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Projects and Activities

Scaling Up Community–Based Long Acting RH/FP Service through the HEP

1. Project Title:   Scaling Up Community – Based Long Acting RH/FP Service Including Implanon through the Health Extension Program (HEP)
 
2. Project Donor: The David and Lucile Packard Foundation

3. Project Summary: The Ethiopian Public Health Association has been implementing repositioning RH/FP project since 2006 and entered into the second phase with the generous support of the David and Lucille Packard Foundation in North Wollo and South Wollo of Amhara regional state. EPHA initiated and implemented this collaborative project together with Federal Ministry of Health to strengthen family planning program by improving performance of Health Extension Workers.

As a result of the project,   Health Extension Workers (HEWs) obtained knowledge and gained new hands on skills on family planning service provision especially long acting family planning that is implanon insertion at the health post level which they did not apprehend in the pre-service training.  This was made possible by training 190 HEW, 37 supervisors and 53 RH leaders as well as by developing and distributing 84,000 copies of quarterly newsletters on regular bases. During the training session 1,001 mothers and post training 195 (only three woredas report of six month) mothers received long acting family planning services (implanon) at health post level. 
 
  The project clearly showed that there is great demand for Long Acting Family Planning (LAFP) services specifically implanon insertion at the community level and that HEWs can effectively meet this need. Provision of LAFP services at health posts increases the number of users and addresses unmet need by reducing transportation, geographical, and knowledge barriers to service. With proper follow up and technical support, HEWs are technically capable of managing Implanon insertion without difficulty, as was demonstrated during the clinical practicum, supportive supervision and follow-up.
The project at Amhara region enhanced the capacity of FP/RH leaders to contribute to the achievement of the Millennium Development Goals (MDGs), especially 4 and 5. The project at Amhara region has also helped EPHA to learn more about the challenges and opportunities available for scaling-up its intervention and maximize the impact of repositioning FP.  
 
In recognition of EPHA’s experience and knowledge in North and South Wollo zones, the Federal Ministry of Health has requested joint partnership between EPHA and FMOH to expand long acting family planning services including Implanon in the Southern Nations, Nationalities and Peoples Regional State (NSSPRS).  In this regard, EPPHA has prepared a scaling up project for community based service delivery of long acting family planning including Implanon in SNNP Regional State  to be implemented in partnership with the Federal Ministry of Health. This project that is built on the achievements of the past project and informed by the lessons learned 
 
4. Project Justifications: Long term methods of contraception are rarely practiced in SNNPRS women, as elsewhere in the country. Therefore, strengthening the capacity of Health Extension Workers who are providing family planning services at Health Posts on long term method of contraception is becoming priority issue. 
 
5. Project Goal: Scale up community based RH/FP service delivery including Implanon in the SNNPRS through the HEP
 
6. Implementation Location:  13 zones and three special Woredas of Southern Nations Nationalities and Peoples Regional State 

Strengthening the Link between Households and Primary Health Care Units for Improved RH/FP Services


1. Project Title: Strengthening the Link between Households and Primary Health Care Units for Improved Reproductive Health /Family Planning Services.
 
2. Project Donor: The David and Lucile Packard Foundation 
 
3. Project Summary: The Ethiopian Public Health Association has been implementing repositioning RH/FP project since 2006 with the support of the David and Lucille Packard Foundation in North Wollo and South Wollo of Amhara regional state. EPHA initiated and implemented this collaborative project together with Federal Ministry of Health to strengthen family planning program by improving performance of Health Extension Workers.
 
As a result of the project, Health Extension Workers (HEWs) obtained knowledge and gained new hands on skills on family planning service provision which they did not apprehend in the pre-service training.  This was made possible by training 1516 HEW, 37 supervisors and 71 RH leaders as well as by developing and distributing 84,000 copies of quarterly newsletters on regular bases.    
 
The project enhanced the capacity of FP/RH leaders to contribute to the achievement of the Millennium Development Goals (MDGs), especially 4 and 5. Through this project, EPHA fostered the inclusion of topics that focus on linkages between the MDGs and FP/RH into the teaching curriculums of health professionals. In line with this, 12 university lecturers from six universities were trained on achieving MDGs: reproductive health, poverty reduction and health sector reform.
 
The project has also helped EPHA to learn more about the challenges and opportunities available for scaling-up its intervention and maximize the impact of repositioning FP.  The major lessons learned from the project include: 
 
(a) Although the project has enabled HEWs to reach households with RH/FP information and selected services, the attitude and knowledge of HEWs towards young people SRH is very minimal.  “I will advice a girl or a student not to start such a thing (sexual intercourse) and will not give her if she come seeking a contraception” (EPHA baseline study 2006); 
 
(b) There is limited knowledge and skill of HEWs in providing long acting FP methods; 
 
(c) There is no linkage among the primary health care unit, which includes the HEWs and  health posts and centers are not youth friendly; and
 
(d) There is limited knowledge of service providers at all level on exiting national policies and guidelines and adolescent reproductive health issues.
 
