Primary Health Care In Ethiopia Research Articles

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage.

The Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency. We used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs. On average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934-40,746) in health posts, US$ 254,340 (range: US$ 68,860-832,647) in health centers, and US$ 634,354 (range: US$ 505,208-970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets. The study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE's PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.

Prevalence of herbal and traditional medicine in Ethiopia: a systematic review and meta-analysis of 20-year studies

BackgroundThe widely accepted prevalence of traditional medicine (TM) in Ethiopia was about 80 %, of which 95 % were sourced from plants. The purpose of this study was to update knowledge of the prevalence of herbal medicine or TM in Ethiopia and describe the characteristics of the population mostly relying on herbal medicine or TM to inform health policy-makers.MethodsPubMed, Google Scholar, Hinari, Scopus, and the Directory of Open Access Journals (DOAJ) were searched. The methodological quality of each included study was assessed using the quality assessment checklist for prevalence studies. Meta-analysis was conducted using STATA version 17, and the heterogeneity between studies was assessed using I2 test statistics based on the random effect model. Forest and funnel plots were used to present the data. Subgroup analysis was done by the study population, region, and setting.ResultsThirty-six studies with a total of 16,288 participants met the inclusion criteria. Meta-analysis of the study revealed that the prevalence of herbal medicine use in Ethiopia is 46 % (95 % CI, 37–54 %), with significant heterogeneity among the studies (I2 = 99.19 %). Egger’s test for publication bias of herbal medicine use revealed significant results (Egger, P = 0.002) which indicates possible missing of small sample size studies. The prevalence of TM use in Ethiopia is 65 % (95 % CI, 52–77 %) with significant heterogeneity among the studies (I2 = 99.18 %). Egger’s test for publication bias of TM use revealed non-significant results (Egger, P = 0.275). The subgroup analysis by the study setting and the region revealed variability amongst the studies. Community-based studies and Oromia National Regional State showed higher prevalence. By population type, a higher prevalence of TM use was observed amongst children and lowest amongst malaria suspects.ConclusionsThe current study revealed that TM/herbal medicine utilization remained an important source of primary healthcare in Ethiopia. In comparison to the commonly reported prevalence of TM/herbal medicine, there is a considerable decline in TM/herbal medicine prevalence. High TM/herbal medicine use tendency during pregnancy necessitates safety studies to optimize the utilization.

Facilitators and barriers to integration of noncommunicable diseases with HIV care at primary health care in Ethiopia: a qualitative analysis using CFIR.

The rise in non-communicable diseases (NCD), such as hypertension and diabetes among people living with human immunodeficiency virus (PLWH), has increased the demand for integrated care due to multiple chronic care needs. However, there is a dearth of evidence on contextual factors implementing integrated hypertension and diabetes care with HIV care. This study aimed to identify facilitators and barriers that could affect the integration of hypertension and diabetes with HIV care at primary health care in Ethiopia. Five primary health facilities from five districts of the Wolaita zone of South Ethiopia were included in the qualitative study. Fifteen key informant interviews were conducted with healthcare providers and managers from the zonal, district, and facility levels from October to November 2022. Data collection and analysis were guided by a consolidated framework of implementation research (CFIR). Ten CFIR constructs were found to influence the integration. Perceived benefit of integration to patients, healthcare providers, and organization; perceived possibilities of integration implementation; availability of NCD guidelines and strategies; a supportive policy of decentralization and integration; perceived leaders and healthcare provider commitment were found to be facilitators. Perceived increased cost, insufficient attention to NCD care needs, inadequate number of trained professionals, inadequate equipment and apparatus such as blood pressure measurement, glucometers, strips, and NCD drugs, inadequate allocation of budget and weak health financing system and poor culture of data capturing and reporting were identified as barriers to integration. It is important to address contextual barriers through innovative implementation science solutions to address multiple chronic care needs of PLWH by implementing integrated hypertension and diabetes with HIV care in primary healthcare. Training and task shifting, pairing experienced professionals, and strengthening the health care financing system to implement evidence-based integration of hypertension and diabetes are recommended.

