Guji [49%] zone . Among towns Sebeta[79%], Burayu[72%], Mojo[67%] and Bishan Guracha [63%] were towns reporting below the national target .

Diseases Outbreak

This year there was cholera, measles, malaria and scabies outbreak in the region .

Cholera Outbreak: Cholera outbreak occurred in three zones of Oromia region in 2011 EFY . The diseases occurred in West Hararge, Borena and Finfine Surrounding Oromia Special Zones and eleven woredas which affects 470 (AR-0 .35/1000 pop) peoples and 4 death (CFR-0 .86) as of June 30/2011EFY . From the total 470, the highest number four hundred twenty(420) were reported from West Hararghe and the rests 23 from borena, 26 from East Hararghe, 21 from Finfine special zone and 2 from West Arsi .


45

Figure 40.Cholera Epidemiological curve by date of onset Oromia region, 2011 EFY(#) Key Interventions undertaken; Capacity Building/Training, Surveillance, Case Management,

Coordination (among line departments, partners and other sectors) of taskforces and Technical Working

Group like Social Mobilization, WASH and Regulatory, Monitoring & Evaluation and Resource Mapping

and Mobilization (Budget, Drugs, Supplies and Logistics)

Measles Outbreak Measles outbreak was also occurred in seven zones and one town administration (Bale, West and East

Hararge, North Shoa, West Shoa, Horo Guduru Wollega, Arsi and Robe town) of 36 woredas which

affects 8,254 peoples and 33 deaths.

Table 9.Measles CFR by zone, Oromia Region,

S.N Affected Zone #Cases #Deaths CFR%

Regional 4718 32 0.7 1 Bale 2443 7 0.3 2 W/Harerge 608 8 1.3 3 Robe Town 470 1 0.2 4 H/G/Wollega 380 7 1.8 5 E/Harerge 318 5 1.6 6 W/Shewa 293 4 1.4 7 Arsi 155 0 0 8 N/ Shewa 51 0 0

Of the total cases about 56.2% were under five years and 24.2%, 18,9% and 0.7% were 5 to 14, 15 to 44

and 45 years and above respectively. When the vaccination status of the measles outbreak cases

considered majority (62%) have zero dose, 21% received dose 1, 17% unknown status and 3% dose 2.

As response interventions outbreak investigation in SWS, West Hararghe, East Hararghe and Bale zones,

Risk factors assessment, Measles vaccination campaign, Strengthening surveillance, Providing Vitamin

‘A’ supplementation, Case treatment , Conduct social mobilization, Resource mobilization and

Coordinate the overall responses were carried out in all affected places. Measles SIAs campaign was

conducted for under 15 years children in all woredas of Bale zone and Robe Town, Amuru district of

Horro Guduru Wollega with vaccination coverage of 93%, 96% and 91 respectively. In addition measles

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# of

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Figure 40.Cholera Epidemiological curve by date of onset Oromia region, 2011 EFY(#)

Key Interventions undertaken; Capacity Building/Training, Surveillance, Case Management, Coordination (among line departments, partners and other sectors) of taskforces and Technical Working Group like Social Mobilization, WASH and Regulatory, Monitoring & Evaluation and Resource Mapping and Mobilization (Budget, Drugs, Supplies and Logistics)

Measles OutbreakMeasles outbreak was also occurred in seven zones and one town administration (Bale, West and East Hararge, North Shoa, West Shoa, Horo Guduru Wollega, Arsi and Robe town) of 36 woredas which affects 8,254 peoples and 33 deaths .


33

Table 9.Measles CFR by zone, Oromia Region,

S.N Affected Zone #Cases #Deaths CFR%

Regional 4718 32 0 .7

1 Bale 2443 7 0 .3

2 W/Harerge 608 8 1 .3

3 Robe Town 470 1 0 .2

4 H/G/Wollega 380 7 1 .8

5 E/Harerge 318 5 1 .6

6 W/Shewa 293 4 1 .4

7 Arsi 155 0 0

8 N/ Shewa 51 0 0

Of the total cases about 56 .2% were under five years and 24 .2%, 18,9% and 0 .7% were 5 to 14, 15 to 44 and 45 years and above respectively . When the vaccination status of the measles outbreak cases considered majority (62%) have zero dose, 21% received dose 1, 17% unknown status and 3% dose 2 .

As response interventions outbreak investigation in SWS, West Hararghe, East Hararghe and Bale zones, Risk factors assessment, Measles vaccination campaign, Strengthening surveillance, Providing Vitamin ‘A’ supplementation, Case treatment , Conduct social mobilization, Resource mobilization and Coordinate the overall responses were carried out in all affected places . Measles SIAs campaign was conducted for under 15 years children in all woredas of Bale zone and Robe Town, Amuru district of Horro Guduru Wollega with vaccination coverage of 93%, 96% and 91 respectively . In addition measles SIAs were given in East and West Wellega, East and West Hararge zone with the vaccination coverage of 93% and 89%, 112% and 100% respectively .

Meningitis: In 2011 EFY, A total of 1,100 suspected meningococcal meningitis cases were reported with five death in Oromia Region . 215(19 .5%) cases were treated at OPD whereas 885(80 .5%) cases were treated at IPD level .

Maternal Death: In 2011 EFY, 460 suspected maternal deaths were notified to the region through weekly reporting format . Of the total reported cases 161(35%) cases were reviewed and Reported through case based reporting format and entered to maternal death data base . The deaths were notified from East Hararghe (44) followed by West Arsi (38), West Wollega(36), West Hararghe(33), West Shewa(31), Arsi(29), Adama Town (24), Guji (21), Kellem Wollega (18), and Jimma(17) were the ten top zones . The direct cause of those maternal deaths were 46% hemorrhage, 15,5% HDP, 6 .8% obstructed labor, 5 .6% sepsis, 0 .6 abortion and others 9 .9% and the indirect causes were 19 .9% Anemia, 15 .5% others, 1 .9% malaria and 1 .2% TB .


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Internally Displaced Population (IDPs)

Since the last two years; Due to border and internal conflict between Ethio-Somali and bordering woredas a total of 912,767 populations were displaced (East Hararghe, West Hararghe, Guji, Borena and Bale zones) , West Guji- Gedio zone conflict- 293,520 people were displaced , West & East Wollega zones and Benishangul Gumuz region conflict- 260,791 people were displaced with a total of 1,467,078 people were displaced . A total of 64 woredas were affected by this displacement up to now and a total of 157 IDP sites were established with temporary clinics and outreach services for basic primary health care services (57 sites Ethio-Somali (from Somali region & bordering districts), 58 sites Guji- Gedio conflict, 55 sites for East and West Wollega- Benishangul Gumuz region conflict) .

Intervention activities: A total of 1,467,078 IDPs 1,053,217 returned to their home while the other were resettling to eight zones of the region . Key health and nutritional interventions of IDPs were Mass screening of IDPs , Establishment of temporary treatment centres ( Mobile clinics) , Assigning of multi-disciplinary health professionals , Outpatient and inpatient services at temporary clinics (378,925 cases) , Case management of chronic diseases ( DM, HTN, ART, TB and Epilepsy etc .), Screening of malnutrition (140,821 ) and linkage to treatment services(41,800), active surveillance , Strengthening referral linkage of IPDs patients/clients to routine services, construction of temporary latrine and ensuring its utilization , coordination, technical support, capacity building, partner mapping and mobilization, resource mobilization (Budget – More than 55 million ETB (Operational Cost), Drugs and Supplies – 15 Million Birr and 248 EDKs and 76 IEHKs and Logistics (Ambulances and other Vehicles) were provided this year .


35

3 QUALITY IMPROVEMENT AND ASSURANCE

3.1 Hospital and Health center reform Status

The health Care reform is a reform to ensure universal health coverage with the highest possible quality and equity in Health facilities . The achievement of the desired objectives is the most efficient and effective manner, with the emphasis on satisfying the customers . Indeed, despite the tremendous achievements to date, the creation of the national quality strategy acknowledged that more work remains to be done to ground the concept and practice of quality across the healthcare system . To assure this, different reform initiative were implemented . Among those reforms: -Saving Lives through Safe Surgery (SaLTS) initiative, Ethiopia Hospitals Alliance for Quality, Ethiopia Hospital Service Transformation Guideline EHSTG, Clean and Safe Health Facility (CASH), Quality of Care and Equity, Ethiopian Health Center Reform Implementation Guidelines (EHCRIG), Community score card (BSC) and Primary Health Care Clinical Guidelines (PHCG) are the main reforms that implementing in the health facilities to assure the quality of care .

3.1.1 Hospital Reforms

Saving Lives through Safe Surgery (SaLTS) initiative

Saving Lives through Safe Surgery (SaLTS) flagship initiative with a goal to make emergency and essential surgical and anesthesia care accessible and affordable as part of the universal health coverage . The objective of the initiative is to ensure the delivery of quality, safe, essential and emergency surgery throughout the Region to alleviate the Regional burden of diseases, disability and death that are preventable through safe surgery . The plan places special emphasis on strengthening primary care to provide essential surgical care .

Some of the major activities which have been done during this year through the SaLTS initiative were 43,139, 12day and 14% of Surgical Volume, Average waiting list and surgical site infection respectively . The tend of major surgery performance were 33384, 34123, 41962 and 43139 by the year 2008,2009,2010 and 2011 respectively . The results of each program were under achievement comparing with the regional plan and guideline . This is may be due to lack of trained man power, all hospitals are not actively involved on this

program and infrastructures .

Ethiopia Hospitals Alliance for Quality

Ethiopia Hospitals Alliance for Quality initiative designed with a goal to create a quality culture in selected learning health facility as main Objectives of Strengthening the learning system that continuously produces relevant data, measures performance and outcomes, and translates those data into action, Making the learning facilities to be a benchmarking site for others and being supported to learn from their performance, work on quality improvement projects and share to others the results they have got from their efforts . It also identifies best performers and determines the basis for their success as well as supporting each other by financial, logistic, medical equipment and technical . At this time our region performed this initiative by linking each hospital together as Leader, co-leader and members . Based on this, 15 lead hospitals have 3-7 member hospitals beside co-leader . The main achievement of this program is all leading hospitals sharing logistics like drugs, medical equipment and other supply . Also technically, mentorship, Coaching and Supportive supervision have been conducted quarterly .


