Supporting the Regional
Health Bureaus in Ethiopia
Zenebe Melaku, MD
ICAP-Ethiopia
ICAP Guiding Principles
• Integration with national AIDS control plans
• Capacity building for health systems and broad infrastructure
support
• Involvement of PLWHA - adherence, social support
• Integration of Prevention, Care & Treatment
• Family-centered care (adults and children)
• Multidisciplinary Team Approach
• High quality services with program evaluation, operations
research, and program improvement
FMOH - National Road Map
& ICAP Support
ICAP- CU
National Level - TA
ICAP- CU
Regional Road Map
Implementation
ICAP- CU
Facility Level
Implementation
Characteristics of ICAP-E Program
National
• Pediatrics; EID; TB-HIV;
•PLWHA; MLDM
Four RHBs
ICAP - Ethiopia
• Capacity Building/TA
Regional Univ.
Comprehensive
Site Level Support
Oromiya
: 29,118,188
Somali
: 4,325,446
Dire Dawa
: 388,731
Harari
: 194,745
Total Population : 34 million
Characteristics of ICAP-E Program
Health Care System - Ethiopia
• Policy
•National Strategy
•Guideline and
•Training Curriculum
FMOH
RHB
RHB
H
HC
HC
RHB
H
HC
• Oversee Program
Implementation and
Monitoring
Initial Step:
• Needs assessment with RHBs
– Identification of gaps
• Critical Gaps Identified:– Coordination and Strategic planning
– Human Resource
– Infrastructure
– Systems
Modalities of Support:
• Two mechanisms:
– Direct support:
• Short/Medium term
– Sub-agreement:
• Medium/Long term
Regional level Capacity Building –
Coordination and Strategic Planning
• TA in the development of regional annual plan
• Regional Partners Forum
• Joint Regional Planning and Review Meetings
Building Regional Ownership through Participatory
Planning
A Key Strategy for Sustainability
Regional level Capacity Building –
Human Resource
• Basic and ToT
Training:
• Local/International
• Clinical
• Program Mx
• Financial Mx
Multi-pronged
Approach:
Secondment/
Additional staff
Mentoring
Enabling
Environment
•Program staff
•Accountant
•Data clerks….
•Clinical, Program &
Finance
•Access to Internet
•Resource centers
•Office furnitures …..
Capacity Building: Human Resources
(Training)
Regional Capacity Building –
Resource Center
Regional level Capacity Building –
Infrastructure – Training Centers
Training Center with Video-conferencing Facility
Regional level Capacity Building –
Systems
• Laboratory System:
– Development of SOPs: Sample referral
– Implementation of EQA systems
• Monitoring and Evaluation System:
– Data QA systems
– Data use for CQI
• Referral System:
– SOPs for decentralization
• Financial Management System:
– Development of SOPs
Key Achievements and the Way Forward
• Increased scope of activities with increased
funding (5X)
Responsibilities handed over to the RHBs :
–
–
–
–
–
Annual review and planning meetings
Quarterly Supportive Supervisions
Hiring of supernumerary staff
Sample transport system
Management of minor renovations
In the future:
– Phased and Incremental Manner
Challenges:
• Human Resource:
–
–
–
–
Shortage
Work overload
Lack of staff motivation
High Staff Turn-over
At All Levels
• Financial management system
Conclusions-Lessons learned
• Regional level capacity building
– Key strategy for successful transition
• Requires commitment from government,
availing HR and other required inputs
• It requires longer time-frame
• Phased and Incremental Manner
• Attention: Maintaining the ‘Desired Quality’
Thank. You
Obrigado