ETHIOPIAN HEALTH CARE POLICY,PLANNING AND MONITORING AND EVALUATION

Policy and Planning Directorate (PPD)

The main objective of PPD is to create an effective policy analysis and planning system, which ensures effective implementation of health sector programmes and appropriate resource allocations based on the ‘one plan, one budget, one report’ principle of harmonisation and alignment - Health Sector Development Programme (HSDP). Such activities of the directorate are expected to strengthen the health care delivery system in the country leading to greater customer satisfaction.

Case Teams

The Directorate has two case teams working under its supervision.

· Policy analysis and planning

· Monitoring and Evaluation

Policy Analysis and Planning

Health policies are designed to prioritise people’s needs and improve both the health care delivery system and programme outcomes. A decent policy analysis and planning allows for the development of comprehensive policies and creates conducive environments for their implementation. The policy analysis and planning case team coordinates both local and international support to develop evidence-based, realistic and effective strategic/annual plans that are aligned and harmonised the government’s priorities. These strategic and annual plans will then be used as a single point of reference in the different core and support processes of the health sector.

Due to the high demand for quality services and scarcity of funding, it is necessary for the team to device thorough resource allocation mechanisms that enable the Ministry minimise wastage, programme failure and produce cost-effective solutions that satisfy public needs. Performance has a crucial impact on the effective and efficient execution of planned activities and therefore the policy analysis and panning process ought to encompass performance enhancing mechanisms. (Kiros what tell me more about PBC and how we could coordinate these two paragraphs better!) The performance Based contracting (PBC) is have three different contact types, Administrative contact (Contract between Administrative bodies like FMOH, RHB, ZHD, and WorHO Hospitals accountable to this), Service purchase contract (Contract between Administrative bodies and accountable hospitals to the level) and the last one is Individual contract which happens at each level based on ROPA/BSC.

The implementation of the sub-process will be monitored and evaluated through the M&E sub-process.

Monitoring and Evaluation

The monitoring and evaluation case team is responsible for monitoring the appropriate implementation of all strategic and annual plans as well as evaluating the effectiveness of their outcomes. During the monitoring process, the team consistently collects and analyses data/information to verify progress, correct flaws and improve performance when deemed necessary. Similarly, the evaluation process analyses and interprets programme components to assess the success rate of the project implementation process and its expected outcome.

A steady information flow is critical to establishing an effective and efficient health care delivery system that can satisfy the health service needs of the public. As such, the monitoring and evaluation case team seeks to addresses the information needs of its customers in two major thematic areas. These are:

Decision-Making

Monitoring and evaluation activities are designed to continuously feed information to all stakeholders including providers, suppliers, controllers and customer to enable them make informed decision at all levels. Such information comprises data from the following sources:

§ Routine data collected from health facilities using Health Management Information System (HMIS)

§ Reports of programme activities from the Balanced Score Card (BSC) – a performance measurement system

§ Evaluation results from various programmes and interventions – necessary for project expansion, adjustment or modification decisions.

Support

There are various reasons that instigate performance gap both during the implementation of planned activities and on their outcomes. A significant scarcity of skilled professionals and adequate resource coordination are the two major factors that create performance gap at low-level health structures of the country. It is therefore necessary for the Ministry to insert high-end support activities, i.e. gap assessment, supervision, training and problem solving mechanisms deep into the low-end institutions to achieve sustainable and all-round programme results. The monitoring and evaluation case team ……..

1. Routine Data Collection and Aggregation

HMIS is a very important tool that allows routine data collection and aggregation – all important to assess national needs for services and development towards various national and international commitments, such as PRSP/PASDEPand MDG goals. Results from such analysis will allow the Ministry to clearly asses the current situation as well as progress and pace towards set targets. For example, routine operational information regarding immunisation strategies would enable decision-makers to compare actual results against set standards and make the necessary adjustments to areas failing to meet their targets. Besides programme outcomes, HMIS amalgamates information on administrative activities, including finance, procurement, human resources and drug supply essential to improving the over all health care delivery system. Although HMIS is expected to be the major source of information for the health care system, the Policy and Planning Directorate will continue to utilise other mechanisms, such as research results, surveys and census to support evidence-based decision-making and the overall operation of the health sector.Full implementation of HMIS is well underway – various activities, such as extensive sensitisation, micro planning and hiring trainers have been completed in all the Regional Health Bureaus (RHBs). To date, EMR (what is it?) have been implemented in one region, 6 regions have completed training on HMIS and over 5 million family folders that will be handled by health extension workers (500 hundred folders per 1 health extension worker] have been printed.