Exploring the interface between community health systems and primary health care in Ethiopia, Kenya, Nigeria, Rwanda, and Senegal

Exploring the interface between community health systems and primary health care in Ethiopia, Kenya, Nigeria, Rwanda, and Senegal

Capacity of the Ethiopian primary health care system to achieve universal health coverage: a primary health care progression approach.

Comprehensive and globally comparable evidence about primary health care (PHC) capacity is needed to inform policies and decisions. We carried out a study to assess the Ethiopian PHC capacity in terms of governance, inputs, and population health and facility management domains. The PHC capacity of all the regions, city administrations and the Ministry of Health was assessed using the PHC progression model. The model has 33 measures categorized into three domains. Data were collected and synthesized from all relevant national and regional documents, datasets and key informants. A team of trained evaluation experts conducted external assessments at national and regional levels followed by an internal assessment and a validation workshop. All 33 measures were scored from 1 (lowest) to 4 (highest). The inter-rater reliability test indicated that the overall agreement between internal and external scores was 65%. We found the highest consistency in the internal assessment with a score of 0.84. The findings of this study indicated that the governance domain score was 2.8 out of 4, showing varying scores in quality management, priority setting as well as innovation and learning. The inputs domain score was 2.3 for drugs, supplies and facility infrastructure. The score for the population health and facility management domain was 2. A comparison of federal and national average scores for all measures indicated no significant difference between the two (P-value = 0.69). There are relevant PHC policies and leadership structures at the federal and regional levels. However, the capacity to effectively implement these policies and strategies at sub-national levels is sub-optimal. The challenges related to major inputs coupled with data-quality problems reduced the capacity of the PHC system at the local level. Periodic assessment of the PHC system and closely working with subnational units will potentially improve the capacity of PHC in Ethiopia.

An Analysis of Zonal Health Management Capacity and Health System Performance: Ethiopia Primary Healthcare Transformation Initiative.

District management is emerging as a lynchpin for primary healthcare system performance. However, delivery of district-level interventions at scale is challenging, and overlooks the potential role of management at other subnational levels. From 2015-2019, Ethiopia's Primary Healthcare Transformation Initiative (PTI), aimed to build a culture of performance management and accountability at the zonal level. This paper aims to evaluate the longitudinal change in management practice and performance in the 19 zones participating in PTI, which included 315 districts and 1617 health centers. Using data from PTI intervention (2018 to 2019), we employed quantitative measures of management capacity at health center, district, and zonal levels, and quantified primary healthcare service performance using a summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We used multiple generalized linear regression models accounting for clustering of health centers within zones to quantify (1) change in management and performance during the two-year intervention, (2) associations between the changes in management capacity at the zonal, district, and health facility level. Adherence to management standards at the zonal, district, and health facility level improved significantly over two years (37%, P<.001; 18%, P<.001; 18%, P<.001; respectively), as did the performance summary score (14%, P<.001). Adherence at the zonal level in year one was associated with district level adherence in year one (P=.04), and, over the two-year period (P=.002), and district management mediated the relationship between management practice at zonal and health center levels (P<.001). Improvements in zonal-level management practice were associated with significant improvements in district-level management and performance in PTI sites. Investments in managerial practices at the zonal level may provide an immediate way to energize primary healthcare system performance at scale in low-income country settings.

Risk factors of anemia among preschool children in Ethiopia: a Bayesian geo-statistical model