36

Ethiopia Hospital Service Transformation Guideline (EHSTG)

Ethiopia Hospital Service Transformation Guideline (EHSTG) is guidelines and accompanying operational standards are intended to support the efforts of hospitals in fulfilling minimum standards for client satisfaction being consistent with operational standards comprehensively, selected management and clinical functions and bring all services under its umbrella . This guideline has 193 Standard and 758 verification criteria . According to this guideline, the region has been performed 63% of the total set standard . Even if the results of this achievement seems incremental through year to year, it is under expected comparing with 100% of national plan and standards of guideline . The reason for this under achievement mainly infrastructure, man power, negligent of health workers and budgets . Trends of EHSTG performance of the region from 2009 to 2011 EFY indicates that 17 .32 .and 63 respectively .

Clean and Safe Health Facility (CASH)

Health facility cleanliness is an important determinant of quality of care and patient satisfaction . Health care provided in health facilities should be safe, effective, patient-center, timely, efficient and equitable . This would entail for health facilities to be responsive to the values, beliefs and culture of patients in all aspects as well as creating a healing health care environment . Healthcare facilities are required to achieve a high level of environmental cleanliness and safety throughout the facilities on the site . Mainly they assess the level of health facility cleanliness and safety in order to provide onsite support and identify areas for improvement . They also provide a cost efficient, quality driven Cleaning Service which achieves an optimum standard of cleaning for all buildings and areas of the hospital complex appropriate for their use; and is held in high regard by patients, staff and visitors alike .Cumulatively, the performance of this initiative get improves from the year to year . As results, this year performance was 57 % . This was under expected when compare to 100% national CASH guideline . Main reason of under achievement is infrastructure, Negligent and lack of man power .

3.1.2 Health Center ReformsEthiopian Health Center Reform Implementation Guidelines (EHCRIG)

Oromia Regional Health Bureau has started the implementation of health center reform guideline a minimum standard which all health centers are required to function . In order to realize health center reform, the Ethiopian Health Center Reform Implementation Guideline (EHCRIG) with 81 standards in 10 chapters was prepared . As a region EHCRIG covered 61% of the set standard . The reason for this performance is capacity building , commitment of all level management and regional staff efforts . But Guji, HGW and W/Hararge needs especial attention since the they were performs the lowest achievement


37

9384

73 71 71 69 67 65 64 62 62 61 60 60 59 59 56 5345 39 38

0102030405060708090

100

Wes

t Guj

i

Buno

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ele

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hoa

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e

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na

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t Ars

i

Figure 41. EHCRIG performance(%) of the region by zone, 2011 EFY

Community score card (BSC)

Community score card is the legal basis for citizens and communities to claim their rights and make government officials and civil servants accountable to the people and for their action . Main objective of CSC is Capture community perceptions in a measurable and actionable way, provide a tool for HEWs and HDA members to understand and relay community needs and perceptions and reinforce accountability of primary health care facilities and Woreda health offices to the community . As a region survey is conducted quarterly, resulting 40% (average of the six CRC indicators) at the end of 4th quarter of 2011 . This result is low achievement comparing of 80% regional target . The reason behind of low achievement were:- Persistent instabilities in some parts of the region, Majority of the Woreda are not implementing the CSC and Poor commitment of ZHO management team, Governing boards and Woreda health office management in supporting CSC .

Primary Health Care Clinical Guidelines (PHCG)

Ethiopia’s PHC clinical guide is an algorithmic guideline, prepared to be used as a quick and action oriented reference material for care givers in a Health Center; and primarily it targets health officers and nurses as care givers . It is divided into two main parts: first part for “adults” (15 years or older) and second part for children (5 to 14 years) . Each part is divided into two sections: symptoms and chronic conditions (Routine Care) . For management of the child aged younger than 5 years . The region has been performed new reform, Primary Health Care Clinical Guidelines,by providing orientation and training for 180 health worker from 95

selected Health Centers . Currently, 88 health centers are implementing the new initiative guideline .

3.2 Blood bank services

To reduce deaths due to lack of safe blood and to contribute to the quality of health care service delivery, one of the major activities in EFY 2011 was availing safe and adequate blood and blood products to all

patients who need blood transfusion . Blood bank is a collection, separating and storing of the blood . The region have been planned to collect 50,416 unit of blood . From the target, 42,071 (90%) have been collected . This performance is mainly collected from volunteers especially from students .This achievements were the the cumulative efforts of all 9 blood banks in the region .


38


51

Figure 42.Trends of blood unit collected in the region as of 2011 EFY

The above figure showed that there is improvement from year to year it could be at most due to the

expansion of the blood bank centers and it requires more mobilization to achieve more and to address

the blood demand in our hospitals to save life.

3.3. Clinical Services

There are indicators help the health sector to measure the quality of clinical services provided at facility

level. Among these proxy indicators OPD per capita, Admission rate, Bed Occupancy Rate (BOR) and

Average Length of stay (ALOS) are the major indicators. Implementation of hospital and health center

reforms can improve quality of clinical service, improve performance of programs and enhance to

provide equity services for the community.

OPD Attendant Per capita

OPD Attendant Per capita is a proxy indicator for measuring accessibility and utilization of health

services that may reflect the quality of services and reflects the average of an individual made visit at

health facility within the given fiscal year. According to WHO standards on average all individual need to

visit health facilities 2 times for different services including medical check up. In 2011 EFY a total of

23,187,080 OPD visits were made at health facilities found in the region which an average of 0.62 OPD

visit per person per year. This achievement shows there was 10% increment from 2010 EFY

performance. This progress could be due to improvement of access to primary health care units and

hospitals as well as due to implementation of different health reforms which could improve quality of

clinical services.

2007 year 2008 year 2009 year 2010 year 2011 yearBlood Un 21128 22816 37692 39754 45270

21128 22816

37692 3975445270

0

10000

20000

30000

40000

50000

Figure 42.Trends of blood unit collected in the region as of 2011 EFY

The above figure showed that there is improvement from year to year it could be at most due to the expansion of the blood bank centers and it requires more mobilization to achieve more and to address the blood demand in our hospitals to save life .

3.3 Clinical ServicesThere are indicators help the health sector to measure the quality of clinical services provided at facility level . Among these proxy indicators OPD per capita, Admission rate, Bed Occupancy Rate (BOR) and Average Length of stay (ALOS) are the major indicators . Implementation of hospital and health center reforms can improve quality of clinical service, improve performance of programs and enhance to provide equity services for the community .

OPD Attendant Per capita

OPD Attendant Per capita is a proxy indicator for measuring accessibility and utilization of health services that may reflect the quality of services and reflects the average of an individual made visit at health facility within the given fiscal year . According to WHO standards on average all individual need to visit health facilities 2 times for different services including medical check up . In 2011 EFY a total of 23,187,080 OPD visits were made at health facilities found in the region which an average of 0 .62 OPD visit per person per year . This achievement shows there was 10% increment from 2010 EFY performance . This progress could be due to improvement of access to primary health care units and hospitals as well as due to implementation of different health reforms which could improve quality of clinical services .

52

Figure 43.Annual Performances of OPD Visit by age category, Oromia 2011EFY (%)

Figure 44.Annual Performances of OPD Visit by Gender,Oromia 2011EFY(%)

The following figure showed that there is significant variation of OPD visits among different age

categories. Age group of <5 years made more OPD visits as compared to other age group. OPD per

capita for <5 years population, an individual made average of 0.9 visits per year. This could be due to

most of child less than 5 years have a opportunity to visit health facility for different child health services

such as EPI, Nutritional screening, GM etc. Old age groups especially age more than 45 years need due

attention to improve their OPD visits as they are at risk for different non-communicable diseases.

Figure 45.Annual Performances of OPD Visit by age category,Oromia 2011EFY(%)

0.4 0.48 0.520.62

1

0

0.2

0.4

0.6

0.8

1

1.2

2008 year 2009 year 2010 year 2011 year HSTP

Female, 53%

Male, , 47%

Female Male

24.1%

9.6%

11.7%19.8%

18.4%

10.8%5.6%

<5 years 5-10 years

11-19 years 20-29 years


>=66 years

As figure 52 showed females had made more visits to

health facilities than males. When to calculate from female

and male population they made OPD visit 0.68 and 0.58 per

year respectively. This could be because of there are

chances of visiting at health facility for different maternal

health services such as Family planning, ANC, Delivery, PNC

and diseases etc…



39

52










0.4 0.48 0.520.62

1

0

0.2

0.4

0.6

0.8

1

1.2


Female, 53%

Male, , 47%

Female Male

24.1%

9.6%

11.7%19.8%

18.4%

10.8%5.6%

<5 years 5-10 years



>=66 years







and diseases etc…

As figure 52 showed females had made more visits to health facilities than males . When to calculate from female and male population they made OPD visit 0 .68 and 0 .58 per year respectively . This could be because of there are chances of visiting at health facility for different maternal health services such as Family planning, ANC, Delivery, PNC and diseases etc…


The following figure showed that there is significant variation of OPD visits among different age categories . Age group of <5 years made more OPD visits as compared to other age group . OPD per capita for <5 years population, an individual made average of 0 .9 visits per year . This could be due to most of child less than 5 years have a opportunity to visit health facility for different child health services such as EPI, Nutritional screening, GM etc . Old age groups especially age more than 45 years need due attention to improve their OPD visits as they are at risk for different non-communicable diseases .