2. Performance Monitoring and Quality Improvement

The performance Monitoring and quality Improvement is necessary to track progress, give solution immediately and improve performance. This has to be emplaced at all level of the Health system and recommends to apply the BSC for weekly Assessment and performance review, monthly Performance review based on the planned activities. Activities and results should be assessed frequently for the better performance and improving the customers satisfaction through services delivery system. (This is the same as what we have under ‘Support’ above – how can we integrate both??)

3. Integrated Supportive Supervision (ISS)

An integrated supportive supervision (ISS) is important to strengthen the capacity of employees in the health care delivery system. ISS allows decision makers to identify weakness/flaws in their human resources and device innovate schemes for improvement. Results from initial situation assessment and outcomes from applied solutions should be well documented and communicated to device further improvement mechanisms and sustain performance.

4. Evaluation and Operational Research

Evaluation questions may arise at any stage of the monitoring process requiring more detailed examination of implementation and or effects of programmes.

The identified processes are not standalone by themselves, rather are interlinked with each other leading to the ultimate goal of informing appropriate decision making. Routine data collection and aggregation provides the inputs for performance monitoring and quality improvements during which priorities that need more emphasis during ISS will be identified.

Throughout the whole process of monitoring described above, evaluation questions may arise requiring more detailed examination of implementation and/or effects of programs. These specific detailed information needs will be addressed through program evaluation which may take the form of either process or outcome evaluation. In general, the purpose of the whole process of monitoring and evaluation is to improve program implementation and designed to lead to informed decision making at all levels. (Please explain this paragraph as it doesn’t give much information or add value to the text above).

Contact Details

Mr. Dereje mamo Tsegaye

Director, Policy and Planning Directorate

Mr. Kiros Kidanu

Deputy Director, Policy and Planning Directorate




inance and Procurement Directorate

The main objective of Finance and Purchase Directorate, in relation to ensuring appropriate utilisation of financial resources, is ascertaining whether monetary income and expenditure activities are undertaken as per the finance laws and directives of the country. It is also the objective of the directorate to facilitate supply of goods and services contributing to the success of the health sector.

Case Teams

The directorate has three case teams working under its supervision.

Income and Reimbursement Case Team

§ Prepare and submit quarterly cash-flow statements to Ministry of Finance and Economic Development (MoFED) based on annually approved budgets. And subsequently, follow-up on the collection of approved fund from MoFED.

§ Collect ‘income and against issue receipts’ from various sources including donations and loans in the form of cheques or bank deposits.

§ Settle all payments including services, purchases, wages, allowances and other financial commitments of the Ministry.

§ Process bank transfers of programme-based donations to regional states and prepare letters to respective regions regarding the transfer and the intended purpose of the fund.

§ Provide payment services on various regional sites, where workshops, seminars, conferences or events are being conducted.

§ Control payments by the Ministry to avoid the possibility of to exceeding approved budgets.

§ Evaluate and make recommendations on budget transfers.

§ Follow-up on the settlement of pre-payments.

Registration Case Team

§ Register and code all income and expenditure documents.

§ Document all income and expenditure information under government, donors and creditors accounts.

§ Submit weekly, monthly and quarterly reports to internal audit and management as well as to MoFED. These reports should also be submitted to donors upon request.

§ Prepare reports on outstanding balances, debtors or receivable accounts based on recorded ledger and follow-up on settlements.

§ Submit documents on accounts requiring reversal or adjustments.

§ Balance and close accounts once a year and petty cash monthly.

§ Facilitate all external and internal audits.

§ Obtain pre-approved procurement budget plan from the World Bank and ensure that the deposited amount matches the approved budget.

Purchase and Property Administration /Management

§ Summarise all purchase plans of the Ministry

§ Verify the availability of budgets and float tender

§ Analyse and approve tenders in order to prepare contracts for suppliers of goods and services

§ Ensure quality of purchased goods upon delivery and dispatch to the correct destination at the Ministry and regional offices

§ Manage stock movement, perform emergency purchases and dispose scrap goods in line with the financial regulation and manual.

§ Control and administer properties of the Ministry.

§ Provide support to regional health bureaus on the implementation of BPR, specifically regarding the purchase and property administration processes.

§ Prepare and submit monthly reports to all stakeholders.


