Rethinking public health training: What would be ideal for the 21st century?

It was only at the latter half of the last century that public health training started in Ethiopia. If we consider Gondar Public Health College as the locus for the beginning of public health training in Ethiopia, it has been a mere 60 years on its journey. Gondar College focused on the training of health officers and community midwives, working in rural areas at rudimentary health centers, who were tasked primarily with preventive health (1). The basic philosophy behind their training and deployment was the basic health services approach that dominated public health thinking in the 1950s and 1960s (2)

Editorial

Strengthening the Link between Economic Development, Environment and Public Healt

DETERMINANTS OF COMMUNITY HEALTH AGENT FUNCTIONALITY IN ARSI REGION

ABSTRACT: A comparative case-control study to assess the determinants of Community Health Agent (CHA) functionality was done in two Arsi districts, in mid-southern Ethiopia. This was a census study which was conducted by interviewing 347 CHAs from a structured questionnaire. The objectives were to describe the situation of the CHAs trained up to the end of 1987, and to elucidate determinants of CHA functionality by comparing the attributes of functional CHAs (cases) with that of the nonfunctional ones (controls). The findings revealed that only 25.8% of the CHAs interviewed were performing 50% or more of the activities mentioned in their job description. It also revealed a point prevalence attrition rate of 45%. Comparing cases and controls showed a strong association between functionality and community support for the CHAs (RR = 72.4 with 95% CI 35 - 153). Association was also found between functionality and supervision by health institutions, presence of health posts, provision of stationary drugs and to the CHA, and establishment of an active health committee. These findings emphasize the importance of provision of proper community and health system support for the success of the community health services program

Community members’ views on Addis Ababa University’s rural community health training program: A qualitative study

AbstractBackground: Community-Based Education (CBE) is an educational process aiming to ensure educational relevance to community needs, thereby contributing to improved community health needs. Addis Ababa University runs a six-week long Rural Community Health Training Program at Adami Tulu District, East Shoa Zone. In the program, the final year medical students are attached to the community to apply their theoretical training and address the community’s health problems. This study explored views of the local community about the program.Methods: A descriptive qualitative study was carried out in Adami Tulu District of East Shoa Zone – the district is the site of the training program. Data was collected from community members, local administrators, health extension workers, school principals and opinion leaders selected from three kebeles within the attachment area. A total of five FGDs and six key informant interviews were conducted using a semi-structured interview guide. The audio-taped data was later transcribed verbatim and translated into English. Themes were developed guided by the objective of the study with the application of Open Code Version 4.02.Results: The finding of the study revealed that the local community, beyond recognizing the participants as some kind of medical professionals from Addis Ababa University, knew very little about the program and its objectives. For example, the only benefit all the participants rightly mentioned in common, as evidence of their knowledge the program is free treatment for sick children by the students. Lack of communication between the university and local administration; absence of community involvement in the planning, execution and evaluation of the program; and problems related to language were identified as key areas for improvement.Conclusion: The Rural Community Health Training Program (RCHTP) is an important resource for both the university and the local community. It is therefore important that the university take proactive measures and optimize the involvement of local leaders and community members to enhance their sense of ownership of the program. [Ethiop. J. Health Dev. 2018;32(1):10-17

Causes of maternal death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis

The study documented causes of maternal deaths, and risk factors contributing to deaths aggravated by pregnancy and its management in Ethiopia (1990 to 2016), using a systematic review with meta-analysis. The nationwide registration of causes of maternal death should be strengthened to understand the causes in detail, their attributes, as well as the patterns of causes of death. Findings reveal that the main direct causes of maternal death in Ethiopia include obstetric complications such as hemorrhage, obstructed labor/ruptured uterus, pregnancy-induced hypertension, puerperal sepsis, and unsafe abortion. The health sector should sustain its current effort to tackle the diverse causes of maternal death in Ethiopia

Ethiopia’s urban primary health care reform: Practices, lessons, and the way forward

