Task shifting and Task shifting and regulatory frame work, regulatory frame work,

Ethiopia Ethiopia

Yibeltal AssefaYibeltal AssefaNational HIV/AIDS National HIV/AIDS

prevention and control officeprevention and control officeJune 14,2007June 14,2007

KigaliKigali

Background Background Population around 78 millionPopulation around 78 million National adult HIV prevalence-National adult HIV prevalence-

– ANC based- 3.5 ANC based- 3.5 PLWHAs - 1.3 million (ANC data)PLWHAs - 1.3 million (ANC data) Need ART----280,000 Need ART----280,000 More than 150, 000 people are More than 150, 000 people are

started on chronic care.started on chronic care. More than 90,000 people are More than 90,000 people are

started on ARTstarted on ART

Trend on Chronic HIV/Care and ART as of March 2007

13773

129547

8276

76479

60501

0

20000

40000

60000

80000

100000

120000

140000

3rd Q 054th Q 05

1st Q 06

2nd Q 06

3rd Q 064th Q 06

1st Q07

Num

ber o

f peo

ple

Ever Enrolled Ever Started ART Currently On ART

ART Site Expansion ART Site Expansion ART Site Expansion

241212

192

323

115 115

11764

77

107

124

0

50

100

150

200

250

300

Num

ber o

f site

s

Total

Hospitals

Health C

HEW and the Ethiopian heath HEW and the Ethiopian heath systemsystem

The Ethiopian health system is The Ethiopian health system is organised around the concept of the organised around the concept of the HNW model with different HNW model with different components:components:– PHC (community, health posts and PHC (community, health posts and

health centres) providing service for health centres) providing service for 25,000 people25,000 people

– Hospitals of different levelsHospitals of different levels HEW are assigned at the Health postHEW are assigned at the Health post

Health extension workersHealth extension workers They are community health workers They are community health workers

assigned at the health postassigned at the health post Two HEW provide service for 5000 Two HEW provide service for 5000

people at each health postpeople at each health post More than 9000 HEW are already More than 9000 HEW are already

deployeddeployed We have planned to produce 30,000 We have planned to produce 30,000

HEW in total (two per Kebele or HEW in total (two per Kebele or health post).health post).

Their main task is preventive and Their main task is preventive and promotive (very little on curative)promotive (very little on curative)

The process of introduction of HEWThe process of introduction of HEW(The regulatory frame work)(The regulatory frame work)

MOH raised the need to introduce HEP MOH raised the need to introduce HEP as a vehicle to attain MDGsas a vehicle to attain MDGs

MOH Proposed :MOH Proposed :– the components of the package and the components of the package and

key intervention areakey intervention area– duties and responsibilities of the duties and responsibilities of the

HEWHEW– Proposed Recruitment criteriaProposed Recruitment criteria– Duration and training MethodologyDuration and training Methodology

The process, contnd…The process, contnd…

All relevant ministries and bodies were All relevant ministries and bodies were involved from the inception involved from the inception – MOCB- approves Keble level civil service MOCB- approves Keble level civil service

structurestructure– Civil service agency-approves minimum Civil service agency-approves minimum

job requirements and grading job requirements and grading – MOEMOE– MOFED MOFED – CBO/FBOCBO/FBO

The process has taken almost two years The process has taken almost two years

RecruitmentRecruitment FemaleFemale

– EmpowermentEmpowerment– Easily accepted by the community Easily accepted by the community – Can stay longer in the communityCan stay longer in the community

High school graduatesHigh school graduates Selected by the communitySelected by the community Need to speak the local languageNeed to speak the local language

Training and DeploymentTraining and Deployment A one year trainingA one year training Both class room and practical sessionsBoth class room and practical sessions After completion they will be certified After completion they will be certified They need to go to their locality after They need to go to their locality after

graduationgraduation Defined career structure and promotionDefined career structure and promotion System designed for continuous ongoing System designed for continuous ongoing

training training Working condition – 75% outreach and 25% at Working condition – 75% outreach and 25% at

Health postHealth post Supervises 15-20 Voluntary CHWsSupervises 15-20 Voluntary CHWs

M&E and quality& safetyM&E and quality& safety There is a plan to really evaluate There is a plan to really evaluate

whether the HEW are doing whatwhether the HEW are doing what they are supposed to dothey are supposed to do As part of the HNW they are also As part of the HNW they are also

considered to be mentored by the considered to be mentored by the health centre staffhealth centre staff

SummarySummary HEW has been HEW has been planned planned with a with a

greater involvement of the greater involvement of the concerned bodiesconcerned bodies from the very from the very beginning and its beginning and its implementationimplementation is is also being also being monitored with all the monitored with all the concerned partiesconcerned parties so that it will be so that it will be effective and sustainableeffective and sustainable..