Lessons from the evolution of human resources for health in Ethiopia: 1941-2010

Human resources for health (HRH) policy and planning is highly challenging in any setting but the more so in underdeveloped countries. Ethiopia has relatively vast and distinctive experience in accelerated training, use of substitute categories/task-shifting… from which important lessons could be drawn.Based on thorough analysis of documents (official, unofficial, government and others) and 1st hand experience of the authors, the paper explores the major issues in HRH development between 1941 – end of the Italian Occupation - and 2010 – end of the Health Sector Development Program (HSDP) III.The socio-cultural and economic context; development in education, higher education in particular and the general human resources development policy, strategy and plans in the successive periods are assessed briefly.Major developments of• Reconstruction and Basic Health Services Period (1941-1974): the successive five-year plans; the training of orderlies/dressers, the 1st nursing schools, training abroad…; the Gondar Public Health College and the Gondar Team; the beginnings of medical education …• Primary Health Care Period (1974-1991) the Ten Years Perspective Health Plan; the training of Community Health Workers - Community Health Agents and Trained Traditional Birth Attendants -, nurse practitioners, health assistants; discontinuation of the health officers (HO) training, the initiation of Jimma College of Health Sciences and of post-graduate training in medicine at the Faculty of Medicine Addis Ababa University…• Sector-Wide Approach Period (1991-2010) the Health Sector Development Programs I-III, the reintroduction of Health Officers training, the accelerated training/‘Flooding Strategy’, Health Extension Workers, retention/‘Brain-Drain’ of health workers…are explored in some depth and lessons drawn for future HRH development in the country.The conclusions underscore the laudable efforts in all periods but difficulties of learning from the past; the continued very low workforce density and the highly skewed distribution; the recurring challenges of sustained human resources development – quality, motivation, retention… - of the task-shifting and accelerated training attempts and the need to develop specific HRH policy and strategy

Assessing Soil Nutrient Additions through Different Composting Techniques in Northern Ethiopia

The use of vermi-compost in northern Ethiopia is not a common practice. It is, therefore, important to understand the possible impediments through studying its chemical and biological properties and its extra contribution compared to other composting techniques. Four compost types (vermi-compost, conventional compost, farmers’ compost and community nursery compost) with three replications were used in this study. The farmers’ and community nursery compost samples were collected from different places in Tigray; whereas, the vermi- and conventional composts were prepared at Mekelle University following a standard composting procedure. Six major composting materials were identified in the visited sites from farmers’ and community nursery foremen’s interview. These composting materials were also used for the vermi- and conventional composting. Twelve composite compost samples were taken for analysis of macro- and micro-nutrients. The results of the experiment showed that for all treatments, despite of having high content of total C (5.04 – 10.67%), the C/N ratio (12.19 – 12.22) was low. This suggests that as the C/N ratio is lower than the threshold (< 30), mineralization is faster, nutrients eventually become available and a large amount of N is lost. Soil pH, exchangeable Magnesium (ex.Mg), exchangeable Potassium (ex.P), available Phosphorus (ava.P), and Cation Exchange Capacity (CEC) showed significant differences among the different composting techniques. Among the selected compost types, ex.Mg, ex.Ca and av.P were higher for vermi-compost. The lowest was recorded in community nursery compost. The use of vermi-compost is, therefore, very helpful in terms of providing beneficial soil nutrients as compared to other compost types.Keywords: Conventional compost, Vermi-compost, farmers’ compost, Nursery compost, Macro-nutrients, Micro-nutrients

International Research Institute for Climate and Society

The role of climate in health is currently enjoying a high profile among the international community in terms of demonstrating climate risk management and adaptation to a changing climate. The effect of climate variability and change on heath is a serious issue for most sub-Saharan African countries. Among the diseases that have public health importance in Ethiopia are malaria, meningitis and acute watery diarrhea. Understanding the relationship of climate and health in Ethiopia would be a tremendous help in early containment of these diseases. In Ethiopia, before the establishment of a Climate and Health Working Group (CHWG), which includes the Federal Ministry of Health and the National Meteorological Agency among other partners, the sharing of information among the two key players was minimal. The goal of this working group is to create a climate-informed health sector that routinely requests and uses appropriate climate information to improve the effectiveness of health interventions. In order to meet its goals, the working group, in collaboration with the International Research Institute for Climate and Society (IRI), organized a six-day training course for health professionals on climate and health. In this training, the Summer Institute course ‘Climate Information for Public Health’ (held for the past two years at IRI in New York), was adapted and implemented. The Summer Institute has involved four Ethiopian participants, one from the National Meteorological Agency (NMA), and three from the Ministry of Health. They played a key role in facilitating some of the course lectures themselves and in identifying local professionals who could also contribute to the curriculum. The general goal of the six-day training was to build the national capacity in order to utilize climate information for decision-making in the health sector at national and regional state levels. The training was comprised of three components: core lectures, practical sessions, and short recap presentations by the participants. Sixteen participants were involved in the training. The selection of the participants was done in consultation with the Federal Ministry of Health. Participants came primarily from the Public Health Emergency Management Units of regional and federal health bureaus and were chosen for their roles in the decision-making around the prevention and control of climate-sensitive diseases. Three types of evaluation were carried out, a pre- and post-test, as well as an overall evaluation. The pre- and post-test helped to evaluate the level of knowledge about climate and health before and after the training. The latter helped in evaluating the organization of the overall training. Generally, the evaluations revealed that the training helped to increase the knowledge of the links between climate and health, as well as the use of climate information for decision-making in the public health sector. This training is the first of its kind organized in Ethiopia, especially at a national level. Most of the participants agreed on the suitability of the content, design and delivery of the course and showed their interest in organizing similar training initiatives in their respective home institutions. It is possible to recommend that this training should be extended to the regional health bureau level, with the already trained participants taking the primary responsibility of facilitating these follow-on activities with the close support of the CHWG. The collaboration of the regional branch offices of the National Meteorological Agency, with respect to using climate information, would play a crucial role in this endeavor. The most important point is to sustain this training and update its contents accordingly. The future research agenda and evidence generation efforts of the CHWG and its members should also focus on other climate-sensitive diseases. Even though participants did not indicate there were always established ties to local universities in different parts of the country, these potential partnerships should be addressed in sharing the knowledge of the use of climate information for public health decision-making and in prioritizing locally important diseases. The training was held at UNECA, Addis Ababa, Ethiopia, between November 31st and December 5th, 2009. Financial and technical support was provided by IRI with funding from the Google.org sponsored project “Building Capacity to Produce and Use Climate and Environmental Information for Improving Health in East Africa”