BackgroundThe etiology and risk factors of anemia are multifactorial and varies across context. Due to the geospatial clustering of anemia, identifying risk factors for anemia should account for the geographic variability. Failure to adjust for spatial dependence whilst identifying risk factors of anemia could give spurious association. We aimed to identify risk factors of anemia using a Bayesian geo-statistical model.MethodsWe analyzed the Ethiopian Demographic and Health Survey (EDHS) 2016 data. The sample was selected using a stratified, two- stage cluster sampling design. In this survey, 9268 children had undergone anemia testing. Hemoglobin level was measured using a HemoCue photometer and the results were recorded onsite. Based on the World Health Organization’s cut-off points, a child was considered anaemic if their altitude adjusted haemoglobin (Hb) level was less than 11 g/dL. Risk factors for anemia were identified using a Bayesian geo-statistical model, which accounted for spatial dependency structure in the data. Posterior means and 95% credible interval (BCI) were used to report our findings. We used a statistically significant level at 0.05.ResultThe 9267 children in our study were between 6 and 59 months old. Fifty two percent (52%) of children were males. Thirteen percent (13%) of children were from the highest wealth quintile whereas 23% from the lowest wealth quintile. Most of them lived in rural areas (90%). The overall prevalence of anemia among preschool children was 57% (95% CI: 54.4–59.4). We found that child stunting (OR = 1.26, 95% BCI (1.14–1.39), wasting (OR = 1.35, 95% BCI (1.15–1.57), maternal anemia (OR = 1.61, 95% BCI (1.44–1.79), mothers having two under five children (OR = 1.2, 95% BCI (1.08–1.33) were risk factors associated with anemia among preschool children. Children from wealthy households had lower risk of anemia (AOR = 0.73, 95% BCI (0.62–0.85).ConclusionUsing the Bayesian geospatial statistical modeling, we were able to account for spatial dependent structure in the data, which minimize spurious association. Childhood Malnutrition, maternal anemia, increased fertility, and poor wealth status were risk factors of anemia among preschool children in Ethiopia. The existing anaemia control programs such as IFA supplementation during pregnancy should be strengthened to halt intergenerational effect of anaemia. Furthermore, routine childhood anaemia screening and intervention program should be part of the Primary health care in Ethiopia.

Health system capacity and readiness for delivery of integrated non-communicable disease services in primary health care: A qualitative analysis of the Ethiopian experience.

Non-communicable diseases (NCDs) now account for about 71% and 32% of all the deaths globally and in Ethiopia. Primary health care (PHC) is a vital instrument to address the ever-increasing burden of NCDs and is the best strategy for delivering integrated and equitable NCD care. We explored the capacity and readiness of Ethiopia's PHC system to deliver integrated, people-centred NCD services. A qualitative study was conducted in two regions and Federal Ministry of Health, Addis Ababa, Ethiopia. We carried out twenty-two key informant interviews with national and regional policymakers, officials from a partner organisation, woreda/district health office managers and coordinators, and PHC workers. Data were coded and thematically analysed using the World Health Organization (WHO) Operational Framework for PHC. Although the rising NCD burden is well recognised in Ethiopia, and the country has NCD-specific strategies and some interventions in place, we identified critical gaps in several levers of the WHO Operational Framework. Many compared the under-investment in NCDs contrasted with Ethiopia's successful PHC models established for maternal and child health and communicable disease programs. Insufficient political commitment and leadership required to integrate NCD services at the PHC level and weaknesses in governance structures, inter-sectoral coordination, and funding for NCDs were identified as significant barriers to strengthening PHC capacity to address NCDs. Among the operational-focussed levers, fragmented information management systems and inadequate equipment and medicines were identified as critical bottlenecks. The PHC workforce was also considered insufficiently skilled and supported to provide NCD services in PHC facilities. Strengthening NCD prevention and control through PHC in Ethiopia requires greater political commitment and investment at all health system levels. Prior success strategies with other PHC programs could be adapted and applied to NCD policies and practice, giving due consideration for the unique nature of the NCD program.

Policies, delivery models, and lessons learned from integrating mental health and substance abuse services into primary health care in Ethiopia.

