All Corners Covered: Providing Hard-to-reach Areas in Ethiopia with Lifesaving Services

March 10th, 2020 | Story


Although Ethiopia has reduced its maternal and under-5 mortality rates over the past two decades, much more needs to be done to ensure that inequities in access to healthcare are addressed and essential services reach all segments of the population. To improve the coverage and quality of services in the health sector, the USAID Transform: Primary Health Care project identifies hard-to-reach woredas and communities through consultation with regional health bureaus, woreda health offices, and local administrative kebeles and supports Integrated Periodic Outreach Services (IPOS) that provide lifesaving healthcare services, including immunization, and health education and promotional messages to improve awareness and behaviors.

Teltele woreda, located in the Borena zone of the Oromia region, is responsible for providing healthcare to 80,455 people living in some of the most remote locations in the country. The woreda oversees four health centers and 19 health posts. Haphe Hibre, maternal and child health coordinator at the woreda, remembers the challenges the woreda grappled with before IPOS were introduced.

We had seven pocket areas and some of our facilities were almost 240 kilometers away. Due to road inaccessibility, we found it tough to reach with them for routine services and we would only access them through campaigns on immunization, vitamin A, and deworming,” he recalls.

Social mobilization activities prior to the IPOS initiative focused only on polio eradication, and the reporting and recording of health data was extremely poor. According to Haphe, the woreda had unreported cases of maternal and child deaths.

The mobile lifestyle, especially in times of low rainfall, of the primarily pastoralist community and political instability in the region made clients difficult to reach or track. Climatic changes also made roads frequently inaccessible.

In 2018, USAID Transform: Primary Health Care brought IPOS to the woreda, and through technical, logistical, and financial support, Teltele woreda’s ability to reach communities with health services began to slowly improve. The initiative was particularly effective in increasing immunization coverage and nutritional screening of children aged six months to five years. According to Haphe, “Before IPOS was introduced we would only intervene when Severe Acute Malnutrition (SAM) cases were reported to us which was rare, as the distance between our facilities and communities meant a high volume of unreported cases were occurring. This changed drastically in recent months, as 40 SAM cases were reported last quarter because of IPOS.”

The woreda, which had never before reached the national standard of 85 percent coverage rate for vaccinations, has now reached 118 percent, exceeding its targets because of the nomadic clients reached through these services. Service uptake increased, including antenatal 4 services from 50 to 76 percent, and although political unrest and threats to the safety of staff curbed efforts in family planning, there was a slight increase from 25 to 35 percent. Curative services also increased, with 112, 344, and 117 underfive children receiving treatment for malaria, diarrhea, and pneumonia, respectively. Treatment for under-5 sepsis cases rose from 38 to 108 percent. Logistic support from the project was an essential factor for success: the woreda only had one ambulance to provide services and the use of project vehicles allowed for a wider reach.

The project’s all-round support was fundamental to our success. The grant fund they provided us, in addition to the tangible assistance, empowered us to find solutions and act on issues that were important for the woreda,” says Haphe.

The regional health bureau recognized the woreda’s accomplishments, and the experiences of Teltele woreda have been shared with other woredas which are now emulating the steps taken to bring about these impressive results.

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