52










0.4 0.48 0.520.62

1

0

0.2

0.4

0.6

0.8

1

1.2


Female, 53%

Male, , 47%

Female Male

24.1%

9.6%

11.7%19.8%

18.4%

10.8%5.6%

<5 years 5-10 years



>=66 years







and diseases etc…


OPD Percapita performance of 2011 EFY by zone and town has been illustrated below . There is significant variation from zone to zones . The average OPD visit of individual is 0 .62 as a region which varies from the lowest 0 .31(west Guji) to the highest 0 .83(West Wellega) . Moreover, the picture has showed that majority of the zones are below the regional average . On the other hand picture xx showed that almost all of the town administration has achievement of OPD per capita more than the regional average except that of Bishan Guracha town and most of the towns have achieved more than one visits per person in the EFY . This could be due to the facilities found in the towns are providing the service for the population out of the catchment and the urban population may made more visits than the rural population .

53

OPD Percapita performance of 2011 EFY by zone and town has been illustrated below. There is

significant variation from zone to zones. The average OPD visit of individual is 0.62 as a region which

varies from the lowest 0.31(west Guji) to the highest 0.83(West Wellega). Moreover, the picture has

showed that majority of the zones are below the regional average. On the other hand picture xx showed

that almost all of the town administration has achievement of OPD per capita more than the regional

average except that of Bishan Guracha town and most of the towns have achieved more than one visits

per person in the EFY. This could be due to the facilities found in the towns are providing the service for

the population out of the catchment and the urban population may made more visits than the rural

population.

Figure 46. Annual Performances of OPD per capita by zone, 2011EFY

Figure 47.Annual Performances of OPD percapita by town admin,2011

0.31 0.32 0.35 0.38 0.38 0.43 0.45 0.49 0.520.59 0.60 0.60 0.60 0.62

0.71 0.72 0.73 0.74 0.76 0.80 0.83

0.000.100.200.300.400.500.600.700.800.90

West Guji

Arsi

East

Hararge

North Sh

ewa

West Arsi

HGW

East

Wellega FS

SZ

West Hara

rge

Buno BedeleGuji

East

Shewa

Bale

Oromia

West Sh

ewa IAB

Kelem W

ellega

Borena

South W

est Sh

ewaJim

ma

West Welle

ga

0.16

0.62 0.75 0.88 0.89 0.901.16 1.28

1.441.68 1.80 1.84

2.05 2.072.37

2.78 2.82 2.90 3.02

4.26

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

Bishan Gurac

ha Town

Oromia

Ambo Town

Holota Town

Sululta

Town

Batu Town

Burayu Town

Adama Specia

l

Woliso

Town

Nekemte Town

Robe Town

Sebeta Town

Mojo TownL/T

afo

Shash

emene Town

Dukem Sp

ecial

Asalla to

wn

Jimma T

own

Bishoft T

own

Gelan Town



40

53

OPD Percapita performance of 2011 EFY by zone and town has been illustrated below. There is

significant variation from zone to zones. The average OPD visit of individual is 0.62 as a region which

varies from the lowest 0.31(west Guji) to the highest 0.83(West Wellega). Moreover, the picture has

showed that majority of the zones are below the regional average. On the other hand picture xx showed

that almost all of the town administration has achievement of OPD per capita more than the regional

average except that of Bishan Guracha town and most of the towns have achieved more than one visits

per person in the EFY. This could be due to the facilities found in the towns are providing the service for

the population out of the catchment and the urban population may made more visits than the rural

population.



0.31 0.32 0.35 0.38 0.38 0.43 0.45 0.49 0.520.59 0.60 0.60 0.60 0.62

0.71 0.72 0.73 0.74 0.76 0.80 0.83

0.000.100.200.300.400.500.600.700.800.90

West Guji

Arsi

East

Hararge

North Sh

ewa

West Arsi

HGW

East

Wellega FS

SZ

West Hara

rge

Buno BedeleGuji

East

Shewa

Bale

Oromia

West Sh

ewa IAB

Kelem W

ellega

Borena

South W

est Sh

ewaJim

ma

West Welle

ga

0.16

0.62 0.75 0.88 0.89 0.901.16 1.28

1.441.68 1.80 1.84

2.05 2.072.37

2.78 2.82 2.90 3.02

4.26

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

Bishan Gurac

ha Town

Oromia

Ambo Town

Holota Town

Sululta

Town

Batu Town

Burayu Town

Adama Specia

l

Woliso

Town

Nekemte Town

Robe Town

Sebeta Town

Mojo TownL/T

afo

Shash

emene Town

Dukem Sp

ecial

Asalla to

wn

Jimma T

own

Bishoft T

own

Gelan Town


Admission Rate

Admission rate is the number of patients admitted (including those transferred from another health facility) during the reporting period per 1,000 populations . In this 2011 EFY 408,316 patients were admitted to health facilities (at most Hospitals and few HC) and get service accordingly . As the following figure showed in 2011 EFY in average 10 .8 people out of 1,000 were admitted and get health services based on their respective cases in which there is large variation from 2 .6 to 19 .3 in FSSZ and West wollega respectively .

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Admission Rate

Admission rate is the number of patients admitted (including those transferred from another health

facility) during the reporting period per 1,000 populations. In this 2011 EFY 408,316 patients were

admitted to health facilities (at most Hospitals and few HC) and get service accordingly. As the following

figure showed in 2011 EFY in average 10.8 people out of 1,000 were admitted and get health services

based on their respective cases in which there is large variation from 2.6 to 19.3 in FSSZ and West

wollega respectively.

Figure 48.Annual Performances of Admission Rate by Zone of 2011 EFY (per 1000 population)

In the same manner, there is significant variation in town administration from 0.5 to 200.8 per 1,000

peoples get admission services in holota town and Asella town respectively. But L/Tafo, Gelan, Dukem,

Burayu, Bishan Guracha didn’t report admission in the whole 2011 EFY. This large variation is due to

some town has hospital while the other town has only HC in which there is no admission at most.

Inpatient mortality rate

This is inpatient deaths and provides indication regarding quality of care in the facility. Inpatient

mortality rate is calculated as number of IPD deaths divided by the number of IPD discharges in the

facility during a given time period.Accordingly, the regional average during the year was 1.8 and the

zones reported above the regional average were Jimma, East wollega, HGW, West Shoa, SWS, Borena

19.3

17.6 16.1

15.3 14.5 13.9

10.9 10.8 10.8 9.5 9.4 9.0

6.6 6.4 6.3 5.9

4.2 4.2 3.3 3.2 2.6

-

5.0

10.0

15.0

20.0

25.0

West Welle

ga IABBale SW

S

Borena

Kelem W

ellega

East

Wellega

West Sh

ewa

OromiaGuji

West Hara

rge

East

Hararge

West Guji

HGW

North Sh

ewa

Buno Bedele

West Arsi

Jimma

Arsi

East

Shewa

FSSZ

Figure 48.Annual Performances of Admission Rate by Zone of 2011 EFY (per 1000 population)

In the same manner, there is significant variation in town administration from 0 .5 to 200 .8 per 1,000 peoples get admission services in holota town and Asella town respectively . But L/Tafo, Gelan, Dukem, Burayu, Bishan Guracha didn’t report admission in the whole 2011 EFY . This large variation is due to some town has hospital while the other town has only HC in which there is no admission at most .

Inpatient mortality rate

This is inpatient deaths and provides indication regarding quality of care in the facility . Inpatient mortality rate is calculated as number of IPD deaths divided by the number of IPD discharges in the facility during a given time period .Accordingly, the regional average during the year was 1 .8 and the zones reported above the regional average were Jimma, East wollega, HGW, West Shoa, SWS, Borena Guji West Hararghe and


41

Bunno Bedele with mortality rate 1 .8, 1 .9, 1 .9, 2,2,2 .3, 2 .4, 4 and 4 .4 respectively .While those Zones reported below the regional average North Shoa 1 .7, West Shoa 1 .6, Bale 1 .6, West Arsi 1 .5, East Shoa 1 .4, IAB 1 .3, FSOZ 1 .1, West Wollega 1 .0, Arsi 1 .0 East Hararghe 0 .9 and Kellam wollega 0 .6 . . Similarly the inpatient mortality rate is varies in town which ranges from 0 .1 to 11 .3% in Ambo and sebeta town respectively . No reported inpatient death from Burayu , Dukem, L/tafo,Holeta, B/Guracha, Sululta, Gelan and Weliso town

Bed Occupancy Rate

Bed Occupancy Rate indicates that Percentage of occupied beds during the specific reporting period . Bed occupancy rate (BOR) is a measure of the efficiency of inpatient services . Hospitals are most efficient at a BOR of 80 – 90% . If it will be lower tan 80% and above 90% the institution need to be alerted for intervention . In 2011 EFY the regional BOR is in average 41% which varies from 14% to 65% in zone East shoa and SWS respectively and from 2% to 75% in town facility in Holeta and Robe respectively . No ALOS reported from L/Tafo, Gelan, Dukem, Burayu, Bishan Guracha town since these towns didn’t report admission

Figure 49. Bed occupancy rate of 2011 by Zone and towns (%)

Average Length of Stay (ALOS)

This reveal that the average length of stay (in days) of patients in an inpatient facility during a given period of time . ALOS reflects the appropriate utilization of inpatient services . This indicator helps to montor length of stay, hospitals which assess if patients remain in hospital for longer than is necessary, perhaps due to nonclinical reasons, and investigate further if required .


42

Figure 50.Average Length of Stay of 2011 by Zone(days)

As the above figure indicated in 2011 EFY Average Length of Stay at regional level is 4 .0, so that the region has achieved the target set for HSTP in which there is some difference from 3 .0 to 6 .1 in East wellega and west Guji zones respectively and from 1 to 7 .1 Welliso and Adama Town respectively . Where, no reported ALOS from Legetafo ,Gelan,B/guracha,Burayu and Dukem towns since there is no reported admission .

3.4 RegulatoryThe main objective of regulatory system is to promote and protect the public health by ensuring safety, efficacy and quality of health and health-related products and services through product quality assessment and registration; licensing and inspection of health professionals, health institutions, pharmaceutical and food establishments, and provision of up-to-date regulatory information while promoting proper use of health and health-related products and services including proper use of medicines .