In Ethiopia, noncommunicable diseases (NCDs) represent 18.3% of premature mortality, consume 23% of the household expenditures, and cost 1.8% of the gross domestic product. Risk factors such as alcohol, khat, and cannabis use are on the rise and are correlated with a substantial portion of NCDs. Associated NCDs include depression, anxiety, hypertension, coronary heart disease, and myocardial infarction. The multi‐faceted nature of mental health and substance abuse disorders require multi‐dimensional interventions. The article draws upon participant observation and literature review to examine the policies, delivery models, and lessons learned from the Federal Ministry of Health (FMOH) experience in integrating Mental Health and Substance Abuse (MH/SA) services into primary care in Ethiopia. In 2019, FMOH developed national strategies for both NCDs and mental health to reach its population. Ethiopia integrated MH/SA services at all levels within the government sector, with an emphasis on primary health care. FMOH launched the Ethiopian Primary Health Care Clinical Guidelines, which includes the delivery of NCD services, to standardize the care given at the primary health care level. To date, the guidelines have been implemented by over 800 health centers and are expected to improve the quality of service and health outcomes. Existing primary care programs were expanded to include prevention, early detection, treatment, and rehabilitation for MH/SA. This included training and leveraging an array of health professionals, including traditional healers and those from faith‐based institutions and community‐based organizations. A total of 244 health centers completed training in the Mental Health Gap Action Programme (mhGAP). In 2020, 5,000 urban Health Extension Workers (HEWs) participated in refresher training, which includes mental health and NCDs. A similar curriculum for rural health workers is in development. Ethiopia's experience has many lessons learned about stakeholder buy‐in, roles, training, logistics, and sustainability that are transferable to other countries. Lessons include that "buy‐in" by leaders of public health care facilities requires consistent and persistent nurturing. Ensure the gradual and calibrated integration of MH/SA services so that the task‐sharing will not be viewed as "task dumping." Supervision and mentorship of the newly trained is important for the delivery of quality care and acquisition of skills.

The origins of Ethiopia's primary health care expansion: The politics of state building and health system strengthening.

Ethiopia’s expansion of primary health care over the past 15 years has been hailed as a model in sub-Saharan Africa. A leader closely associated with the programme, Tedros Adhanom Gebreyesus, is now Director-General of the World Health Organization, and the global movement for expansion of primary health care often cites Ethiopia as a model. Starting in 2004, over 30 000 Health Extension Workers were trained and deployed in Ethiopia and over 2500 health centres and 15 000 village-level health posts were constructed. Ethiopia’s reforms are widely attributed to strong leadership and ‘political will’, but underlying factors that enabled adoption of these policies and implementation at scale are rarely analysed. This article uses a political economy lens to identify factors that enabled Ethiopia to surmount the challenges that have caused the failure of similar primary health programmes in other developing countries. The decision to focus on primary health care was rooted in the ruling party’s political strategy of prioritizing rural interests, which had enabled them to govern territory successfully as an insurgency. This wartime rural governance strategy included a primary healthcare programme, providing a model for the later national programme. After taking power, the ruling party created a centralized coalition of regional parties and prioritized extending state and party structures into rural areas. After a party split in 2001, Prime Minister Meles Zenawi consolidated power and implemented a ‘developmental state’ strategy. In the health sector, this included appointment of a series of dynamic Ministers of Health and the mobilization of significant resources for primary health care from donors. The ruling party’s ideology also emphasized mass participation in development activities, which became a central feature of health programmes. Attempts to translate this model to different circumstances should consider the distinctive features of the Ethiopian case, including both the benefits and costs of these strategies.

Recurrent costs in primary health care in Ethiopia: facility and disease specific unit costs and their components in government primary hospitals and health centers

BackgroundContinued investment, especially from domestic financing, is needed for Ethiopia to achieve universal health coverage and a sustainable health system over time. Understanding costs of providing health services will assist the government to mobilize adequate resources for health, and to understand future costs of changes in quality of care, service provision scope, and potential decline in external resources. This study assessed costs per unit of service output, “unit costs”, for government primary hospitals and health centers, and disease-specific services within each facility.MethodsQuantitative and qualitative data were collected from 25 primary hospitals and 47 health centers across eight of the eleven regions of Ethiopia for 2013/14, and 2014/15 and 2015/16 but only for primary hospitals, and supplemented by other related health and financial institutions records. A top-down costing approach was used to estimate unit costs for each facility by department – inpatient, outpatient, maternal and child health, and delivery. A mixed-method approach was used for the disease-specific unit costs exempt from fees.ResultsHealth center median unit cost was 146 Ethiopian birr (ETB) (17 PPP$, 2012), the Delivery department had the highest median unit cost (647 ETB; 76 PPP$, 2012) and Outpatient department (OPD) had the lowest (124 ETB; 14 PPP$, 2012). Primary hospital median unit cost was 339 ETB (40 PPP$, 2012), with Inpatient department having the highest median unit cost (1288 ETB; 151 PPP$, 2012), while OPD was the lowest (252 ETB; 29 PPP$, 2012). Drugs and pharmaceutical supplies accounted for most of the costs for both facilities. Among the exempted services offered, tuberculosis and antiretroviral treatment are the costliest with median unit costs from 1091 to 1536 ETB (128–180 PPP$, 2012), with drugs and supplies accounting for almost 90% of the costs.ConclusionsHigh unit costs of service provision could be indicative of underutilization of the primary health care system, coupled with inefficiencies associated with organization and delivery of health services. Data from this study are being used to assess efficiency and productivity among primary care facilities, facilitate premium setting for health insurance, and improve budgeting and allocating health resources for a more sustainable and effective primary health care system.

Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study

BackgroundThere have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare.MethodsA comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment.ResultsNo significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09).ConclusionIn this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention.

Availability and inequality in accessibility of health centre-based primary healthcare in Ethiopia.

BackgroundAchieving fair access to healthcare and improving population health are crucial in all settings. Properly staffed and fairly distributed primary health care (PHC) facilities are prerequisites to ensure accessible healthcare services. Nevertheless, availability and accessibility issues are common public health concerns, especially in under-resourced countries including Ethiopia. Measuring inequalities in accessibility of healthcare resources guide policy decisions to improve PHC services and ultimately achieving universal health coverage (UHC).PurposeTo assess availability and measure magnitude and trend of inequalities in accessibility of health centre-based PHC resources in Ethiopia during 2015 to 2017.MethodsWe conducted a cross-sectional population-based analysis of district-level data collected from 16th December 2017 until 24th May 2018. Afar, Dire-Dawa, and Tigray regions were purposefully included in the study to represent the four pastoralist/semi-pastoralist, three urban and four agrarian regions in Ethiopia, respectively. We used ratios, different inequality indices and Gini decomposition techniques to characterise the inequalities.ResultsIn 2017, median of health centres (HCs) per 15,000 inhabitants and their Gini indices (GIs) for Afar, Dire-Dawa, and Tigray were 0.781, 0.566, 0.591 vs. 0.237, 0.280, 0.216 respectively. Median overall skilled health workers (SHWs) per 10,000 inhabitants were 5.250, 7.539, and 6.246, respectively. These accounted for 11.80%, 16.94% and 14.04% of the WHO target of 44.5 to achieve SDGs. The corresponding GIs for the regions were 0.347, 0.186 and 0.175. Despite a higher overall SHWs inequality in the urban districts of Tigray (GI = 0.301), only Tigray showed significant inequality reductions in GHE (p < 0.001) and in all categories of SHWs (p < 0.05).ConclusionsOur analysis provided a clear picture of availability and inequalities in PHC resources across three regions in Ethiopia. Identifying contributing factors to low densities and high inequalities of SHWs may help improve PHC services nationwide, along with pathway towards UHC.

Quality of routine health data collected by health workers using smartphone at primary health care in Ethiopia

BackgroundMobile phone based applications are considered by many as potentially useful for addressing challenges and improving the quality of data collection in developing countries. Yet very little evidence is available supporting or refuting the potential and widely perceived benefits on the use of electronic forms on smartphones for routine patient data collection by health workers at primary health care facilities. MethodsA facility based cross sectional study using a structured paper checklist was prepared to assess the completeness and accuracy of 408 electronic records completed and submitted to a central database server using electronic forms on smartphones by 25 health workers. The 408 electronic records were selected randomly out of a total of 1772 maternal health records submitted by the health workers to the central database over a period of six months. Descriptive frequencies and percentages of data completeness and error rates were calculated. ResultsWhen compared to paper records, the use of electronic forms significantly improved data completeness by 209 (8%) entries. Of a total 2622 entries checked for completeness, 2602 (99.2%) electronic record entries were complete, while 2393 (91.3%) paper record entries were complete. A very small percentage of error rates, which was easily identifiable, occurred in both electronic and paper forms although the error rate in the electronic records was more than double that of paper records (2.8% vs. 1.1%). More than half of entry errors in the electronic records related to entering a text value. ConclusionsWith minimal training, supervision, and no incentives, health care workers were able to use electronic forms for patient assessment and routine data collection appropriately and accurately with a very small error rate. Minimising the number of questions requiring text responses in electronic forms would be helpful in minimizing data errors.

