FOOD AND NUTRITION TECHNICAL ASSISTANCE

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Review of Incorporation of Essential Nutrition Actions. into Public Health Programs in Ethiopia, January 2008. Prepared by , Joan Jennings Consultant, Mesfin Beyero Hirbaye Consultant. Food and Nutrition Technical Assistance FANTA Project. FHI 360, This report is made possible by the generous support of the American people through the support. of the Office of Health Infectious Disease and Nutrition Bureau for Global Health United. States Agency for International Development USAID and the USAID Mission in Ethiopia . under terms of Cooperative Agreement No HRN A 00 98 00046 00 through the FANTA. Project operated by FHI 360 The contents are the responsibility of FHI 360 and do not. necessarily reflect the views of USAID or the United States Government . Food and Nutrition Technical Assistance Project FANTA . 1825 Connecticut Ave NW Washington DC 20009 5721, Tel 202 884 8000 Fax 202 884 8432 E mail fantaPDLO IKL org Website www fantaproject org. Table of Contents,ACRONYMS i,EXECUTIVE SUMMARY iii.
1 OBJECTIVES OF THE REVIEW 1,2 BACKGROUND 1, 2 1 Health Services in Ethiopia 1. 2 2 Nutrition in Ethiopia 2, 2 3 Essential Nutrition Actions and Key Contact Points 3. 2 4 Activities by LINKAGES to Support Adoption of ENA in Ethiopia 4. 2 4 1 In partnership with the F MOH and other actors creating national level support and ownership. through advocacy and strategy development for ENA implementation 5. 2 4 2 Developing behavior change messages and materials to strengthen and harmonize information. across multiple partners including the F MOH and NGOs 5. 2 4 3 Capacity building and training of F MOH NGOs and university partners to integrate ENA into. their programs 6, 2 4 4 Strengthening training of health professionals through incorporation of ENA in pre service. curriculum by the Carter Center EPHTI and universities 6. 2 5 Essential Services for Health in Ethiopia and ENA 6. 3 METHODOLOGY OF THE ENA REVIEW 7,4 MAIN FINDINGS 8. 4 1 Nutrition and ENA at National Level 8, 4 1 1 Advocacy 8.
4 1 2 National Nutrition Strategy 9, 4 1 3 National Strategy for IYCF 9. 4 1 4 Control and Prevention of Micronutrient Deficiencies 9. 4 1 5 Baby Friendly Hospital Initiative 9, 4 1 6 ENA and Health Management Information Systems 10. 4 2 Incorporation of ENA into Health and Nutrition Programming 11. 4 2 1 The Federal Ministry of Health 11, 4 2 2 Essential Services for Health in Ethiopia 11. 4 2 3 MOH Health Services at RHBs and ZHO DHOs 12. 4 2 4 ENA Counseling at the Community Level 13, 4 2 5 UNICEF 15. 4 2 6 NGOs 16, 4 2 7 ENA and Management of SAM 17.
4 3 ENA and Pre service Training of Health Professionals 17. 5 FACTORS THAT FACILITATED THE INSTITUTIONALIZATION OF ENA 20. 6 FACTORS THAT INHIBITED THE INSTITUTIONALISM OF ENA 21. ANNEXES, Annex 1 Scope of Work 22, Annex 2 Websites Documents and Presentations for ENA Review 26. Annex 3 List of Site Visits and Key Informants at National and Regional Levels 28. Annex 4 Itinerary of Site Visits 30,Annex 5 Map of Districts Visited 33. Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. ACRONYMS,ANC Ante Natal Care, AJJDC American Jewish Joint Distribution Committee. BCC Behavior Change Communication,BFHI Baby Friendly Hospital Initiative. CARE Cooperation for Assistance and Relief Everywhere. CBGMP Community Based Growth Monitoring and Promotion. CHP Community Health Promoter, C IMCI Community Integrated Management of Childhood Illness.