Saturday, October 9, 2010

Outstanding Achievements Need to be Scaled- Up to Realize GTP: Ministry


4 September 2010, Addis Ababa – The Ministry of Health said remarkable achievements registered in the health sector should be scaled up to realize the five year National Growth and Transformation Plan (GTP).
Speaking at a training organised for journalists on TB Public Relations and Health Communication Directorate with the Ministry, Ahmed Emano said government will give prior attention for the reduction of maternal and child mortality rate, HIV/AIDS and malaria epidemic.
The Government is striving to achieve MDGs and mass media, he said and urged mass media to play indispensable role in for the same cause.
TB Good Will Ambassador Artist Fikadu Tekilemariam on his part said the public should go to heath facilities immediately when it observes signs of the disease. He urged the mass media and public relations practitioners to raise the awareness of the public on mode of transmission and prevention ways of TB disease.
According to WHO report, Ethiopia ranks 7th among 22 countries where TB is rampant. The culture of visiting health facilities is poor and the transmission of the disease increasing in an alarming rate, it was learnt.
St. Petros General Hospital Chief Executive Officer (CEO), Bahiredin Mohammed said due to improper usage of TB medicine and owing to the low level of understanding about the treatment of the disease, the medicine given for six to eight months is adhering with the virus.
Hence, he said mass media and public relation practitioners have indispensable role to address this public health threat. He said government upgraded the hospital to a general level with a view to expand its service for a wider community.
The CEO said the service given to TB out patients around Mesalemia area in the metropolis, will be transferred to St. Petros Hospital as of September 11, 2010.

Pharmaceutical Services

Pharmaceutical Services
The objective of the pharmaceutical services component is to ensure a regular adequate supply of effective, safe and affordable essential drugs, medical supplies and equipment in the public and the private sector and ensuring their rational use.
The Drug Administration and Control Authority (DACA) and Pharmaceutical Administration and Supply Services (PPASS) of the Federal Ministry of Health are the two responsible bodies in the pharmaceutical sector.
The local production of pharmaceuticals and medical supplies has increased consistently. By the end of 2003, three of the 13 pharmaceutical manufacturers have received DACA’s licenses for export. The number of importers has also increased from 49 in 2001/02 to 70 in 2003/04. Except for the drug shops that show increment from 250 to 375, the number of pharmacies has decreased from 304 to 302 and rural drug vendors from 1,950 to 1,783 for the period 2000-2001 (1992-94 EFY). Drug formulary and standard treatment for different levels of health facilities have also been developed. In general, the availability of drugs in the health facilities has improved.
To build the capacity of Drug and Quality Laboratory, new equipment, including a complete condom testing equipment has been installed at a cost of Birr 3.5 million. Guidelines have been developed and distributed on drug and pesticide registration, adverse drug reaction reporting, drug advertising and promoting, imports and wholesalers working methods, and standard for intravenous fluid production in hospitals. Inspection guideline has also been distributed to all regions where the regional pharmacists were given delegated responsibilities for inspection and licensing. In year 2003/04 (1996 EFY), achievements made in inspection of health care units and drug outlets; and in-service training on drug management were 65% and 76% of the planned targets respectively. Studies have also been conducted on adverse drug reaction monitoring and drug information.
With regard to pharmaceutical human resource, the number of diploma schools for druggists and pharmacy technicians has increased resulting in increasing number of these groups of personnel in the public sector. A school of pharmacy was also opened in Jimma University in 1994 EFY, and the same year the School of Pharmacy in AAU started two postgraduate courses. Recently, the private teaching institutions have started training in pharmaceutical areas. Several trainings have also been conducted on different topics and the produced guidelines. Moreover, a drug information bulletin is being published regularly.
The national availability of essential key drugs, based on a survey result published in 2003, was 75%, 85% and 95% for public health facilities, regional drug stores, and private retail drug outlets, respectively. The general availability of drugs has improved significantly. On the other hand, the general average for presence of expired drugs by year 2003 was 8%, 2% and 3% in health facilities, regional drug stores and private retail drug outlets, respectively.

Blindness Prevention and Control is almost in a good position but still it needs suport

Blindness Prevention and Control
Blindness is one of the major health problems in Ethiopia. Cataract, trachoma, glaucoma and childhood blindness are the major causes of loss of eyesight. Trachoma and cataract alone constitute more than 70% of the total blindness in the country.

The main causes of childhood blindness appear to be corneal scarring, which is related to measles, Vitamin-A deficiency, acute infections and trauma. More than 80% of all blindness in Ethiopia is preventable or curable.

