Ethiopia, child health program
Ethiopia has registered substantial progress in reducing newborn and child morbidity and mortality over the past decades as a result of strong leadership of the FMOH, coordination of efforts and intensive investment in the health system by government, development partners and the community at large. The National Child Survival Strategy (2005-2015) and the Child Survival Partnership were instrumental in guiding the design, implementation, coordination, monitoring and evaluation of high impact newborn and child health interventions in the country. The Strategy provided platform for implementation of key interventions to reduce child mortality in line with achieving the MDGs. Since its development in 2005, several evidence based interventions critical for child survival were initiated and implemented. Effective coverage of high impact interventions has been steadily increasing; however, utilization has not been uniform across the different section of the population and geographic areas. In 2015, Ethiopia developed the National Strategy for Newborn and Child Survival in Ethiopia (2016-2020) which allowed taking stock of achievements and successes, integration of key lessons learned as well as inclusion of new global innovations and developments critical for newborn and child survival.
Over the past several years, Ethiopia has been among the few countries that initiated outpatient treatment for possible serious bacterial infections (PSBI) for sick young infants within the 4Cs framework in the public health system at scale. Findings from the Community Based Interventions for Newborns in Ethiopia (COMBINE) trial and integrated Community Case Management (iCCM) scale up were used to develop the community based newborn care (CBNC) package. Partners have been working in the zones of four regions in Ethiopia to implement CBNC (strengthen the different components of care during pregnancy, delivery and postnatal period; and introduce management of PSBI) that was layered upon the iCCM implementation platform. In addition to policy guidelines and tools, there is a mix of published and program documentation outlining the experience and lessons learned.
Ethiopia has strong policies and plans to continue implementation at scale of newborn and child health interventions as part of five-year health systems plans, the Call to Action on Child Survival and Development, and movement toward SDGs.
Ethiopia has achieved MDG 4 target three years earlier by reducing under-five mortality by 67% from the 1990 estimate. (World Health Statistics Report, 2014 ) Under-five mortality rate has declined by two thirds from the 1990 figure of 204/1,000 live births to 67/1,000 live births in 2016. From 1990 to 2000, the average Annual Reduction Rate (ARR) of U5MR was at 2%, which accelerated to 5% since 2000. (HSTP 2014). Deaths due to malaria, measles, HIV, diarrhea and pneumonia have declined (The Lancet, 2012), HSTP.
Trend in Child Mortality rates
Common causes of under five death in Ethiopia
To capitalize on the momentum and sustain the gains the child and newborn health program at the national level is lead through six major initiatives that are implemented at the community and facility level. The major initiatives are:-
1. Community level initiatives
2. Facility level initiatives
Community based Newborn care (CBNC)
CBNC aimed at reducing newborn mortality at community level and it is a package of nine different interventions delivered to the community by the health extension worker. The nine packages are:- Early Identification of pregnancy, Provision of focused Antenatal Care (ANC), Promotion of institutional delivery, Safe and clean delivery including provision of misoprostol in case of home deliveries or deliveries at health post level, Provision of immediate newborn care, including application of Chlorhexidine gel on cord, recognition of asphyxia, initial stimulation and resuscitation of the newborn, prevention and management of hypothermia, Management of preterm and/or low birth weight neonates, Management of neonatal sepsis/very severe disease at the community level
Integrated Community Case Management (iCCM)
A package of interventions aimed at reducing child mortality through community level interventions.The goal is to achieve the greatest possible reduction of child mortality. introduced in 2010 to enable health extension workers (HEWs) manage common childhood problems like pneumonia, diarrhea, SAM and Malaria. It is a version of the IMNCI at a community level.The goal is to ensure the greatest possible reduction of mortality in children less than five years of age
Integrated Management of Newborn and Childhood Illness (IMNCI)
IMNCI is a globally promoted integrated package of preventive and curative child health services provided at health facility level (health centers and hospitals).The target coverage is 100% of facilities to provide Newborn and Child Health interventions at the under five clinic using the IMNCI principles.
Newborn Corner Initiative (NBC)
NBC is a package of interventions to address gaps in preventing newborn morbidity and mortality by ensuring standard newborn care (essential newborn care and basic neonatal life support) immediately after birth in every health facility. Targets the three main causes of newborn mortality; Prematurity, asphyxia and infection.
Neonatal Intensive Care Unit (NICU) Initiative
NICU is a facility based package of interventions to address newborns who need further/advanced care and to complete referral and linkage. Target coverage is to ensure all primary hospitals will have level I NICU, level II NICU will be operational in general hospitals and level 3 NICUs will be opened in tertiary hospitals
Early child hood development program is an initiative to enable Ethiopian children develop the ordered emergence of interdependent skills of sensory-motor, cognitive-language, and social-emotional functioning.Interventions are multi-sectoral. Thus, collaboration across Ministry of Women and Children Affairs, Ministry of Health, Ministry of Education, and Ministry of Labour and Social Affairs is vital to the long-term sustainability and success of high-quality early childhood development services. Early childhood development is not a standalone programme. Building on existing structures and expanding interventions that promote nurturing care is a cost-effective way to promote health, learning, productivity, wellbeing and the building block for future human capital formationand to reduce the effects of adversities on young children. The family will be taken as the first line of response and will be supported to provide adequate and holistic care for the survival, care and development of their children. Play is an active role in ECD programmes so that the community will be highly responsible to put-up ECD centres at community level and contribute locally available play tools for services of care-givers.