Evaluation of collaborative TB/HIV activities in a general hospital in Addis Ababa, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Ethiopia has had mechanisms for TB/HIV collaborative activities since 2002. However, no published account has defined the role of these collaborative efforts in strengthening linkages between HIV and TB management units at the point-of-care level. Our objective was to assess the extent of linkages between the two programs at the patient management level at Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Between January and December 2008, the registers of 241 TB patients were reviewed to determine the HIV testing rate, the treatment charts of 238 randomly selected patients were reviewed for providers' compliance with evaluation criteria, and exit interviews were conducted with 309 TB/HIV co-infected clients to validate providers' compliance.</p> <p>Results</p> <p>From register review, it was determined that the HIV testing acceptance rate was 95%, and that 70% of patients received post-test counseling. A review of the patient chart revealed that of 51 patients with a complaint of cough, duration for cough was recorded in 35 (68.6%) cases and cough > 2 weeks was recorded in 25 (49.0%) cases. Seventy two percent (18 of 25) were linked for sputum microscopy. Linkage to cotrimoxazole prophylactic treatment was 81%, but only 47% of eligible patients were linked to isoniazid preventive therapy (IPT). Correct diagnosis was accomplished at a rate of 100% for smear positive pulmonary TB, 23% for smear negative pulmonary TB and 88% for extra pulmonary TB patients. Both chart review and exit interviews indicated that history of TB contact and cough > 2 weeks predicted TB disease.</p> <p>Conclusion</p> <p>The rates of HIV testing and linkage to cotrimoxazole prophylactic therapy were high. Improvement is needed in the areas of recording patient information, screening HIV positives for TB, initiation of IPT, referral, linkages, and TB diagnostic capacity.</p

Comparison of artemether-lumefantrine and chloroquine with and without primaquine for the treatment of Plasmodium vivax infection in Ethiopia: A randomized controlled trial

Background: Recent efforts in malaria control have resulted in great gains in reducing the burden of Plasmodium falciparum, but P. vivax has been more refractory. Its ability to form dormant liver stages confounds control and elimination efforts. To compare the efficacy and safety of primaquine regimens for radical cure, we undertook a randomized controlled trial in Ethiopia. Methods and findings: Patients with normal glucose-6-phosphate dehydrogenase status with symptomatic P. vivax mono-infection were enrolled and randomly assigned to receive either chloroquine (CQ) or artemether-lumefantrine (AL), alone or in combination with 14 d of semi-supervised primaquine (PQ) (3.5 mg/kg total). A total of 398 patients (n = 104 in the CQ arm, n = 100 in the AL arm, n = 102 in the CQ+PQ arm, and n = 92 in the AL+PQ arm) were followed for 1 y, and recurrent episodes were treated with the same treatment allocated at enrolment. The primary endpoints were the risk of P. vivax recurrence at day 28 and at day 42. The risk of recurrent P. vivax infection at day 28 was 4.0% (95% CI 1.5%–10.4%) after CQ treatment and 0% (95% CI 0%–4.0%) after CQ+PQ. The corresponding risks were 12.0% (95% CI 6.8%–20.6%) following AL alone and 2.3% (95% CI 0.6%–9.0%) following AL+PQ. On day 42, the risk was 18.7% (95% CI 12.2%–28.0%) after CQ, 1.2% (95% CI 0.2%–8.0%) after CQ+PQ, 29.9% (95% CI 21.6%–40.5%) after AL, and 5.9% (95% CI 2.4%–13.5%) after AL+PQ (overall p < 0.001). In those not prescribed PQ, the risk of recurrence by day 42 appeared greater following AL treatment than CQ treatment (HR = 1.8 [95% CI 1.0–3.2]; p = 0.059). At the end of follow-up, the incidence rate of P. vivax was 2.2 episodes/person-year for patients treated with CQ compared to 0.4 for patients treated with CQ+PQ (rate ratio: 5.1 [95% CI 2.9–9.1]; p < 0.001) and 2.3 episodes/person-year for AL compared to 0.5 for AL+PQ (rate ratio: 6.4 [95% CI 3.6–11.3]; p < 0.001). There was no difference in the occurrence of adverse events between treatment arms. The main limitations of the study were the early termination of the trial and the omission of haemoglobin measurement after day 42, resulting in an inability to estimate the cumulative risk of anaemia. Conclusions: Despite evidence of CQ-resistant P. vivax, the risk of recurrence in this study was greater following treatment with AL unless it was combined with a supervised course of PQ. PQ combined with either CQ or AL was well tolerated and reduced recurrence of vivax malaria by 5-fold at 1 y