The major targets of this program is to develop a national strategic plan, perform about 36,000 cataract surgeries per year, and assist in developing an administrative directive for corneal transplantation, and to conduct survey on prevalence of blindness. Ultimately, it aims to reduce the prevalence of blindness from 1.5% to 0.7%.

Achievements
  • The launching of the Global Initiative Vision 2020;
  • Establishment of National and Regional Committees for the Prevention of Blindness;
  • Development of national Five-Year Strategic Vision 2020 Plans on Eye Care;
  • Development and standardization of cataract surgeons’ training curriculum;
  • An Administrative Directive was developed and consequently a National Eye Bank was established;
  • The number of ophthalmologists increased from 63 to 76 and the number of primary eye care units increased from 46 to 54;
  • Secondary eye care units increased from 18 to 23 in the country;
  • The number of cataract surgeries also increased from around 20,000 per year in 2002 to 25,000 per year in 2004 and

The number of lid-surgeries for trachomatous-trichiasis increased from around 15,000 in 2002 to 35,000 in 2004.

 

Tuberculosis and Leprosy: TB case detection is still low however the treatment success rate and cure rate is good

Tuberculosis and Leprosy
This program aims to increase the demand for TB care by raising community awareness through advocacy, communication, social mobilization and integration into the Health Extension Program.

The three TB prevention and control indicators are TB case detection rate, TB treatment success rate, and TB cure rate. Overall, this program is maintaining high levels of treatment success and cure rate. Once put on TB treatment, adherence of patients to the treatment is satisfactory.

There is a decline in TB treatment success rate and TB cure rate from 85% and 69% in EFY 1999 to 84% and 67% in EFY 2000 respectively. The TB case detection rate increased from 32 % in EFY 1999 to 34% in EFY 2000.

Malaria in ETHIOPIA IS NOt public Health problem

Malaria
Malaria is a major public health problem in Ethiopia – an estimated 68% of the total population is at risk of contracting malaria. Transmission is seasonal and predominantly unstable, with frequent and often large-scale epidemics. The impact of malaria, in addition to its health consequence, is a significant impediment to social and economic development in Ethiopia. It causes loss of work force and time both of the sick and the family members who provide care, loss of income, increases school absenteeism and depletion of family savings.
Cognizant of the health and socio-economic problems the disease causes, the Federal Ministry of Health (FMOH), Regional Health Bureaus and partners have been working jointly to strengthen malaria prevention and control activities in the country in order to ensure access to early and equitable services for the population at risk of malaria.
The Malaria Prevention and Control Program is guided by a five-year strategic plan developed in line with the goals of Health Sector Development Plan (HSDP). The first phase of the program has been completed in 2005, and it is currently implementing the Second Five-Year Strategic Plan covering the period 2006-2010.
The program has four key intervention strategies in the fight against malaria.
· Early Diagnosis and Treatment - Ethiopia is targeting 100% access to effective and affordable malaria treatment by the end of 2010.
· Selective Vector Control - National goals are targeting 100% coverage of all households in malaria risk areas with an average of two ITNs per household by 2007 and 60% coverage of villages targeted for indoor residual spraying (IRS) by the end of 2010.
· Epidemic Prevention and Control - Ethiopia is aiming, by 2010, for early detection and 80% containment of malaria epidemics within two weeks of onset compared to 31% in 2005 and to strengthen malaria surveillance.
· Information, Education, Communication (IEC) - Ethiopia is working to strengthen community knowledge, attitudes, and practices for malaria prevention and control by developing and disseminating appropriate health education materials.
Achievements
· In-patient case fatalities in age group older than 5 years fell from 4.5% to 3.3%;
· Case fatality rate of malaria in age group younger than 5 has fallen from 5% to 4.5% (1999 EFY);
· Morbidity due to malaria declined by 48%, hospital admissions by 54% and mortality by 55%;
· More than 20 million Insecticide Treated Nets (ITNs) were distributed, meeting the target set in all regions and resulting in a national coverage of 102%;
· More than 2 million homes were covered with Indoor Residual Spray (IRS);
· More than 30,000 Health Extension Workers were deployed resulting in timely treatment and diagnosis;
· Highly effective anti-malaria medicine has been introduced nationwide;
· National indoor residual spraying guidelines were updated and disseminated and
· The national malaria indicator survey was completed.
Committed leadership, sufficient funding and strong partnership in Ethiopia have produced exceptional results in a short time frame. The FMOH strongly believes that working in close collaboration with the government, communities and partners is needed to maximize resources and provide integrated services to bring the intended end results that will contribute to improved health and socio-economic conditions in Ethiopia and achieve the Millennium Development Goals (MDGs).