AbstractBackground: At present there is remarkable expansion of urbanization in Ethiopia. By 2050, 38% of the population in Ethiopia is expected to reside in urban settings. The majority of this future urban population is believed to live in slums. In response to this daunting health challenge, the Ministry of Health launched urban health extension program in 2009. The outcome of this initiative, however, is still uncertain - Urban Health Extension Professionals seem to have failed to meet the desired end. To improve the situation, experiences were drawn from middle-income countries and piloted in Addis Ababa in 2014. This is a report of the study conducted to assess the implementation of the pilot initiatives. In the assessment of the implementation, attempts were also made to identify lessons and challenges encountered.Methods: Qualitative data were collected from purposively selected individuals involved in the design, implementation, and use of the pilot initiative. Checklists developed on the basis of the objective of the study were used for data collection.Findings: The findings indicated that the initiative had a team of health professionals - people who had the skills needed to work as a team and implement the pilot activities. The health team improved linkages and collaboration between the health system and the community. Through the team, identification of the most neglected sections of the population was ensured and this section has accessed health services. For example, the disabled, the sick, the elderly, persons with chronic health problems, girls and women were identified as social sectors that had either no or very little access to health care. The health team created a strong sense of collaboration between itself and the community level structures. This has been recognized to have an important role in improving service delivery to community. However, the level of the team’s recognition of local community set up and structures as facilitators of health services needs improvement. Furthermore, a shortage of transportation to distant places in the catchment areas and a lack of timely provision of supplies and drugs to address some basic health problems at household and community levels were identified as major problems.Conclusions: Ensuring proper urban health care requires multifaceted and multi-sectoral responses. Defining strategies of enhancing the engagement of different sectors in achieving the objectives of the initiative is an important point to be noted. Ways to provide continuous supplies to the health teams need to be sought. An equally important point that needs to be noted to ensure further successes of the initiative is empowering and enabling community level structures to focus more on health-related activities. [Ethiop. J. Health Dev. 2018; 32(1):4-9

Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

Background: Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods: Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results: The cost of test per client for facility-based, stand-alone and mobile-based VCT was USD 5.06, USD 6.55 and USD 3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were USD 158.82, USD 150.97 and USD 135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion: Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.publishedVersio

Moving towards universal health coverage for mental disorders in Ethiopia

Background: People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage. Aims: To propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia. Methods: We conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia. Results: Opportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention. Conclusion: Expansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care

Under five causes of death in Ethiopia between 1990 and 2016 : systematic review with meta-analysis

The study worked to identify causes of death for neonatal, post-neonatal, infants and children under five years old in Ethiopia. Causes- targeted obstetric and child healthcare interventions will reduce mortality, and will require improving healthcare units. Major causes of death revealed in this study are bacterial sepsis, birth asphyxia, prematurity, acute lower respiratory infection and diarrheal diseases. Almost all causes are easily preventable and treatable and can be addressed by strengthening health extension services and improved quality of primary health care

Towards a Global Interdisciplinary Evidence-Informed Practice: Intimate Partner Violence in the Ethiopian Context

Background. Intimate partner violence is a global health issue and is associated with a range of health problems for women. Nurses, as the largest health workforce globally, are well positioned to provide care for abused women. Objectives. This nursing-led interdisciplinary project was conducted to understand the current state of knowledge about intimate partner violence in Ethiopia and make recommendations for country-specific activities to improve response to intimate partner violence through practice changes, education, and research. Methods. The project involved two phases: review of relevant literature and an interdisciplinary stakeholder forum and a meeting with nurse educators. Findings. The literature review identified the pervasiveness and complexity of intimate partner violence and its sociocultural determinants in the Ethiopian context. Two significant themes emerged from the forum and the meeting: the value of bringing multiple disciplines together to address the complex issue of intimate partner violence and the need for health care professionals to better understand their roles and responsibilities in actively addressing intimate partner violence. Conclusions. Further research on the topic is needed, including studies of prevention and resilience and “best practices” for education and intervention. Interdisciplinary and international research networks can support local efforts to address and prevent intimate partner violence