Papers Published and REACH Ethiopia Contributions

   REACH Ethiopia is the first organization to announce

          GeneXpert machine in 2012 and Fluorescence  microscope in 2010        for Ethiopia.

REACH Ethiopia has been implementing various TB REACH projects throughout its existence.

TB REACH project focuses on innovative community based approach which addresses neglected and poor communities with minimal health accesses and concentrates on early identification of TB cases at community level.

Health extension workers (HEWs)are front runners assigned at health post level implementing health extension program (constitutes 17 components) of which the community based TB care package is one. HEWs are mandated to screen all individuals presenting to the health post and during their regular home visits for TB-symptoms with particular attention to contacts of an infectious pulmonary TB. Through the process, identified presumptive TB cases are  referred to the catchment health centres for clinical evaluation.

TB REACH project has been implemented to enhance health conditions and address poor communities and individuals  who are suffering by TB. The situations were made to improve by procuring  motorbikes and 1st technology Fluoresce microscopy as well as Xeprt machine that quality of diagnosis and treatment in SNNPR is better upgraded. REACH Ethiopia is a pioneer organizations to introduce these diagnostic technologies to Ethiopia. In addition, the organization exerted efforts to supporting the poorest of poor to be examined by x-ray all expenses covered.

 REACH Ethiopia implemented TB REACH projects in Sidama Zone across 19 districts and 2 city administrations,9 districts of Silte Zone, 5 districts of Hadiya Zone and 13 districts and one City Administration of Gurage zone. Through project implementations the organization has donated the under shown diagnostic tools and other useful electronics to the smooth running of activities.

table1: Contribution of REACH Ethiopia to the community

pic1: Sample pictures of donated motorcycles

pic2: Sample picture of donated LEDFM Fluorescence Microscope

more on TB REACH Evaluation Report 2010-2015 

Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia?

W. Mengesha 1, R. Steege 2, A.Z. Kea 1, S. Theobald 2, D.G. Datiko 1

1 REACH Ethiopia, Hawassa, Ethiopia

2 Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK Address correspondence to Rosalind Steege, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 The paper is here  https://academic.oup.com/jpubhealth/article/40/suppl_2/ii74/5247473

ABSTRACT

 Background Health extension workers (HEWs) are the key cadre within the Ethiopian Health Extension Programme extending health care to rural communities. National policy guidance supports the use of mHealth to improve data quality and use. We report on a mobile Health Management Information system (HMIS) with HEWs and assess its impact on data use, community health service provision and HEWs’ experiences.

Methodology We used a mixed methods approach, including an iterative process of intervention development for 2 out of 16 essential packages of health services, quantitative analysis of new registrations, and qualitative research with HEWs and their supervisors.

Results The iterative approach supported ownership of the intervention by health staff, and 8833 clients were registered onto the mobile HMIS by 62 trained HEWs. HEWs were positive about using mHealth and its impact on data quality, health service delivery, patient follow-up and skill acquisition. Challenges included tensions over who received a phone; worries about phone loss; poor connectivity and power failures in rural areas; and workload.

Discussion Mobile HMIS developed through collaborative and locally embedded processes can support quality data collection, flow and better patient follow-up. Scale-up across other community health service packages and zones is encouraged together with appropriate training, support and distribution of phones to address health needs and avoid exacerbating existing inequalities.

Keywords CHWs, equity, ethics, Ethiopia, Health Management Information system, HEP, maternal health, mHealth, TB

W. Mengesha, eHealth Project Coordinator

R. Steege, PhD candidate

A.Z. Kea, Field Director for REACHOUT Project

S. Theobald, Chair in Social Science and International Public Health

D.G. Datiko, Director

 

 The paper published  

 CONTEXT ANALYSIS: CLOSE-TO- COMMUNITY PROVIDERS IN ETHIOPIA  

Many countries are striving to achieve the Millennium Development Goals (MDGs) and universal health coverage. In the 1970s, countries invested in Community Health Workers (CHWs) who received basic training and were often volunteers. However, programmes involving CHWs went into decline due in part to political instability, economic policies and difficulties in financing. There has been recent and renewed interest in strengthening community-level services, using a variety of close-to-community (CTC) providers more 

 

Policy brief addressing TB and HIV

 Expanding innovative community-based approaches:

enhance TB prevention and control efforts for maximum IMPACT

you can down load and read

Author:Gemeda Bora (MEd, MA)

Year: 29 August, 2015

Presented at:   Ethiopia National Experience Sharing Meeting, Lewi Resort, Hawassa

CONTEXT

Though TB affects or at least used to affect all countries in the world, in most cases it appears to be a disease restricted to poor countries. One of the greatest challenges confronting service providers in these countries is that the best available treatments are of so limited quantity and are reaching only a s-mall fraction of people who need them. Since Ethiopia is categorized in the countries classified as poor, the challenge, if not worse, is no better than other countries. Ethiopia is the ninth high-TB burden country in the world, with an estimated 230,000 new cases of TB (incidence rate 247 per 100,000 populations) reported in 2012. The same is true with regional states, of which SNNPR is one.