Experiences, Strengths and Challenges of Integration of Mental Health into Primary Care in Ethiopia. Experiences of East African Country

Background: The burden of mental disorders is increaasing in low and middle income countries including Ethiopia but the number of psychiatry professionals is scarce. Integrating mental health in primary health care is vital to address the problem. This survey aimed in assessing the experiences, strengths and challenges of integrating mental health in primary health care in Ethiopia. Methods: Facility based supervisions was done in primary health care centers where the scale up program was implemented and giving mental health services. Semi structured and standardized WHO mental health Global Action Programme support and supervision questionnaires was used to collect information's. Findings: A total of 1576 mental, neurological and substance use (MNS) disorders were identified and treated in selected four regions. Majority of identified cases were epilepsy (46.64%) followed by psychosis (28.49%). Essential drugs for treating psychosis, depression and epilepsy were available in almost all health institutions. Delayed support and supervisions, staff turnover, interrupted supply of drugs and shortage of budget were the major identified challenges of integrations. Conclusions: In general the experiences of mental health integration in Ethiopia have shown promising findings in achievements in number of trained professionals, health care centers involved, availability of drugs and cases identified and treated by trained professionals. Increasing number of staff trained in mental health care and Continuous support and training for trained professionals, supply of psychotropic medication is vital for effectiveness of integration. In additions researches in scale up concentrating on impact and outcomes of interventions are implicated for understanding the success of interventions.

Mobile health data collection at primary health care in Ethiopia: a feasible challenge

ObjectivesFeasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia. Study Design and SettingA total of 14 health workers were recruited from 12 primary health care facilities to use smartphones, installed with customized data collection application and electronic maternal health care forms for assessing pregnant women's health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users' perception and experience in using the application and forms. ResultsAll health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers' acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges. ConclusionIntroducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application.

Women’s perception and risk factors for delayed initiation of breastfeeding in Arba Minch Zuria, Southern Ethiopia

BackgroundBreastfeeding is one of the components of Primary Health Care in Ethiopia. In Ethiopia a wide range of harmful infant feeding practices has been documented despite the implementation of infant and young child feeding guidelines. However, there is no well documented study of women’s perception of breastfeeding patterns and factors associated with delayed initiation of breastfeeding (with timely initiation of breastfeeding being within the first hour) in rural communities of Arba Minch Zuria.MethodsA community-based cross-sectional study was carried out in Arba Minch Zuria from January to February, 2012. Quantitative data were collected from a sample of 383 respondents supplemented by qualitative data generated using in-depth interviews of 10 key informants. A multivariate logistic regression analysis was used to identify the predictors of delayed initiation of breastfeeding practices. Qualitative data were analyzed using thematic frameworks.ResultsIn the rural communities of Arba Minch Zuria almost all mothers (98.2%) have ever breastfed their children. More than three-fourth (89%) of mothers provided colostrum to their infants while others discarded the first milk until the white milk was produced. A large number of mothers (42.8%) started breastfeeding one hour after childbirth. Delayed initiation of breastfeeding was positively associated with lack of maternal education (AOR 1.91; 95% CI 1.02, 3.44). Maternal knowledge about the duration of exclusive breastfeeding (AOR 0.39; 95% CI 0.15, 0.93), attending a primary health education (AOR 0.74; 95% 0.15, 0.98) and health personnel support for women at delivery time (AOR 0.52; 95% CI 0.21, 0.58) were inversely associated with delayed initiation of breastfeeding practices.ConclusionsA large number of mothers (42.8%) were short of the national and global recommendations about breastfeeding initiation. Therefore, sustained health and community based nutritional education is recommended for pregnant and lactating mothers to promote optimal breastfeeding for the initiation of breastfeeding practices using health extension workers and local community resource people as key actors.