As a Region different activities were performed in the year of 2011 EFY based on the regulatory system . Quality assurance assessment, Licensing, Inspection of different facilities and institution, provision of up-to-date regulatory information are the main performance that performed in this year .


43

Table 10.Performance of regulatory system of the region in 2011 EFY.

Sr . No Major Activities Performances

1 New registration of professional license 4850 (>100%)

2 Renewing of professional registration 3100 (>100%)

3 Licensing of private HF(New) 440 (98 .2%)

4 Inspection of governmental Health facilities 633 (% 67 .1)

5 Inspection of private Health facilities 4350 (85 .1%)

6Different levels of corrective measures taken on private health facilities identified with problem

1106

7 Food and drinking establishment and Industries inspected 48800 (91 .6%)

8Different levels of corrective measures taken on Food and drinking establishment and Industries have problem

980


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4 LEADERSHIP AND GOVERNANCE

4.1. Human Resource management and developmentHuman capital is one of the six building blocks of health system identified as a major area that every health institution needs to have the required number of health professionals’ mix . The existed shortage and attrition of health professionals, especially of higher level health professionals highly affects the quality of health service provided in the public health facilities . This problem is intensified by the concentration of skilled and high-level health professionals especially Physicians, laboratory, pharmacy professionals etc .


59

4 . L E A D E R S H I P A N D G O V E R N A N C E

4.1. Human Resource management and development

Human capital is one of the six building blocks of health system identified as a major area that every

health institution needs to have the required number of health professionals’ mix. The existed

shortage and attrition of health professionals, especially of higher level health professionals highly

affects the quality of health service provided in the public health facilities. This problem is intensified

by the concentration of skilled and high-level health professionals especially Physicians, laboratory,

pharmacy professionals etc.

Figure 51.Trends of density of human capital in health sector as of 2011 EFY Health staff to population ratio by category

This indicator suggests priority areas for increasing staff according to equity standards. Population

densities and geographic conditions are also powerful influences on staffing needs.

Indicators 2003 2010 2011 Target

Health work force Density 0.73:1000 1.9:1000 1.9:1000 2.3:1000 WHO1.5 GTP2

Specialist (all type) 1:274,918 1:253,905

General Practitioner 1: 97,591 1:29,353 1:23,367 1:10,000 WHO

Nurse 1:3,818 1:2,476 1:2209 1:5,000 WHO

Midwifery 1:40,706 1:8,948 1:8818 1:6,759 GTP2

61239 64409 67756 7009888969

2008 YEAR 2009 YEAR 2010 YEAR 2011 YEAR HSTP TARGET

Figure 51.Trends of density of human capital in health sector as of 2011 EFY

Health staff to population ratio by category

This indicator suggests priority areas for increasing staff according to equity standards . Population densities and geographic conditions are also powerful influences on staffing needs .

Indicators 2003 2010 2011 Target

Health work force Density 0 .73:1000 1 .9:1000 1 .9:1000 2 .3:1000 WHO1 .5 GTP2

Specialist (all type) 1:274,918 1:253,905

General Practitioner 1: 97,591 1:29,353 1:23,367 1:10,000 WHO

Nurse 1:3,818 1:2,476 1:2209 1:5,000 WHO

Midwifery 1:40,706 1:8,948 1:8818 1:6,759 GTP2

Table 11.Pre service and in-service training in Oromia region for 2011 EFY

Training(Newly generic)SN Professions Plan Achievement %%1 x-ray technician 180 121 67 .2

3 Laboratory 400 183 45 .8

4 Pharmacy 410 190 46 .3

5 HIT 150 100 66 .7

6 EMT level III 160 0 0 .0

Upgrading

1 PHD 5 5 100

2 Specialist all type 143 168 100+

Training from Level III to Level IV1 Clinical nurse to Anesthesia IV 100 59 59


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Training(Newly generic)SN Professions Plan Achievement %%2 EMT III to EMT IV 100 84 84

3 Health Extension 1500 1500 100

4 IT IV to HIT IV 39 39 100

4.2. Evidence Based Decision MakingTo strengthen evidence-based decision making, the EFY 2011 annual plan was prepared based on the HSTP plan set for the year and woreda based plan . To improve data quality and information use practices at all levels in the health system by escalation of three One principles (One Plan, One Budget and one Report) . Regional health bureau did plan alignment with other government sectors and partners to strength the collaboration so that , it helps in achieving the jointly set plan .

Based on the prepared and aligned plan with all stakeholders, bureau has monitored the implementation of different health programs using routine HMIS report and findings of different supportive supervision conducted integratedly and program specific at different times . Beside this integrated and program specific review meeting with all stakeholders had been conducted . In 2011 EFY conducted supportive supervision was fruitful because, all the supervision team have stayed for more than a month and provided mentorship by developing action plan for monitoring the implementation & the improvement of identified gaps during the consecutive supervision .

To enhance appropriate decision making at all level to improve quality of services and program performance improvement , strengthening information use is crucial . To improve information use for evidence decision making, strengthening of routine data collection and aggregation of Health Information System and ensuring data Quality is important . To strength the routine health information system, regional health bureau is working on strengthening the implementation of different HIS reforms such as revised HMIS, CHIS (Agrarian,Urban and pastoralist) ,eCHIS ,DHIS2 etc so that,the quality of the data at source level is assured .

As the PMT has great role to strength the regional health information system, regional health bureau payed attention in 2011 EFY to strength PMT and team was revitalized & meet monthly based in reviewing the data quality, performances and started to provide technical support to enhance decision making . Additionally, in line with the ministry of health, the regional health bureau has started to strength the mentorship capacity of the health sector by working with Jimma University on capacity building and mentorship program (CBMP) in selected woredas and hospitals to fully put on the ground the implementation of information revolution .

Moreover, bureau has started to use routine HMIS report for government and other fund budget allocation, so that it enhances data utilization at all level .

4.3. Gender Main-streamingMobilization and Awareness Creation Activities on Gender Mainstream:

Orientation on Gender Main-streaming were conducted different times for different stakeholders in 2011 EFY . Accordingly, orientation on sexual violence and response was provided for zonal health department heads, women& child and youth affairs bureau, Oromia communication bureau, attorney from zonal and


46

towns, during the fiscal year . Similarly, to increase public awareness on sexual violence panel discussion on OBN media with was conducted with key stakeholder and influential Community representatives (Abagada,elders)

Orentation on Gender Panel discussion on sexual violence

Figure 52.Pictures of different workshops and awareness creation on Gender Main streaming/sexual violence, 2011 EFY

Institutionalizing Gender Main-streaming: As a structural amendment done for all zone/town, and hospitals level, in 2011 EFY 17 Zonal health department,6 town administrations and only 10 hospitals have recruited professionals on the structure . Similarly, woreda health office has started hiring professionals based on the structure approved for the woreda level . Moreover,237 model women were selected from zone, town, woreda and ,hospitals and got training on leadership and different health reforms for 18 days and generally as of 2011EFY 218 women were assigned on leadership position at zone, woreda and hospital levels

Figure 53.Closing program of women training on leadership and health reforms.

Partnership towards multi-sectoral response to prevent gender-based violence: To respond to sexual violence in the region the integrated service with other stakeholder has started in 20 general hospitals and 230 health centers . In 2011 EFY a total of 1882 clients (35 male and 1847 Females) got integrated services in those facilities . Since the service is free of fee; the regional government allocated 8mill birr for this fiscal year to compensate the service and medicine fee for 50 hospitals .For upgrading integrated service unit 1 .7 mill Birr was allocated for Adama hospital and 12 million birr for upgrading of other six hospitals found in the region and accordingly the construction has started .


47

5 HEALTH SYSTEM CAPACITY

5.1 Health InfrastructureIn health system currently there are three-tier system, which are the first level of tier system (PHCU), that includes a primary hospital, health center and Health Posts, second level is General Hospital and the third one is Specialized Hospital . This tier assumes the realization of physical access of the population to health service for the community .

Several efforts have been exerted to meet the HSTP goal during the last four years and this report period . Accordingly, there is good progress in increasing number of health posts, health centers and hospitals as depicted on figure below

Figure 54.Trends of Health facilities expansion by year(number)

As figure presented above though, there are incremental in number of health facilities there is gaps to achieve as per the standard set to facility to population ratio especially regarding the Health centers, health posts and especially for primary hospital as figure illustrated below .

Figure 55.Ratio of Health center and health posts to population of the region,2011.


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Figure 56.Ratio of different types of hospitals to population of the region,2011.

5.2 Pharmaceutical Supply and Services

The availability and rational use of medicines and supplies are the key contributors to the betterment of health and well being of citizens . To this end, ORHB prepared and adopted different legacies, policies, directives and key documents that will be pillars for the pharmaceutical supply and services in the region .

Among the core achievements of ORHB for the pharmaceutical service is the identification and endorsement of indicators that correctly measure and keep the pharmaceutical sector on track . By considering this indicators; the ORHB in collaboration with its partners, revised a mechanism to improve the information flow between all levels of the health structure and make that information useful for decision making . Implementation of the pharmaceutical supply chain management and pharmacy service monitoring and evaluation of implementation was found a mechanism that would become the best solution for the absence of performance measurement and evaluation in the pharmaceutical care system .

Information on availability such as drugs actually dispensed, line fill rate, proportion of HCF allocated for medicine purchase, conduction of inventory twice a year with an ease, monitoring of expiry, promising implementation of clinical pharmacy in some hospitals like Shashemene RH, and improvement of storage are core ideas among the many .Health facilities are using the indicators for decision making rather than the mere sending of reports up the pipeline . Metahara health center, in East Showa Zone of Oromia, is a live example which used the M & E report for decision . This health center used to have a very small and congested medical store which is confounded by the hot weather of the town . As an attempt to meet the indicator related with storage, the health center began to secured more than 1 Million Birr from the Mayor’s office to build a very standard -store room- which at the end means ownership and leadership will help the health center to provide medicines of assured quality for the public . Newly built medical store, metahara health center, august 19, 2019


49

ZHDs themselves have proved to implement the requirements of M&E by organizing review meetings . An example is West Arsi ZHD, which could be able to organizing an annual pharmacy zonal review meeting for the 15 WoHo under its custody knowing that preparation of review meetings is one of the indicators expected of ZHDs . The great home take message from this is that the ZHD did this from its own earmarks instead of asking for budget from external bodies .