 Though Ethiopia has implemented a very unique health system extension program (HSEP) of which TB is one, the approach to reaching all corners of the nation and segments of the society was not producing favorable impression within the set time frame. In other words, this does mean, universal access to effective TB treatment is unachievable with current routines and traditional course of implementation. If to be achieved it needs an approach that accelerates it. Consequently, TB-REACH project implemented by REACH ETHIOPIA in collaboration with Ministry of Health, LSTM and The Global Fund was designed a complementary innovative approach. The approach was proven to be effective through the involvement of all stakeholders and within the set time.                                                    

INTERVENTIONS

A package of interventions include:

  • conducting extensive advocacy, communication and social mobilization (ACSM) activities;
  •  engaging all stakeholders, councils, communities and Health Extension Workers (HEWs) in TB control activities;
  •  training of HEWs, staff working in TB clinics and TB coordinators;
  •  HEWs conduct house-to-house visits as part of the routine community-based activities and identify TB suspects, collect sputum samples, prepare and fix smears;
  •  Then, HEWs contact supervisors by telephone to collect and transport smeared slides to laboratories for smear-microscopy;
  •  Supervisors initiate treatment for smear-positive TB cases within their community and examine contacts of index cases and initiate Isoniazid preventive therapy (IPT) for asymptomatic young children;
  •  HEWs support and supervise treatment and report drug adverse effects and treatment outcome;
  •  The field team and the supervisors conduct regular supportive supervision and review meetings with HEWs and staff, discuss progress and challenges encountered and agree on action points2.

    

 

 EVIDENCE

 REACH Ethiopia made a concerted effort to engage community members, councils, other stakeholders, TB programmers at all levels, former TB patients and religious and community leaders to increase awareness about the disease as well as expanding availability of TB services at the community level. TB case finding nearly doubled in the first nine months of the initiative. Focusing on the elderly and disabled, women and children, the project has not only brought the million people living in Sidama, Hadiya, Silitie and Gurage Zones within the healthcare system, but the team turned TB into a disease that can be talked about out loud.

 

The innovative community-based approach has demonstrated that making TB diagnostics and treatment accessible at the community level increases the detection of cases, enhances treatment completion and reduces the stigma associated with the disease. ACF has significantly contributed for such achievement thus needs to be replicated across the nation.

 

 

REACH ETHIOPIA hopes such fruitful experience will soon be replicated all over the country and beyond. 

 GAPS IN NON-PROGRAM IMPLEMENTATION AREAS

 Nearly in all parts of the nation TB notifications remain low despite major expansion of health services;

  • Efforts made to identify and treat those cases are far below satisfactory;
  • Though the disease seems to affect all segments of the society indiscriminately, poor continued to be more affected at far greater rates than their richer counterparts;
  • Much of the efforts focus on curative aspect and interventions as the community based approach is totally ignored if not, not well promoted;
  • Passive case finding approach followed/employed and TB cases are identified among patients visiting health facilities;
  • TB diagnostic centers in most cases are located in urban and semi-urban areas and patients often need to make several visits before initiating treatment;

These visits are burdensome for rural population, women, children, elderly and patients with disabilities;

  • Geographic accessibility, socioeconomic and cultural barriers affect health seeking behavior of the communities;
  • Stigma associated with TB and lack of awareness about the disease and availability of the services further compromise service utilization;

KEY RECOMMENDATIONS

1)    Expand Active Case finding (ACF) across the region and Ethiopia, and address TB more effectively and for maximum IMPACT;

2)    Include all health professionals, build their capacities and apply task-shifting on activities like sputum collection, smearing, etc;

3)    Put concerted effort towards strengthening community education program in order to combat ignorance, fear and stigma with knowledge of how to diagnose, prevent and treat TB;

4)    Invest in facilities, human and other resources to properly isolate and treat TB;

5)    Overcome the compounded problem by improved laboratory infrastructure and diagnostic equipment;

6)    Expand and enhancement DOTS in every corners of the region and nation;

7)    Engage all care providers;

8)    Empower patients and communities;

9)    Strengthen follow up that adherence to TB treatment is maintained as this is the main cause of drug resistance;

10) Promote researches;

11)  Contributing to health systems strengthening;

 

REFERENCES

1TB and HIV Concept note, 15 October 2014

2TB-REACH short summary, unpublished

3BMC-Public health 2015;  Patient and community experience of tuberculosis diagnosis and care within community based intervention in Ethiopia: a qualitative study 25February,2015

4The complexity of attending TB diagnostic services for adults in resource poor settings, November, 2012

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