Ethiopian Health system views by kirazbest

Public Relations and Health Communication Directorate

The success of any institution, whether public or private, is greatly dependent upon its reputation. Opinions of consumers, employees, investors, policy makers and the media have powerful impacts on the prosperity of an organisation. Their perceptions will drive their decisions about whether they want to work with, deal with and support the institution. Consequently, there is an indisputable need for a strong communication, with the aim of building the organisations reputation, earning understanding and support as well as influencing public opinion and behaviour.
The Federal Ministry of Health (FMoH) should not be exceptional to this fundamental principle of information. The current globalisation became ever so ubiquitous; it escalated customer dynamism and demand for better goods and services. Similarly, the development of new technologies, medications, innovative prevention strategies and splendid research findings created a highly competitive market; the government realised the need for healthcare reform as well as a complete information communication strategy on the…..
The Public Relations Directorate was established to create and maintain goodwill and mutual understanding between FMoH and its stakeholders. The vision of the Public Relation Directorate is to see the creation of a healthy and prosperous society, who takes advantage of timely and accurate information on health policies, strategies and their execution. It is also believed that access to accurate and timely information enables the public to actively participate in the development process of Ethiopia based on understanding and mutual consensus.
§ Provide the public, stakeholders and employees of the Ministry with accurate and timely information to assist them with their ultimate goal of securing a healthy, productive and prosperous society.
· Create effective and information network between the FMoH, Regional Health Bureaus (RHBs), and other representative offices to strengthen the capacity of the Ministry and to provide expedited response to legitimate public enquires.
Case Teams
The Public Relations Directorate has five provisional case teams and three permanent case workers:
· Event Management and Promotion Case Team
· Media Monitoring Case Team
· Media Relations Case Team
· News, Press Release and Publications Case Team
· Promotion and Scale-up Case Team
Case Workers
· Audiovisual Case Workers
· Information and Library Case Workers
· Information Desk Case Workers
Major Roles and Responsibilities
· Establish an information network between various core and supporting processes within the Ministry as well as the Regional Health Bureaus and ensure sustainability.
· Act as a spokesperson/information focal point of the Ministry to disseminate accurate and timely information using various information mediums including print materials, information desk, resource centre, mass media and website.
· Plan, coordinate, and execute various public relations events geared towards creating favourable image of the Ministry and winning public support. Liaise with media organisations (including TV and Radio) to ensure key messages, major events and health sector accomplishments have gained sufficient coverage.
· Coordinate press briefings/press conferences to strength relationships between the Ministry and various media organisations.
· Provide appropriate response to media enquires and ensure all responses are provided by the Public Relations Directorate or other relevant sections of the Ministry.
· Provide information and assistance to foreign journalists and film professionals, who produce valid permits from the appropriate authorities.
· Monitor both international and local media reports, conduct situational analysis, and scrutinise pubic and professional opinions to prepare reports for appropriate action.
· Organise panel discussions and forums to secure transparency and increase national consensus on the Ministry’s policies, directives and regulations.
· Organise field trips and sight visits of health sector development programmes for high-level officials from FMoH and other government bodies, NGO representatives, development partners, media professionals and civil society to promote various achievements.
· Design FMoH’s official logos, produce audio-visual materials as well as various print and electronic publications both for internal and external consumption.
· Guarantee all promotional works convey clear messages to the society and are in line with the Ministry’s rules and regulations.
· Monitor and evaluate all activities of the public relations directorate regularly and opt new methods to improve performance.
Management Role
· Ensure that the directorate has been organised as per the institutional directives, and secure the necessary budget, human resources, and availability of appropriate tools.
· Design a communication strategy based on national directives as well as the Ministry’s strategic and annual plans.
· Establish evaluating and monitoring mechanism to ensure the designed communication strategy has been successfully implemented, adequate support has been provided and effective results have been secured.
· Ensure all stakeholders have been provided with reports and other essential information on the progress of the communication strategy.
· Plan and execute various trainings to foresee competent and ethically sound public relations officers in consultation with concerned authorise.
· Utilise public opinions, comments and suggestions as inputs to ensure quality of public relations and the overall health care services.