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Strengthening Ethiopia’s Urban Health Program (SEUHP)

“For the first time in human history, the majority of the world’s population is living in urban areas – and the proportion continues to grow. By 2050, estimates suggest 42 percent of Ethiopians will live in urban settings.” – World Urbanization Prospects 2007

BACKGROUND

To address health challenges related to rapid urbanization in Ethiopia, the U.S. Agency for International Development (USAID) launched Strengthening Ethiopia’s Urban Health Program (SEUHP) in July 2014 to promote urban health leadership and enhance implementation capacity in cities and towns across seven regions of Ethiopia. SEUHP extends cost-effective, high quality, and appropriately targeted support and services to strengthen the roll-out of the Government of Ethiopia’s Urban Health Extension Program (UHEP) and related urban services. Program activities are closely aligned with the PEPFAR blueprint—creating an AIDS-free Generation—and other PEPFAR guidance, as well as the Government of Ethiopia's strategic priorities at the federal, regional and city/town levels.

Strengthening Ethiopia’s Urban Health Program promotes access to health care and improved health status for more than 1.6 million households in 47 cities in Addis Ababa, Dire Dawa, Harari, Oromia, Tigray, Amhara, and SNNP regions. The activity focuses on building sustainable urban system for more and better primary health care outcomes, bringing together urban stakeholders across multiple sectors, and fostering stronger community and private sector involvement in primary care and community health service delivery.

The project will be implemented until June 2018.

SEUHP OBJECTIVES

To strengthen the Government of Ethiopia’s UHEPs, by incorporating new programmatic directions and innovations to build capacity, strengthen the health system, and ensure scale, quality, and sustainability. Objectives are:

  • Improved quality of community-level-urban health services,
  • Increased demand for facility-level urban health services,
  • Strengthened regional platforms for improved implementation of the national urban health strategy, and
  • Improved sector convergence for urban sanitation and waste management.

SEUHP FACTS

  • Activity duration: July 2014 – June 2018
  • Goal: Improve the health status of the urban population in Ethiopia by reducing HIV/TB-related maternal, neonatal and child morbidity and mortality, and the incidence of diseases
  • Geographic coverage: Addis Ababa, Amhara, Dire Dawa, Harari, Oromia, SNNP, and Tigray