Among the ORHB’s M & E indicators, the attention and support given for APTS are like no others . The history of APTS in Oromia is not long because it has been implemented many years later than did other regions . The combined effects of viable support by ORHB leadership, hospitals’ management, dedications of pharmacy professionals and contributions of partners made APTS implementation in Oromia be realized at an alarming pace . Though started late, it only took ORHB only a few years and its hospitals to get APTS implemented in 41 hospitals . These hospitals have become successful in witnessing the good things of what APTS has purport to bring about . Many APTS site hospitals are witnessing in the open that their income has increased, expiry becomes much lower than the national target of 2%, medicines are affordable-far below the target of 96 birr per patient, level of efforts of pharmacy professionals are measured routinely with no difficulty . Though benefits of APTS are many, the renovated pharmacies have helped the patients to get services with waiting time decreased, care time increased and their privacy secured .

ORHB is being doing great and exemplary supports for APTS . Its great work commenced from enaction of the pharmacy supply and service regulation which created fertilize ground for transparency and accountability . An applaudable and historic supports of ORHB for APTS are the provision budget for renovation of 10 model APTS Sites . Doing this on its part has become inspiration for the rest of the hospitals which resulted in surges of APTS sites in Oromia . About 30 hospitals have allocated budged on their own and energized APTS implementation in Oromia . There are also hospitals like Olanchiti which constructed a sizeable medical store to meet requirements of APTS . ORHB is still helping APTS site hospitals in provision of financial vouchers and APTS registers .

One of the latest attractive works of ORHB for the sustainability of improvements in pharmaceutical supply and services is the approval of directive for The Community Pharmacy Initiative (MCP) . The core objective


50

of MCP is the assurance of accessibility and affordability of medicines for the community . Being opened outside the health facilities -in towns near -the places where community can access medicines within walking distance and at very moderate mark up, accessibility and affordability will eventually be achieved through the MCP . The fact that prices of medicines at MCPs are really moderate and regulated, makes prices of medicines to be liberalized which at the end means that prices of medicines from all outlets including privately owned outlets will be stabilized . In addition, MCP has something to do with reduction of health facility pharmacy staff turnover-over since the employees of MCP are the same pharmacy professionals and related staffs are the same ones as those working in the health facility .

Pharmacy professionals should consider the good works of ORHB such as M & E indicators, APTS, MCP and the like as an opportunity for the inbuilt professional growth . Working in the system that has such reforms will have tremendous effect in the professional skill of the pharmacy professionals . Thus, ORHB urges all concerned to contribute all their possible shares for these indicators to bring about the needed results sustainably .

5.3 Health Information System (HIS)Health information system is one of the six building blocks of the health system that plays a cross cutting role in generating quality data for evidence based decision making and improving equity and quality of health services at all level of the health system . To improve culture of information use; the existing HMIS is revised and implemented, community health information system is strengthened, civil and vital registration system (CVRS) put in place . Similarly, as part of the initiative to digitalize the health information system DHIS2 is introduced ,the manual CHIS is partially digitalized and electronic community health information system(eCHIS) is being implemented, human resource information system(HRIS),electronic medical recording(EMR-MRU) and other digitalization initiatives have been implemented . A detail of implementation

status of different reforms is presented below .

Revised HMIS implementation The HMIS indicators and tools were revised, HMIS tools revised, printed and distributed for all zones and town administrations health offices and trainings were given for health workers . In this budget year a gap filling training on revised HMIS provided for hospital matrons and CBMP woredas and different HMIS tools and registers distributed . Currently it was implemented in all health health centers and Hospitals of the region


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Community Health Information System (CHIS) : The health extension program (HEP) uses CHIS as a routine health information system to monitor the program’s performance . The CHIS is a component of the reformed HMIS designed by the FMOH according to the standardization, integration and simplification to provide information for decision (FMOH, 2008) . The full implementation of CHIS was started in 2013 in most of the agrarian kebeles of all Oromia zones and majority of health posts have been providing health services using CHIS tools (family folder and tally sheets) . Following the introduction of second generation HEP, CHIS is revised to accommodate changes . Accordantly, the RHB allocated and distributed budget for zones for revised CHIS tools printing and distribution, provided regional level TOT for 10 zones and and pipeline to cascade to lower level . On the other hand, the Urban Community Health Information System (U-CHIS) was piloted in two kebeles’ of Bishoftu Town and assessment was conducted and tools revised based on recommendation from pilot test and training was provided and scaled up to all kebeles in Bishoftu Town . Similarly, Community Health Information System has been implemented in pastoralist kebeles of the region .

National Classification of Disease (NCoD): The NCoD was developed as part of the HMIS reform to organize disease information . It is the national standard system of defining, monitoring and reporting health conditions and their outcomes . The DHIS2 capture event data based on the NCoD and health care providers need to understand the NCoD, how to write the appropriate code for a diagnosis according to NCoD and use NCoD in morbidity and mortality recoding and reporting . To this end, the RHB in collaboration with FMOH provided training on NCoD for about 269 physicians and HIT professionals from hospital and ZHD and this same training was cascaded to woreda level where 3284 health Centers’ HIT and OPD heads trained . Before the NCoD training, event report for the region was only 21 %, whereas after NcoD training and DHIS2 update, the reporting rate was significantly increased to 80% as of the end of this fiscal year . To maintain this momentum, continuous mentorship and capacity building that focus on gap filling is recommended . Civil and Vital Registration: In order to mark progress towards higher birth and death registration coverage in the region, in addition to major activities implemented during last year (2010), awareness creation for health workforce done integrated with different workshops and trainings, basic and a gap filling trainings for hospitals and some selected health centers delivery unit heads conducted, consultative meeting with MOH held, vital events notification pads printed and distributed . Currently, almost all hospitals, health centers and some health posts are implementing CVRS . However, notification rate from live birth in Oromia is only 15 %; this implying that more effort is needed to improve the current notification rate .

Data Quality status: One of the objectives of reforming HMIS is ensuring improved measurement and standardization towards improvement in quality of data enabling better decisions and thus better health outcomes . Pertinent to this; different data quality assurance mechanisms have been deployed at different levels . At regional level data completeness, timeliness and data validations are done and feedback given to ZHD on the status of their report . In addition, at facility level, Lot quality assurance sampling (LQAS) and routine data quality assurance (RDQA) are done to check data consistency .

Graph below presents completeness and timeliness of health centers, health posts and hospital/clinic service delivery reports . As 100% achievement is expected for both completeness and timeliness, much is expected to improve in the future .


52


68

region was only 21 %, whereas after NcoD training and DHIS2 update, the reporting rate was

significantly increased to 80% as of the end of this fiscal year. To maintain this momentum,

continuous mentorship and capacity building that focus on gap filling is recommended.

Civil and Vital Registration: In order to mark progress towards higher birth and death registration

coverage in the region, in addition to major activities implemented during last year (2010), awareness

creation for health workforce done integrated with different workshops and trainings, basic and a

gap filling trainings for hospitals and some selected health centers delivery unit heads conducted,

consultative meeting with MOH held, vital events notification pads printed and distributed. Currently,

almost all hospitals, health centers and some health posts are implementing CVRS. However,

notification rate from live birth in Oromia is only 15 %; this implying that more effort is needed to

improve the current notification rate.

Data Quality status: One of the objectives of reforming HMIS is ensuring improved measurement and

standardization towards improvement in quality of data enabling better decisions and thus better health

outcomes. Pertinent to this; different data quality assurance mechanisms have been deployed at different

levels. At regional level data completeness, timeliness and data validations are done and feedback given

to ZHD on the status of their report. In addition, at facility level, Lot quality assurance sampling (LQAS) and

routine data quality assurance (RDQA) are done to check data consistency.

Graph below presents completeness and timeliness of health centers, health posts and hospital/clinic

service delivery reports. As 100% achievement is expected for both completeness and timeliness, much is

expected to improve in the future.

Figure 57. Services Delivery monthly report completeness and timeliness, 2011(%)

Performance Monitoring Team (PMT): Performance Monitoring Team is a team of multidisciplinary

health workforce, composed of members of the management committee at health administration

units and unit/case team leads and heads of health institutions at hospitals and health centers. The

team meets on monthly basis at all levels before report is submitted to the next level and evaluate

performances and data quality based on selected indicators. The team focuses on ensuring data

99 9430

73 7321

0

200

Health Center Health Post Hospital/Clinic

Completeness Timeliness

Figure 57. Services Delivery monthly report completeness and timeliness, 2011(%)

Performance Monitoring Team (PMT): Performance Monitoring Team is a team of multidisciplinary health workforce, composed of members of the management committee at health administration units and unit/case team leads and heads of health institutions at hospitals and health centers . The team meets on monthly basis at all levels before report is submitted to the next level and evaluate performances and data quality based on selected indicators . The team focuses on ensuring data quality and continuous use of information that will improvement access, utilization, coverage and quality of health services . The regional level performance monitoring team was revitalized and conducing its monthly meeting, discussed on PMT guide line, reviewed performance of selected indicators and data quality, identified problems and developed action plans to address identified gaps .

Health Net

Health Net is a Virtual Private Network (VPN) service, provided by Ethio Telecom (ETC), that connects FMOH, RHBs, Woreda Health Offices, hospitals, and Health Centers through Virtual private network for secure and efficient transmission of data, with the objective of achieving the HSTP’s Information Revolution agenda includes the Connected Woreda strategy . Health Net uses the existing public communication lines of ethio telecom but maintains the security of the communication so no external party can interrupt the communication or receive any data that is exchanged within the health system . Through Health Net, users will be able to securely and efficiently share health data (Like DHIS2 and HRIS) voice (like tele-Medicine and teleconferencing), and video (Tele radiology) .