CMBS Code of Marketing of Breastmilk Substitutes,CRS Catholic Relief Service. CTC Community Therapeutic Care,DHS Demographic and Health Survey. ENA Essential Nutrition Actions,EPHTI Ethiopia Public Health Training Initiative. EPI Expanded Program of Immunization,ESHE Essential Services for Health in Ethiopia. FANTA Food and Nutrition Technical Assistance,F MOH Federal Ministry of Health.
FHD Family Health Department,FP Family Planning,GH Global Health. HEW Health Extension Worker,HMIS Health Management Information System. HSDP Health Sector Development Program,ICD Institute for Curriculum Development. IMNCI Integrated Management of Newborn and Childhood Illness. IMC International Medical Corps,IR Intermediate Result. IRT Integrated Refresher Training,IU International Unit.
IYCF Infant and Young Child Feeding,LAM Lactational Amenorrhea Method. LCD Liquid Crystal Display,M E Monitoring and Evaluation. MOH Ministry of Health,NU Nutrition Unit,NNS National Nutrition Strategy. NGO Non Governmental Organization,NWG Nutrition Working Group. PASDEP Plan for Accelerated and Sustained Development to End Poverty. PMTCT Prevention of Mother to Child Transmission,PRSP Poverty Reduction Strategy Program.
RHB Regional Health Bureau, i, Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. SAM Severe Acute Malnutrition,SCF UK Save the Children United Kingdom. SCF US Save the Children United States, SNNPR Southern Nations Nationalities and Peoples Region. TFC Therapeutic Feeding Center,TOT Training of Trainers. TVETC Technical and Vocational Education Training Centers. UN United Nations,UNICEF United Nations Children s Fund.
USAID United States Agency for International Development. USG United States Government,WHO World Health Organization. ZHO DHO Zonal and or District Health Offices, ii, Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. EXECUTIVE SUMMARY, In FY 2003 USAID Ethiopia introduced the Essential Nutrition Actions ENA package as an. approach to support the Ethiopian government and its partners in their efforts to improve the. nutrition of women and children under two years of age USAID Ethiopia requested the USAID . GH LINKAGES Project to provide wide ranging support in this strategy When the LINKAGES. Project ended in September 2006 USAID Ethiopia requested the bilateral Essential Services for. Health in Ethiopia ESHE Project to carry on implementation of the ENA approach In FY. 2007 USAID Ethiopia requested the USAID GH Food and Nutrition Technical Assistance. FANTA Project to review the degree to which the ENA approach has been incorporated into. the Ethiopia Federal Ministry of Health F MOH system and multilateral and non governmental. organization NGO programming and to identify factors that have facilitated or inhibited this. integration , Site visits and interviews with key informants were conducted by two FANTA consultants over a. period of three weeks in October 2007 Interviews and observations included government and. non governmental institutions at the national regional and community levels . Findings, The Review found that among sites and institutions visited ENA has been incorporated into the.