In line with the above, EPHA envisages changing the current situation by enhancing the capacity of service providers, including HEW and community Health volunteers; fostering the link between households and Primary Health Care Units  and by promoting national policies and guidelines on RH at all levels. In this regard, EPPHA has prepared a continuation project proposal that is built on the achievements of the past project and informed by the lessons learned.
 
4. Project Justifications: One of the gaps evidenced during the implementation of the repositioning project is the reproductive health needs of youths and adolescents.  EPHA has especially observed that the RH needs of married girls are seemingly overlooked by health extension workers and others.  There is a general lack of awareness among health service providers, teachers, parents, community health volunteers and the community at large about the reproductive health needs of youth. Therefore, much has to be done to make the health services youth friendly.
 
5. Project Goal: To strengthening the link between Households and Primary Health Care Units for improved reproductive health of women and young people
 
6. Implementation Location:  North Wollo and South Wollo Zones of Amhara National Regional State (ANRS)

Multiple Concurrent Partnerships-One Love Campaign


1. Project Title: Youth leadership in multi-sectoral approach to reduce MCPs: Community mobilization and outreach “One love” campaign  
 
2. Project Donor: CDC
 
3. Project Summary: Youth leadership in multi-sectoral approach to reduce multiple concurrent sexual partnerships: One love campaign project which is a functional model project to disseminate information to the risk groups using the already established infrastructures of SYGE which ensure cost effectiveness, sustainability and result oriented. The project has been implemented since October 2009.  General objective: To change the behavior that puts high school students at risk of infection of HIV and AIDS, particularly MCP. Specific objectives:
 
a. Increasing perception of risks associated with partners’ unknown HIV status and sexual behaviors.
b. Increase individuals’ communication and negotiation skills and perceived self efficacy to prevent infection.
c. Increase fidelity in long-term partnerships; reduce the number of partners students have, especially concurrent partners.
d. Change social and cultural norms (especially gender norms) that encourage/perpetuate MCPs.
e. Increase consistent and correct condom use in concurrent relationships.
 
Target Population: High School Students in 5 schools in Addis Ababa: Addis Ketema Preparatory School, Lem High School, Yekatit 12 Preparatory school, Medhanialem Highschool, and Frehiwot Preparatory school.
 
4. Justifications: In Ethiopia the highest HIV infections are being occurred among the  persons aged 15 to 25 years. Adolescence, when sexual activity generally commences but behavior patterns are still impressionable, is a critical time for HIV prevention.  Schools are particularly important for adolescent sexual behavior interventions, especially where health services are inaccessible. Yet, well organized school-based AIDS prevention programs do not exist in Ethiopia. The knowledge, attitude, behavioral change and practices of people concerning HIV and AIDS have brought a positive change. Adolescence is a critical stage when physical, psychological and social changes take place. The adolescent are curious and wants to try everything including sex and drugs. This kind of curiosity is a way that increases the adolescents’ vulnerability to HIV infection. Therefore, it is urgent and elemental to give adolescents school HIV/AIDS prevention education to help them develop a healthy lifestyle. Youth are the future of a country. But, most of the time student do not considered as the main agents in the prevention and control of the disease. And, they have a potential to be best HIV/AIDS educators to their fellow students and know best about the sexual behaviors and activities of their peers and their needs. This approach encourages genuine openness and strong commitment among students about their sexual escapades and their risky practice. 
 
5. Project Goal: To change the behavior that puts high school students at risk of infection of HIV and AIDS,  Particularly MCP
   
6. Implementation Location: The project is implemented within five High schools in Addis Ababa ( medihanai lem, lem, yekatit, frehiwot and Addis ketema Highschools)

 MARPs


1. Project Title:  Survey on Most at Risk Populations for HIV infection in Ethiopia: Identification, Size Estimation and Determination of Magnitude and Risk Factors
 
2. Project Donor: CDC

3. Project Summary: Since this survey is the first step since 1990, the plan is to address few MARPs groups (female sex workers and long distance drivers) in selected sites at a national level. The data generated in this survey is intended to  help to know the types of MARPs in the country, to estimate the population sizes of female sex workers at regional capitals and to generate data on biological and behavioral aspect among female sex workers and long distance drivers which will help to show the level of the infection and their sexual behavior and networking in the population.
 
4. Project Justifications:
 
5. Project Goal: To conduct Survey on Most at Risk Populations for HIV infection in Ethiopia
 
6. Implementation Location: All 11 Regions    
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