To achieve this, Oromia Regional Health office have started implementing Health Net in collaboration with FMOH, a virtual private network (VPN) service provided with Ethio-Telecom for more than 1800 health facilities and administrative health units in the Region . In 2011 More than 1302 health facilities and administrative health units in the Region which around 72 % of the planned site have been connected to the National HealthNet Network .

All Zonal Health offices, 98 % of Towns except Bishan Guracha , 80 % Woredas , 65 % Health Centers have been connected to the national Health Net connection are currently using it to access DHIS2 online and for Internet Purposes .


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Table 12.HealthNet Connectivity by Facility type and connection type

Health Net Connectivity by Facility type connection type

S .No By Facility Type Count of No S .No Type Of Connection Count of No

1 Health Insurance 5 1 ADSL 671

2 Health Center 924 2 Fiber 38

3 Hospital 74 3 3G 582

4 Regional Lab 1 4 Tailor 11

5 RHO 1 Total 1302

6 WHO 259

7 Town 18

8 ZHO 20

Total 1302

On the other Hand, the region is also working in connecting each service unit in all the connected Health Center to facilitate data and information exchange between the service units Establishment of Local area network for each Health center were very essential . To realize this the region have organized Small enterprises youth groups in collaboration with Oromia Small enterprise agency and trained the youth on Network installation and provided the Network installation toolkit . Moreover, in 2011 the region has managed to distribute the required (cables, trunk, RG45 and others) materials for 622 Health Centers .

Over all 94 Small and Micro enterprises have been established in this project holding member from 4 – 8 group members creating jobs for more than

564 where 94 are Female IT professionals graduated in Level 4 and above in information technology and related field . Currently 302 Health Centers Local area network have been finalized connecting a minimum of 10 service unit and a maximum of 15 service unit have been connected in each facility . Which is utilization of 2,970,000 birr from 6,020,000 million birr transferred to Zonal Health office . From this Amount 270,000 birr have been paid for all women lead Small and Micro enterprise youth groups .

Electironic Community health information system (eCHIS)

As part of the initiative to digitalize the health information system, the FMOH has introduced an application called Electronic Health Information System (eCHIS) that digitalizes the existing manual family folder and service workflows to record and report the households and members’ health and related data . The eCHIS is primarily a mobile-based application that works in an offline environment . However, it needs connectivity for data synchronization to the server and to facilitate digital referral linkages . It is also capable to create a digital link between unique identifiers and health information about households and individuals, and prevent the creation of duplicative household or individual records . It also enables electronic sharing


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of household and individual information between HEWs and Midwives at the Health center level . The application makes for the health extension workers to easily monitor updates on patient status . One other important advantage of the application is that it facilitates a referral linkage between the health post and health centers (FMOH website) .

In 2011 Oromia Regional Health Bureau (ORHB) has owned this initiative and stared implementation in 426 health posts in 10 Zones and 15 Woredas . The implementation has started by participating in the national TOT and immediately after, by providing regional level TOT training for six days for about 60 participants invited from selected region, zone and partners .

A total of 1172 end users from 10 zones, 15 woreds, 93 health center and 426 HPs have been trained in two rounds . The participants are Mainly Midwives and Health Extension workers, it has also included HIT from Health centers, HEW coordinators from Health Centers and Woredas . All training have been done using translated training manuals and power points .

The other major task accomplished this year Installation, configuration, distribution and supportive maintenance of the 426 tablets distributed for HEWs not only that out regional staff have been committed to be involved in the translation of the application to the use and practice of the software user friendly . The region has also taken its own initiatives in creating awareness about the software by conditioning review meetings twice with all stake holders and Regional level application launching program . In addition, the region has motivational program for those HEWs who have outstanding performance .

In 2011 HEWs have managed to register 122,364 House Holds with its all properties and 386680 members .

DHIS2

Based on the findings of an assessment conducted on the eHMIS in 2015, the FMOH introduced DHIS2 at the end of 2017, replacing the eHMIS software after intensive discussions about both types of software . The assessment findings showed that despite intensive efforts to improve the efficiency of the eHMIS, data quality and information use had been a challenge for a few years . The eHMIS was unable to deliver the information needed to advance improvements in health outcomes as set in HSTP . DHIS2 is District Health Information Software 2 (DHIS2) is a free and open source software platform developed by the Health Information Systems Program (HISP) and supported by the University of Oslo’s Department of Informatics . DHIS2 is used to aggregate statistical data collection, validation, analysis, management, and presentation . DHIS2 is the world’s largest health management information system (HMIS) platform, in use by 67 low and middle-income countries .

DHIS2 Training

Following the finalization of the DHIS2 customization, a validation workshop, and a Master TOT Oromia regional health bureau prepared rollout plan and immediately move to implementation by conducting Regional TOT and planning to train 4200 end users from all levels of the health institutes . The Region have managed to train 4021 end-users achieving 95% of its plan within 45 days simultaneously in 5 clusters . This could have been achieved by signing Memorandum of Understanding (MoU) Adama Science and Technology University, Jimma University, Nekemte Health Science College, Asella Health Science College and Ambo University . This collaboration and arrangement created an opportunity for the bureau to accommodate as many participants as the planned at the same time .


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In 2011 alone a total of 3,284 experts have been trained on DHIS2 updaters and Other DHIS2 related trainings . Participants from all woreda health offices, hospitals, and zones were mentored and coached on how to use DHIS2, specifically relating to data entry, importing/exporting data and data analysis . This effort has elevated the region performance to the first stages entering 97% of service delivery report in couple of days .

MFR Cleaning: Master Facility Registry (MFR) has been developed to collect, store, and distribute an up-to-date and standardized set of facility data to all health system stakeholders and to facilitate governance . So far, data from SPA+ and eHMIS have been cleaned and uploaded in the MFR software and a public access portal has been developed . The region has worked with MOH to exported the facility list from the existing eHMIS applications, and curated the data including the parent-child hierarchy . The region has organized a regional data curation and consultative workshop with the aim of engaging zonal health departments (ZHDs) to review and update their health facility list . The updated list is sent to FMOH and imported into MFR which will serve as one common repository for DHIS2 and other eHealth applications – one key component for interoperable eHealth systems .

5.4 Community Based Health Insurance

Since the start of CBHI, Oromia regional health bureau has been strongly working, toward the scale up of CBHI in all woreda’s of the region . Especially this year about 46 new woredas and 5 towns were added to CBHI schemes and the cumulative number of rural woredas in which CBHI started was 242 and that of towns were 5 . The regional woredas coverage of CBHI 247( 74%) . From this, about 152 woreda’s established community health insurance scheme and started the service .

According to the current report, the overall enrolment rate is 1,626,932(35%), with wide variation by zones . Enrolment ranges from a low of 8 percent in Jimma to 74 percent in FSOZ . Similarly, when the health Service Utilization of CBHI Members were considered, this year about 183,422 and 1,178,657 CBHI members got service at Hospital and Health centers respectively .


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5.5 Health financingThe trend in allocation of funds to the health sector shows that there has been an increase in budget allocation over the past 5 years as illustrated in the Table 13 . The increment is largely attributed to human resource recruitment, additional wage allocation and project external financing towards health .

The Gov’t health expenditure as a percentage of the total Government expenditure has been fluctuating over the 5 years with an average of --------% over the 5 years . The variation has been on account of increasing total health expenditure .

Table 13.Government allocation to the health sector2007 to 2011

YearGovernment

allocation (Bns Birr)Gov’t health expenditure as % of total

gov’t expenditure

2007 4 .27

2008 6 .27

2009 5 .00

2010 5 .53

2011 6 .17

When that of the woreda health office separably seen the trend has been also fluctuating of the five years as shown in the following figure .


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Figure 58.Trends of allocated budget for the Woredas and share of WoHOs'

Figure 59. Trend of budget allocated for woreda Health office by line item

6 . T R A N S F O R M A T I O N A G E N D A S P R O G R E S S

6.1. Woreda Transformation

6.1.1. High Performing Primary Health Care Unit

The average actual performance of primary healthcare units accounted as a key criterion in Woreda

transformation. It has three interrelated components namely; model kebele, EHCRIG and KPIs. Since

the commencement of HSTP, only 24 % of high performing primary health care unit are created in

transformation woredas of Oromia region. The performance is far behind the expected target. In

sum, three Woredas, namely, Gursum Woreda (East Hararghe), Chole Woreda (Arsi) and Dubluk

Woreda(Borena) are in category of Model Woredas. These Woredas will be a demonstration site for

the candidate Woredas having great potential to be transformed in the coming consecutive years.

Additional effort will be exerted to sustain the achievements in stated Woredas above.

14.3%

14.9%

13.5%

15.2%

14.3%

13%13%14%14%15%15%16%

-

10,000,000,000

20,000,000,000

30,000,000,000

40,000,000,000

2007 2008 2009 2010 2011Share of WoHO Total allocated Share of WoHO

Linear (Share of WoHO) Linear (Total allocated)

61% 60% 63% 69% 70%

39% 40% 37% 31% 30%

0%

20%

40%

60%

80%

2007 2008 2009 2010 2011

Slary Operational

Figure 58.Trends of allocated budget for the Woredas and share of WoHOs’


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Figure 58.Trends of allocated budget for the Woredas and share of WoHOs'


6 . T R A N S F O R M A T I O N A G E N D A S P R O G R E S S

6.1. Woreda Transformation

6.1.1. High Performing Primary Health Care Unit

The average actual performance of primary healthcare units accounted as a key criterion in Woreda

transformation. It has three interrelated components namely; model kebele, EHCRIG and KPIs. Since

the commencement of HSTP, only 24 % of high performing primary health care unit are created in

transformation woredas of Oromia region. The performance is far behind the expected target. In

sum, three Woredas, namely, Gursum Woreda (East Hararghe), Chole Woreda (Arsi) and Dubluk

Woreda(Borena) are in category of Model Woredas. These Woredas will be a demonstration site for

the candidate Woredas having great potential to be transformed in the coming consecutive years.