F MOH and NGO programming Factors that have facilitated ENA s incorporation into the. Ethiopian public health system include advocacy a designated project to support ENA activities. and training of various types of health professionals at different levels of the system . LINKAGES s initial advocacy effort is recognized by partners and stakeholders as having. created awareness of the importance of nutrition for child survival along with a base of. agreement and support for ENA at national and regional levels The ability of a USAID bilateral. project such as ESHE to provide longer term support and technical assistance for. institutionalization of ENA has been instrumental in maintaining and strengthening the capacity. of health workers in ENA The strategy of integrating ENA through many different agents e g . health services pre service training institutions NGOs active in maternal and child health was. considered by key informants of the Review to be worth the investment and has provided an. opportunity to reach the women and children of Ethiopia through multiple channels The. numbers of people trained in these various public private sectors also has created a base of skills. even as individuals change positions or move to other institutions . Factors that have inhibited the institutionalization of ENA include the lack of formal approval for. the draft National Nutrition Strategy NNS lack of ENA related indicators in the Health. Management Information System HMIS and lack of regularly scheduled training courses on. ENA for new and continuing health professionals Although ENA is seen to be incorporated into. health services at regional district and community levels in the regions supported by ESHE and. in the five pre service training institutions visited during this Review Ministry of Health MOH . administrators and university instructors note there is a lack of emphasis on ENA from higher. administrative levels due to the lack of a concerted national strategy As review and discussion of. HMIS results often drives supervision and decision making ENA remains less of a priority. within management systems because of its absence among HMIS indicators Although. iii, Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. LINKAGES trained a great number of people who still are working within the public health. system staff turnover is still cited as problem in continuing implementation of ENA There is . therefore a continuing need for training in ENA among health workers . iv, Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. 1 OBJECTIVES OF THE REVIEW, In FY 2003 USAID Ethiopia introduced the ENA package as an approach to support the. Ethiopian government and its partners in their efforts to improve the nutrition of women and. children under two years of age USAID Ethiopia requested the USAID GH LINKAGES Project. to provide wide ranging support in this strategy When the LINKAGES Project ended in. September 2006 USAID Ethiopia requested the bilateral ESHE Project to carry on activities to. continue implementation of the ENA approach , In FY2007 USAID Ethiopia requested that the USAID GH FANTA Project review the degree to. which the ENA approach has been incorporated into the Ethiopia F MOH system and. multilateral and NGO programming particularly by those organizations that participated in ENA. training and technical assistance through LINKAGES such as the United Nations Children s. Fund UNICEF ESHE and the Carter Center Ethiopia Public Health Training Initiative. EPHTI USAID Ethiopia also requested that FANTA describe how ENA has been integrated. into pre service curriculum by the Carter Center EPHTI and whether the integrated curriculum. is now being implemented at the seven focus universities The specific objective of the Review is. to identify factors that facilitated or inhibited integration of ENA . Please refer to the Scope of Work of the Review in Annex 1 . 2 BACKGROUND,2 1 Health Services in Ethiopia1, The F MOH is into the third phase of a Health Sector Development Program HSDP which was.
launched in 1998 within a context of a strong government commitment to democracy and. decentralization and to respond to the needs of the rural population who constitute about 85 . of the total The program is in accord with the government s Poverty Reduction Strategy. Program PRSP process and addresses multiple aspects of the health system including facility. construction and rehabilitation health care financing pharmaceutical systems and more The. basic objective of the HSDP is to improve the coverage and quality of health services which has. resulted in special programs and packages to contribute to this objective a the Health Service. Extension Program b the Accelerated Expansion of Primary Health Care Coverage and c the. Essential Health Service Package , The health service delivery system consists of four tiers with a primary health care unit at the. lower level with five satellite health posts followed by the first level of referral to a district. hospital By 2004 coverage of health services had been extended to 64 of the population with. the number of health centers almost tripled and the number of health posts increased by a factor. of fifty ,1, Information comes from several sources a Essential Health Services Package for Ethiopia Federal Ministry of. Health August 2005 b Health Sector Development Programme II Final Evaluation Report F MOH March 2006 . c Health Sector Development Programme III 2005 06 2009 2010 Ethiopia F MOH Program and Planning. Department 2005 and d The Earth Institute of Columbia University Center for National Health and Development. in Ethiopia www cnhde et columbia edu November 2007 . 1, Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia. In addition to increasing coverage through the construction or rehabilitation of health facilities a. strategy of creating a new cadre of health workers was initiated HEWs The HEWs are. primarily female and are deployed in pairs at the kebele level of administration and health. services the next administrative unit below district They undergo one year of training in. selected Technical and Vocational Education Training Centers TVETC . Approximately 17 000 HEWs have been trained thus far and the accelerated program plans for. an additional 3 000 to be trained by 2009 A national evaluation of HEW capacity in 2005 found. EPHTI Ethiopia Public Health Training Initiative EPI Expanded Program of Immunization ESHE Essential Services for Health in Ethiopia FANTA Food and Nutrition Technical Assistance F MOH Federal Ministry of Health FHD Family Health Department FP Family Planning GH Global Health HEW Health Extension Worker

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