Some of SEUHP’s Accomplishments

  • Developed competency-based in-service training materials and rolled out the training to more than 2180 urban health extension professionals and their supervisors on core public health topics; HIV, TB, maternal neonatal and child health, urban WASH, as well as data recording and reporting and inter-personal communication. The training improved the knowledge, skill and motivation of urban health extension professionals.
  • Supported the revision, regional level contexualization and translation, printing, and dessimination of the UHEP Implementation Manual. SEUHP organized oreintation sessions on the revised manual at regional and lower levels and continues to support its immplementation at ground level.
  • Supported Quality Improvement (QI) initiatives at health centre level. So far, SEUHP has provided a step by step guidance in the establishment of 63 QI teams at health centers.  SEUHP developed QI field manual on how to initiate and run a QI team at the health center level and trained QI team members (which involve UHEP focal person at health centers, urban health extension professionals and their supervisors, and experts from city/town health offices). SEUHP’s QI initiative aims to establish QI teams at health centers that will measure quality of services by urban health extension professionals and health centers, conduct an analysis of root causes of problems and develop interventions at their respective facilities in their local context. This intitiative helped to enhance defauleter tracing, improved referral by UHE-ps, and streegthened home based HIV counselling and testing. This activity is inline with Ethiopia’s focus on quality as described in the health sector transformation plan.
  • Provided support to FMOH and Addis Ababa Regional Health Buruea in the piloting of the primary health care reform. SEUHP is supporting the implmentiaon of the reform in 11 health centers in Addis Ababa and in one health centers in each of the seven regional towns.
  • Provided technical and financial support in the development of integrated refresher training (IRT) modules to improve the technical capacity of UHE-ps in delivering community-based health services. SEUHP supported the development of five IRT modules (RMNCH, Health Communications, Communicable Disease, Noncommunicable diesease and First Aid and WASH). The project will support effecive cascading of the training complemented by on the job mentoring to enhance competency of health extension professionals and ensure quality service delivery.
  • Supported the development of a new curriculum for ‘next generation’ of urban health extension professionals and the project is also providing ongoing support through printing of training manuals and other mechnisms.
  • Prepared and provided toolkits and job aids for UHE-ps with orientation on how to use them.
  • Strengthened referral and linkage between urban health extension professionals and health facilities through introducing referral forms and other necessary tools and techncial assisstance to ensure beneficiaries have access to a continuum of high quality health services.
  • Facilitated supportive supervision, follow-up, coaching, and mentoring for urban health extension professionals and their supervisors in collaboration with the regional health bureaus and city/town health offices to improve and maintaine the quality of services delivered by urban health extension professionals.
  • Strengthened data recording and reporting system for services by urban health extension professionals by developing ‘Service Data Recording Tool’. To ensure consistency and sustainability in use of the tool, SEUHP worked with the regional health bureaus and city/town health offices and get their approval before implementation. Currently SEUHP is working closely with FMOH to standardize Community Health Information System in the urban context.
  • In partnership with Addis Ababa University, so far, two studies are conducted: ‘Mapping risk and vulnerability of urban residents’ and ‘social determinants of urban health’. To enhance academic- policy- program Interface, SEUHP is supporting the establishment of the ‘Urban Health Think Tank’ group. The establishment of the first ‘Urban Health Development Center’ is also another pillar of the partnership. The Centre is established with the objectives to serve as a knowledge hub (information center) for urban health in Ethiopia; to avail urban health materials; to provide technical support to researchers, programmers, policy makers and other stakeholders working on improving urban health; to draw experiences from the world; and to serve as a center for the think tank group and policy and program reviews.
  • Supported the establishment/strengthening of WASH Platforms in five cities/towns (Addis Ababa, Gondar, Dire Dawa, Harar, and Mekelle). This is because sanitation and waste management service provision responsibilities are spread widely among different sectors and have poor coordination mechanisms. This affects the successful implementation of the UHEP hygiene and environmental health packages. To address this challenge, SEUHP in collaboration with city/town health offices provided support for the establishment and strengthening of urban sanitation and hygiene platforms for key stakeholders of urban WASH in SEUHP. These platforms are led by mayors and aim to facilitate joint planning, implementation, and monitoring.
  • Conducted resource mapping of public and communal latrines and water points using global positioning systems in targete cities/towns. The findings from this assessment are being used to inform planning and development of strategies in some SEUHP targeted cities/towns. Lack of data on the quantity, quality, location, current functional status, and current management practices is one of the major challenges in relation to managing hygiene and sanitation facilities.
  • Constructed public latrines and developed business model for the management of public latrines by renovating/ maintaining selected non-functional public latrines in Dire Dawa and Mekelle cities. SEUHP is also in preparation to construct model public latrines in Harar city, Gondor, Debre Berhan, Shashamane and Wolaiyta Sodo towns.
  • SEUHP is currently immplementing targeted WASH interventions including construction of sanitary facilities and extending water points in selected towns affected by the drought. The implementation of emergency WASH interventions covers the drought affected urban and per-urban areas in Amhara, SNNP and Tigray regions.
  • The project also conducted assessments on human resource management, key health-seeking behaviors, and urban sanitation and waste management. The findings are being used to inform program implementation.
  • The project is supporting government’s effort to control Acute Watery Dieareha outbreak in Addis Ababa and other regional towns/cities.
  • SEUP hired Senior Techcnial Assisstants for the Medical Service General Directorate of FMOH to support the effictive implmentaion of Ethiopia’s health sector transformation plan.

Implementation

SEUHP is implemented by John Snow, Inc., in partnership with Addis Ababa University, and Emmanuel Development Association.

FOR MORE INFORMATION PLEASE CONTACT:

Hibret Alemu (PhD)

Chief of Party

USAID’s Strengthening Ethiopia's Urban Health Program

John Snow, Inc.

Cell: +251-911-618497

Email: hibret_tilahun@et.jsi.com

Skype: hibretalemu.tilahun