Additional effort will be exerted to sustain the achievements in stated Woredas above.

14.3%

14.9%

13.5%

15.2%

14.3%

13%13%14%14%15%15%16%

-

10,000,000,000

20,000,000,000

30,000,000,000

40,000,000,000

2007 2008 2009 2010 2011Share of WoHO Total allocated Share of WoHO

Linear (Share of WoHO) Linear (Total allocated)

61% 60% 63% 69% 70%

39% 40% 37% 31% 30%

0%

20%

40%

60%

80%

2007 2008 2009 2010 2011

Slary Operational



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6 TRANSFORMATION AGENDAS PROGRESS

6.1 Woreda Transformation

6.1.1 High Performing Primary Health Care Unit

The average actual performance of primary healthcare units accounted as a key criterion in Woreda transformation . It has three interrelated components namely; model kebele, EHCRIG and KPIs . Since the commencement of HSTP, only 24 % of high performing primary health care unit are created in transformation woredas of Oromia region . The performance is far behind the expected target . In sum, three Woredas, namely, Gursum Woreda (East Hararghe), Chole Woreda (Arsi) and Dubluk Woreda(Borena) are in category of Model Woredas . These Woredas will be a demonstration site for the candidate Woredas having great potential to be transformed in the coming consecutive years . Additional effort will be exerted to sustain the achievements in stated Woredas above .

Model Kebele: As per the criterion the regional health bureau has been working to make 1110 Kebeles Model . Out of this about 256(23%) kebeles were achieved the criterion and then they are considered as model .

Ethiopian Health Center Reform Implementation Guideline (EHCRIG)The Ethiopia Health Center Reform Implementation Guidelines (EHCRIG) were used to measure management practices in health centers . The EHCRIG scores are varied among health centers in all Zones . The average score of the health centers in Buno Bedele(84%), SW Shoa(73%), Arsi(71%, East Hararghe(71%), Jimma(69%), North Shoa(65%), IAB(64%), West Hararghe(64%), East Shoa(62%), West Shoa(62%), FSOZ(69%) Kellam Wollega(60%), East Wollega(59%), West Wollega(59%), Guji(56%), Bale(53%), West Guji(50), Borena(45%), Horo Guduru Wollega (39%) and West Arsi (38%) . The average for region for this year 60% which is below the the standard . To achieve the required standards a great effort will bee need especially for zones below the regional average . The EHCRIG scores disaggregated by chapters for high, medium and low performing health centers . Health centers all showed room for improvement in all aspects of health center management; particularly in medical equipment management and patient flow . The gaps in management capacity within the Woreda Health Office and inconsistencies in health center staffing also likely to influence the ability of health centers to adhere the EHCRIG standards . Likewise; CASH, Laboratory services, human resources and health center–health post support have numerous low performing facilities; indicating systematic improvements in these areas are needed . Health centers leadership and governance, Medical record management and performance improvement activities need little deal to improve and sustain the progress .


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Model Kebele: As per the criterion the regional health bureau has been working to make 1110

Kebeles Model. Out of this about 256(23%) kebeles were achieved the criterion and then they are

considered as model.

Ethiopian Health Center Reform Implementation Guideline (EHCRIG)

The Ethiopia Health Center Reform Implementation Guidelines (EHCRIG) were used to measure

management practices in health centers. The EHCRIG scores are varied among health centers in all

Zones. The average score of the health centers in Buno Bedele(84%), SW Shoa(73%), Arsi(71%, East

Hararghe(71%), Jimma(69%), North Shoa(65%), IAB(64%), West Hararghe(64%), East Shoa(62%),

West Shoa(62%), FSOZ(69%) Kellam Wollega(60%), East Wollega(59%), West Wollega(59%),

Guji(56%), Bale(53%), West Guji(50), Borena(45%), Horo Guduru Wollega (39%) and West Arsi (38%).

The average for region for this year 60% which is below the the standard. To achieve the required

standards a great effort will bee need especially for zones below the regional average.

The EHCRIG scores disaggregated by chapters for high, medium and low performing health centers.

Health centers all showed room for improvement in all aspects of health center management;

particularly in medical equipment management and patient flow. The gaps in management capacity

within the Woreda Health Office and inconsistencies in health center staffing also likely to influence

the ability of health centers to adhere the EHCRIG standards. Likewise; CASH, Laboratory services,

human resources and health center–health post support have numerous low performing facilities;

indicating systematic improvements in these areas are needed. Health centers leadership and

governance, Medical record management and performance improvement activities need little deal to

improve and sustain the progress.

Figure 60.Shows regional average performance of EHCRIG by chapter, August, 2019, Oromia Region (%)

Key Performance Indicators:

69 65 65 64 64 62 60 56 5544

020406080

Governan

ce…

Medical…

Perform

ance

…

Pharmac

y…

Patien

t Flow

Health

facili

ty…

Human…

Health

…

Laborat

ory…CASH

Figure 60.Shows regional average performance of EHCRIG by chapter, August, 2019, Oromia Region (%)


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Key Performance Indicators:

Used to ensure accountability and use of data for local decision making . These key performance indicators are selected from maternal and child health, communicable diseases, community participation and ownership, supplies and medicines, management systems and quality assurance issues . 18 KPI indicators have been selected for HC and Woredas, and 16 out of 18 KPIs can be tracked from RHMIS . By these indicators all have to achieve at least 85% . Even though dramatic improvement from quarter to quarter; the regional average was 68%

6.1.2 Community Score Card (CSC)

A Community Scorecard is a community-led governance tool which brings primary health care facilities, local government structures and the community to promote accountability and responsiveness to community needs .

Six indicators developed to measure the community concerns on provided services by health facilities . These includes: - Caring, respectful and compassionate care, Waiting time for provision of health care services, availability of medicines, diagnostic services and medical supplies, Infrastructure of health facilities, availability and management of ambulance services, Cleanliness and sanitation of health facility .

Objective of CSC was Capture community perceptions in a measurable and actionable way, create a mechanism for stakeholders to monitor service quality together and respond to community needs, provide a tool for HEWs and WDA members to understand and relay community needs and perceptions . Reinforce accountability of primary health care facilities and woreda health offices to the community . Until Quarter IV, only 14 zones-initiated CSC implementation at least in a Woreda (one HC) and the regional average of quarter IV by those woreda indicates 40% which is half of the regional target .

6.1.3 Woreda Management Standard (WMS)

Since the Woreda Health Office is a very important political and administrative structure for delivery of health services in Ethiopia, transformation of the Woreda’s management and leadership capacity is one of the central pillars of Health Sector Transformation Plan . To shape and evaluate progress toward improved management and leadership, we embarked upon the process of creating a set of management standards for Woreda Health Offices . Woreda Health Office should perform the following core activities for effective and equitable delivery of primary health care services . These are: Leadership and governance, service delivery, Community engagement, coordination with other sectors and performance management .Woredas to be transformed, expected to achieve 80% of Woreda management standards implemented . We tried this set of WMS to measure the management capacity of Woreda Health Offices in the 317 Woredas . The report showed that the regional average WMS was 68% . Zones above regional averages are FSOZ(83%),East Shoa, Buno Bedele, IAB, West Arsi, East Hararghe and Arsi While the rest zone are below regional average .Performance management had the highest WMS score (83%) while Community Engagement had the lowest (54%); indicating the Woreda Health Offices can enhance their preparedness to ensure quality of service and facilitate referral linkages; while all other functional categories also need improvement .


59


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Offices in the 317 Woredas. The report showed that the regional average WMS was 68%. Zones

above regional averages are FSOZ(83%),East Shoa, Buno Bedele, IAB, West Arsi, East Hararghe and

Arsi While the rest zone are below regional average.Performance management had the highest WMS

score (83%) while Community Engagement had the lowest (54%); indicating the Woreda Health

Offices can enhance their preparedness to ensure quality of service and facilitate referral linkages;

while all other functional categories also need improvement.

The Woreda Management Implementation status was analyzed for Transformation Woredas as follows. It indicates there is a positive progress over the time when compared to the target(80%) i.e. 67%, 72% and 74% in quarter II,III and IV respectively

Similarly, Community Based Health Insurance (CBHI) also analysed for Transformation Woredas the average from QII to QIV is progressive which is 32% at QII, 37QIII and 38% at QIV enrolment rate.To be transformed all has to be achieve 80% enrolment rate.

6.2. Equity And Quality Of Care

The Ethiopian National Health Care Quality Strategy (ENHCQS) was launched in March 2016 with the

aim of providing person-cantered, efficient, effective, equitable and high-quality health care for

Ethiopia, resulting in improved health outcomes for the country. A dramatic shift in the statusquo

requires a view to the entire system, to the issues facing health system leaders,

practitioners,outreach workers, community members, and patents alike.

Accordingly, activities have been performed based on the science of Quality Improvement. As a

region, first prototype was implemented in Bokoji Hospital. Based on this implementation, Eight

zones selected for test of scale (TOS) (Jimma, SZAF, Arsi, Borana, SE shoa, B/Bedele and E/Shoa).

After a while, in all hospitals structure was designed and fully implemented at all. Training was

provision for 1898 health worker, structures were redesigned at all levels of the region, especially at

Regional, Zonal, woredas and Hospitals levels, learning network collaborative have been conducted

83 83 8274 74 71 70 68 67 67 66 65 65 64 63 62 61 60 59 59 54

0102030405060708090

SFSZ

East

Shoa

Buno Bedele IAB

West Arsi

East

Harargh

eArsi

ORHBGuji

West Hara

rgheJim

ma

SW Sh

oa

East

Wollega

West Wolle

ga

Borena

North Sh

oaHGW Bale

Kellem W

ollega

West Guji

West Sh

oa

The Woreda Management Implementation status was analyzed for Transformation Woredas as follows . It indicates there is a positive progress over the time when compared to the target(80%) i .e . 67%, 72% and 74% in quarter II,III and IV respectively

Similarly, Community Based Health Insurance (CBHI) also analysed for Transformation Woredas the average from QII to QIV is progressive which is 32% at QII, 37QIII and 38% at QIV enrolment rate .To be transformed all has to be achieve 80% enrolment rate .

