Tuberculosis-NIPH Project

Ethiopia is one of high-burden country for tuberculosis, with an estimated annual incidence of 224 per 100,000 populations. Despite high directly observed treatment, short-course (DOTS) coverage and continued control efforts, tuberculosis prevalence studies in Ethiopia have indicated that many tuberculosis cases are not detected. The same is true for SNNPR, zones and districts in the region.
Though there are a number of identified constraints and diverse facts hindering the progress, tuberculosis has highly been associated with factors linked to socioeconomic deprivation; poverty, overcrowding and malnutrition. The magnitude of tuberculosis is high among the poor, elderly, and malnourished and people living with HIV. TB affects individuals of all ages and both sexes. Nevertheless, poverty stricken households, malnourished individuals and overcrowded living conditions have been known for decades to increase the risk of developing the disease. This is the exact fact of the communities in most rural setups of the nation as well as the region of which Dale District of Sidama Zone takes its share of the phenomenon.

Due to the fact that the large number of undiagnosed TB cases exist everywhere and suffer, efforts to strengthening case finding to every household of the district was found to be crucial. Subsequently, a project entitled “Population-based Tuberculosis case finding in Dale district” that focuses on “Spatial analysis of Tuberculosis clustering” is launched on 22August 2016 at Yirgalem, Furra institute of Development Studies. The kick-off meeting was formally opened by Ato Bedilu Badego, Head of the Zonal Health Department.

Ato Bedilu Badego, Head, Zonal Health Department opening the launching meeting
The meeting has been attended by diversified and pertinent partakers of which the following were among the prominent stakeholders.

  • RHB (TB Expert, Planning and Logistics)
  • Sidama Zone Health Department (Head, D/Head, Planning, TB focal, and Logistics)
  • Sidama Zone Department of Finance and Economic Development (2 Representatives)
  • Dale Woreda Administration (The Administrator)
  • Dale Woreda Health office (Head, D/Head, Planning, TB Focal, Logistics)
  • Dale Woreda Finance and Economic Development Office (Head and Expert)
  • Health Facilities (1 Hosp, 10HCs, 3NGO clinics)
  • Donor and partner institutions – NHA and NIPH
  • NGOs and other partners
  • Religious organizations
  • Ministry of Science and Technology (MoST)
  • Local Media
  • REACH Ethiopia Staffs

The launching meeting was intended to achieve the following objectives:

  • To formally announce the commencement of the project;
  • To stimulate interest and understanding of the project to ensure the involvement of government at all levels, the involvement of other actors and the study team
  • To create an opportunity whereby health and financial authorities at district, zone and region level are engaged and is to involve other relevant stakeholder to discuss on the cooperation expected throughout program implementation;
  • To engage donors in the process and update them on the level of integration between project implementing organization and government relevant authorities as well as other actors;
  • To start documenting on the process leading to the programmed implementation of TB case finding ;

The meeting on progress

During a one day session, apart from the opening and closing speeches, brief regional and district TB related overview, overview on REACH Ethiopia programs in SNNPRS, Norwegian Institute of Public Health and Dale project summary as well as presentations that stands for Norwegian Health Association have been brought on to the audience.
Sr. Fikrte Abera, introducing TB control Program in the SNNPR spoke of regional background, area of the region, population, strategies designed to controlling TB, regional target for 2008 E.C. (2015/16 G.C). Further, she also informed the audience on program components, planning and coordination efforts, objectives of TB control and targets expected to be reached, MDR services, challenges encountered during program implementations and measures taken to overcoming un constructive encounters.

Sr. Fikrte Abera presenting Regional overview

The regional overview was followed by overview of REACH Ethiopia programs in SNNPRS brought forth by Dr. Daniel G. Datiko, Executive Director of the organization. Starting with vision, mission and values of the organization Dr. Daniel went on explaining on the journey in TB control, Genesis and institutional development of REACH Ethiopia, core activities carried out by the organization, contribution to supervision capacity, ACSM and community mobilization activities and packages of interventions undertaken by organization. He further spoke on trends and key achievements, scaling up approaches, number of detected TB cases from 2010-2015, benefits beyond the project and challenges encountered through the course. Finally, he acknowledged a number of stakeholders who have contributed for a great achievement of the endeavour among which the following were prominent contributors;

  • TB REACH/Stop TB Partnership for Financial Support/
  • Southern Regional State Health Bureau
  • Southern Regional State Bureau of Finance and Economic Development
  • Sidama, Gurage, Hadiya, Siltie Zone and Hawassa City Administration Council and Health
    • Federal Ministry of Health
    • Liverpool School of Tropical Medicine
    • Global Fund to fight AIDS, Tuberculosis, Malaria
    • HEWs and community health promoters
    • The rural communities
    • TB REACH field team

Dr. Daniel G. Datiko, ED, presenting overview of REACH Ethiopia programs in SNNPRS

Dr. Daniel’s presentation was followed by the staging of Norwegian Institute of Public Health and Dale project summary. This was brought in by Dr. Brita Askeland Winje, representative of NIPH. She went back to her own memory of years as she was born in Addis Ababa, Ethiopia and of the attachment she has got with the country. She further took the attention of the audience back to the establishment of Yirgalem Hospital 50years ago by H.M. King Olav V in 1966 G.C.

Dr. Brita briefly introduced the Norwegian Institute of Public Health and its current major functions in terms of conducting multidisciplinary research and knowledge transfer. She also spoke on efforts exerted to enhancing international collaboration which Dale project is a part of wide-ranging global effort.
While summarizing Dale project, Dr. Brita explained on investigators and institutional affiliation, background, aim, design of the study, population, inclusion as well as exclusion criteria, sample size, specific objectives, Diagnostic procedure for persons detected by symptom-screening, clinical management, data to be collected, strength of the study, challenges (opportunities) and anticipated partakers in the whole course of project implementations.

NIPH representative, Dr. Brita presenting on NIPH and Dale project
The NIPH and Dale project summary presented by Dr. Brita was followed by Dr. Einar Heldal’s inspiring presentation on Norway’s history and as how the country was able to overcome three demographic crises that last from 700 AD to 1920s.

As explained by Dr. Heldal in comparison with the current living standard of Norwegian populations, the determination, courage and strength of character demonstrated by the Norwegian society was a great input and motivating factor for the fight being made to preventing and controlling Tuberculosis. The graph below shows TB related situations in Norway over a century and the decline it has made due to consolidated efforts, as clearly illustrated by Dr. Heldal.

The phrase from words of the first NHA president Klaus Hansen, spoken a century ago in1910: “We know one thing for certain – we have to learn to make a joint effort, if we do, we will be victorious, whether we are rich or poor. It may take longer or shorter time, but we will move forward. If we work together, our people will one day get rid of tuberculosis», will definitelyserve as a motivating element in the fight we are making to conquer TB.

Dr. Heldal concluded his stimulating presentation by briefing on the global efforts exerted by Norwegian Health Association, expalining on “The end TB strategy components”, approaches applied in other countries and some TB related realities of African, Asian and Latin American countries.

Dr Heldal presenting
Prior to closing the kick-off meeting, discussion has been held on issues that need further elaboration and subjects of common interests.
Finally, the meeting was formally closed by the speech, advice as well as guidance given and commitments spoken out by the District Administrator, Ato Mekete Tesema on the implementation of the project.

REACH Ethiopia grew out of a TB project that started in 2010. This project introduced an innovative community package that engaged health extension workers (HEWs) to increase TB case detection and treatment adherence.
Addis Ababa, Ethiopia

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