Introduction of Complementary Foods to Infants within the First Six Months and Associated Factors in Rural Communities of JimmaArjo

Background: Although breastfeeding is one of the components of Primary Health Care in Ethiopia, a wide range of harmful infant feeding practices are documented even after the implementation of infant and young child feeding guidelines. However, no studies were documented about complementary feeding patterns and factors associated with early introduction of complementary feeding in the study area. Methods and Materials: Community based cross-sectional study was carried out in JimmaArjoWoreda from December to January 2009. Quantitative data were collected from a sample of 382 respondents supplemented by qualitative data generated using in-depth interviews of 15 key informants.Data were analyzed using SPSS version 16.0. Binary logistic regressions were used to measure the strength of association between independent and dependent variables using odds ratios and 95% of confidence intervals. Finally, multivariate logistic regression analysis was done to identify the predictors of early introduction of complementary food.Results: About 42.9% of mothers initiated complementary feeding before 6 months. The majority of mothers early initiated complementary feeding since they believed that breast milk was insufficient and influences from social beliefs. Findings from this study showed that young maternal age, child age below 1 month, child age 1-2 months, breastfeeding initiation within the first hour of child birth, having information about exclusive breastfeeding and maternal attitude about the dietary importance of breast milk for their children were negatively associated with early introduction of complementary food. However, lack of sufficient time with their children was one of predisposing factor for early introduction of the additional food before 6 months. Conclusions: Findings from this study showed that 42.9% of mothers introduced complementary food before 6 months. As this can cause malnutrition and exposure to different types of infections, the contributing factors to early introduction of complementary food should be taken into account while designing intervention strategies. In addition promotion of strong community based networks using Health Extension Workers and local community’s resource people as key actors is important to tackle this problem.

Beyond Plants Professionals &amp; Parchments: The role of home-based medicinal plant use and traditional health knowledge in primary health care in Ethiopia

This paper is concerned with the use of medicinal plants and the related lay traditional health knowledge and practices among rural communities in the Bahir Dar Zuria Wereda (district) of Gojam located in the northwestern highlands of Ethiopia. Much of the research on Ethiopian traditional medicine and medicinal plants to date has been carried out in a compartmentalized manner, with researchers from various disciplines pursuing their interests in the subject in relative isolation. Most studies have been driven by a specific interest in the properties of particular medicinal plants, focusing on two main sources of information, i.e., the knowledge of professional traditional health practitioners and the ancient medico-religious herbal manuscripts with which, the religious traditional health practitioners or debterra, in particular, are closely associated. Focus on the professional realm of traditional health has detracted attention from others in the community who may also be knowledgeable about plant-derived treatments and cultural health practices. Due to the resulting overall ‘plantfocus’, relatively little attention has been paid to the local socio-cultural context in which many medicinal plants continue to be used by ordinary local people and knowledge about them developed and passed on over generations. The preliminary findings of a study seeking to address this research gap by focusing on lay community members are presented here. Qualitative and quantitative analysis of the data gathered through the main phase of the field research (carried out over the period August-December, 2000) is still underway. Nevertheless, this presentation offers an opportunity to discuss some of the general trends and preliminary findings of the household surveys and interviews held with members of five rural farming communities in Bahir Dar Zuria and to revisit the central hypothesis and objectives of the research in light of these findings.

Primary health care in Ethiopia under three political systems: Community participation in a war-torn society

This paper examines primary health care (PHC) development with an emphasis on community participation in Ethiopia under the feudal regime of emperor Haile Sellassie, the socialist/military rule of Mengistu Haile Mariam and the sprouting democracy and free market economy of Meles Zenawi. In spite of the rapid expansion of primary care under Mengistu, community participation was hampered by the protracted war and centralized, urban-based, bureaucratic approaches and attitudes that failed to promote an enabling environment for community participation. The socialist government, although implementing various community programs and expanding the rural health services, did not succeed in revolutionizing the health services. A comparative examination of the democratized rebel health services of the Eritrean People's Liberation Front (EPLF) and the Tigray People's Liberation Front (TPLF) illustrates the inconsistencies between stated policies of the Ethiopian government and actual strategies, and identifies factors promoting and impeding participatory health care development in a war environment. Achievements, opportunities and potential dangers to PHC and community participation in the post-war era characterized by economic progress, democratization, decentralization, lingering ethnic conflict and private initiatives are briefly described.