6.2. Equity And Quality Of CareThe Ethiopian National Health Care Quality Strategy (ENHCQS) was launched in March 2016 with the aim of providing person-cantered, efficient, effective, equitable and high-quality health care for Ethiopia, resulting in improved health outcomes for the country . A dramatic shift in the statusquo requires a view to the entire system, to the issues facing health system leaders, practitioners,outreach workers, community members, and patents alike .

Accordingly, activities have been performed based on the science of Quality Improvement . As a region, first prototype was implemented in Bokoji Hospital . Based on this implementation, Eight zones selected for test of scale (TOS) (Jimma, SZAF, Arsi, Borana, SE shoa, B/Bedele and E/Shoa) . After a while, in all hospitals structure was designed and fully implemented at all . Training was provision for 1898 health worker, structures were redesigned at all levels of the region, especially at Regional, Zonal, woredas and Hospitals levels, learning network collaborative have been conducted in eight zones for 393 health care providers having experience sharing from test of scale . As a region based on the program different,projects were proposed . From these projects, 120 were successful projected and on-going process .

In other hand, equity also the focusing issue of the region . With the collaboration of FMOH, two zone were selected (Guji and Borena) for special support on the six building block of the pillars . Mainly, these special supports are financial, Logistic and technical based on the access and quality of health care .

6.3. Compassionate Respectful And Caring Health Workforce Compassionate, respectful and caring (CRC) is one of the transformation agenda which indicates that Serving patients ,Being ethical, Living the professional oath, and Being a model for young professionals and students . CRC can be characterized as

• Consider patients as human beings with complex Psychological ,social and economic needs Provide person centered care with empathy


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• Effective communication with Health care teams, Patients and Health professionals • Respect for and facilitation of patients and families , participation in decisions and care • Take pride in their health profession and get satisfaction by serving the people and the country

CRC has benefit for a patients as Patients will be less worried , Adherence to medical advice and treatment plans , Positively correlate both with prevention and disease management Improve the healing process as well as quality of health professionals –patient communication . Similarly, Health Professionals, Students, Health Care Facilities have benefits from CRC in different aspects by Providing quality care, decreased medical errors and decreased lawsuits to find their work more meaningful and gratifying so that Quality of health care will be improved and Patient satisfaction will rise .

Hence to address this National strategy and Approach of CRC are creating Ownership and engagement of the leadership at all levels of the system, calls for inspirational leadership, It is also important to identify and engage professionals as part of this movement, National, regional and facility level ambassadors, An advocacy campaign through mass media , Patients and the general public will also be engaged in this movement, An annual health professional recognition event, and CRC has to be a culture, self-driven inner motive and a legacy that the current generation of practitioners leaves to their successors .

Accordingly, regional health bureau has exerted its effort to implement this agenda of transformation . Different advocacy and sensitization workshop for political leaders and health managers, training at different level for 1572 professionals, on pipeline for establishing council committee at different levels are activities so far performed . Though the agenda is implemented in all health institution of the region Bishoftu, Bale Robe, Nekemte and Tullu Bollo hospitals all health work team in mentioned hospitals were trained and

requires intensive support to be a model for the agenda

6.4. Information RevolutionAmong the four interrelated agendas of the HSTP, information revolution (IR) agenda is being under implementation to establishing well-functioning health information system that supports the delivery of health services by ensuring the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status . Two major pillar activities are introduced to realize the information revolution agenda of the HSTP: digitalization of the health information system and cultural transformation of information use at all level of the health system .The RHB in collaboration with its partners is implementing different initiatives such as connected woreda strategy and capacity building and mentor-ship program (CBMP) .

Connected Woreda is a concept that operationalizes the information revolution agendas at woreda level and leverage investments to place the woreda at the center of the Information Revolution . Right now, a considerable amount of health information is being collected at the facility level within the woreda . This occurs at hospitals, health centers, and health posts . The Connected Woreda plan operationalizes data-use innovations through instituting a tiered pathway for facilities and woredas as a whole to achieve the highest standards in data quality and use . This pathway begins with a grading process where facilities are evaluated and scored against a common set of criteria related to M&E infrastructure, data quality, and administrative and clinic data use . Facilities and woredas that meet the highest standards, and that are able to access and share data with higher levels through offline mechanisms, are recognized as “Model Facilities” and “Model


61

Woredas” . Model facilities and woredas that take this one step further by enabling online data access and transmission are recognized as “Connected Facilities” and “Connected Woredas” .

Currently, connected woreda initiative is implemented in 52 woredas in the region . In 52 woredas directly supported by the RHB, a total of 1300 people trained . Similarly, base line assessment was conducted in 94% of the woredas (42 facilities self-assessment, and 8 by the RHB) .Findings of both assessment indicated that, most of the woredas and health facilities are in the emerging category that require huge effort to bring them to the level of model and connected woreda and facilities .

Capacity Building and Mentorship Program (CBMP) implemented is another strategy employed to implement the connected woreda initiative in five woredas in collaboration with Jimma University,FMOH and wollega, Ambo,Metu and Arsi universities . It is an intensive pre-service and in service capacity building and mentorship support provided for the health workforce in selected woredas and their respective health institutions to create model woreda that demonstrate the desired level of data quality and data use . Following the CBMP program launching, a joint planning and different consultative meetings were conducted, baseline data collection and categorization of woredas and facilities finalized, TOT and basic training on data quality and use, DHIS2, revised HMIS, MRU/EMRU given to all HCs, Hospitals and woredas’ targeted for CBMP, and regular facility based mentorship started . One learning woreda (Digalu Tajo in Arsi Zone) is targeted as a learning and demonstration woreda and eCHIS center of excellence is established in Jimma University .


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7 CONCLUSION

This 2011EFY report which is the 4th year of HSTP plan showed a good progresses on some health service delivery indicator performances and presented also areas of some programs need due focus for improvement during the rest one year of the HSTP plan and challenges encountered during the fiscal year . This report mainly highlighted the four pillars of HSTP; Health Service Delivery; Quality Improvement and Assurance; Leadership and Governance; and Health System Capacity with the progress status on the strategic objectives of the health sector under these four themes/pillar .

As illustrated in this bulletin, there are promising on some program performances of maternal health services, child health service, PMTCT services, construction of different WASH projects, nutrition program services, HIV/AIDS services , malaria elimination program, and PHEM programs as well as the commitment and attention given to the implementation of different health reforms including the four agendas of transformation . Implementation of CBHI and regulatory issues and service utilization; OPD per-capita is promising performances in the period of fiscal year .

Various interventions targeted to improve maternal, neonatal and child health status were implemented in the fiscal year . The Min EDHS 2019 results showed a significant improvement in maternal, child, infant and neonatal service in the region . However, there was a slight drop in performance of some maternal indicators during the fiscal year such as Skill birth attendant, Early PNC and Long acting family planning . Similarly, there is low performance in growth and monitoring promotion (GMP) and Low performance in Vit A and deworming which all these need attention during the coming fiscal plan .

The efforts to reduce HIV transmission and provide care support for people who know their status showed improvement in the fiscal year . The region is in a promising position to achieve the UNAIDs three 90 target set for 2020, strengthening HIV primary prevention, focusing on MARPS and improving the clinical care quality will be the major focus areas in the upcoming years .

Moreover, Several efforts to strengthen TB and leprosy control interventions were implemented in the fiscal year . Though, the programs have been successful in the previous years, there were challenges related to multi drug resistance . The regional TB detection rate of all forms has shown a slight increase from last fiscal year performance and treatment outcome; TSR and TCR of the last year performance were promising . Priority focus areas for the upcoming years will include strengthening community engagement, enhancing diagnostic capacities and improving TB and Leprosy program management capacity .

In the same manner, major malaria interventions during the fiscal year especially regarding the malaria prevention and control and malaria elimination strategy are promising which was evidenced by decrease in malaria morbidity and mortality . Similarly, Prevention and control of NTD and NCD were significant priorities in the fiscal year . To address issues related ; service expansion and capacity was cascaded .

With regard to public health expansion and hiring the human resource, though there is good progress from time to time there need to be focus on these areas in the coming left HSTP plan to improve the accessibility as per the number of population . Thus, the region has potential health service coverage of the region in terms of health centers and health posts were 93% and 94% respectively for the year 2011 EFY which are low as compared to the previous preceding years ,because in the recent years including 2011EFY attention


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was given to equipping the existed functional health facilities rather than focusing on new construction . With regard to human resource, there are more than 70,098 health work force density (49,220 health professionals and 20,878 supportive staffs) in sector as of 2011 EFY which is low to achieve the target set at end of HSTP plan .

This report similarly reflects as the regional health bureau has strive to implement the four agendas of transformation this fiscal year ; Quality and Equity services, Woreda transformation, Information revolution, and the Compassionate and respectful care (CRC) at all levels of health institution to realize the quality and equity service provision for the community through strengthening evidence based decision making by strengthening and advancing regional level health information system .


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8. LOOKING FORWARDS TO 2012

²Building on the successes of 2011 and reflecting on the challenges, proposed actions for 2012 .

²Strengthening integrated supportive supervision and review meeting at all levels

²Strengthening community based health insurance by working with all stakeholders .

²Ensure the availability of all inputs such as man power, supplies, drugs, medical equipments, water supplies and electricity .

²Strengthening community participation in all aspects .

²Provide facilities with adequate computers, internet access or modems and electricity .

²Giving due attention for the implementation and its required achievement of all transformation agendas .

Documents

OROMIA REGIONAL HEALTH BUREAU ANNUAL HEALTH SECTOR ...orhb.gov.et/attachments/article/27/Oromia Health... · 2011, efy october 2012 oromia regional health bureau. annual health sector