Supporting A Program of Prevention and Primary Health Care Promotion in Shire - Ethiopia

Project location: ETHIOPIA, Shire
Project start date: June 2012 - Project end date: October 2012
Project number: 2012-047
Beneficiary: MAGIS Foundation


In Ethiopia poverty is widespread, deep and persistent. Around 40% of the population lives under the absolute level of poverty.
Tigray is one of the regions that suffers at most drought and prolonged wars. The population is about 5 millions inhabitants. The percentage of the population that lives under the poverty line is higher than the national percentage.
This project focuses on the North West zone of Tigray, especially on the Wereda(District) of West North, Tahatay-Koraro, constituted by 13 Tabias (sectors) and on the area of Enda-Selassie including 5 Tabias1.
Tahatay Koraro is a District that covers 66.214 km2, of which 18.430 km2 arable; the area is located at an altitude between 1.400 and 2.100 meters above sea-level.
Most part of the territory is mountainous or semi mountainous. Main activities of the population in Tahatay-Koraro Wereda are agriculture and cattle breeding. Main cultivations are Teff, wheat, corn, millet and other cereals. Annual average rainfall is between 600 and 1.700 mm. Average production of wheat is 14 quintals/hectare, which ensure food needs for more or less 7 months. Percentage of clean water supplied is equal to 60% of requirements. The District has 11 health stations and 3 health units that are organized with staff at different, often insufficient, levels of formation.
Shire-Enda-Selassie, with an altitude of 1.984 - 2.126 meters above sea-level, is one of the 12 great cities of Tigray, with a population more than 65.000 inhabitants. The supply of drinking water is around 80% of requirements. Inhabitants of Enda-Selassie are government employees and, mainly animal dealers; social problems such as prostitution, orphans, and street children have been reported. The city has a Centre for Mother and Child Care, two Governmental Health Centres and a Hospital, several private clinics. All Governmental Health Institutions lack staff and equipment.
The main problems in the area are elevated rate of malnutrition, limited access to drinking water and lack of health education. In order to reduce these problems, the Sisters of Charity of St. Giovanna Antida have started a clinic / dispensary to improve health assistance and promotion in Tahatay Koraro District and in the city of Enda-Selassie.
Political context in relation to health
Ethiopia has a very difficult social-health condition, even more serious than that of other poor countries. This condition is caused mainly by food scarcity. Poverty among population is mainly due to low income and lack of education (especially among women); access to clean drinking water and to toilets are inadequate; all this has contributed to spread diseases in the country and particularly in the zones undertaken by the project.
According to the Ministry of Health data (2004), 60-80% of health problems are due to infectious diseases and malnutrition. Malaria, especially in low altitude areas, like Afar region, is still among the greatest causes of morbidity and mortality. HIV infection has rapidly increased in the last twenty years; public health services are shown by reports to be able to offer basic services only to 64% of the population. The majority of rural areas population has scarce access to modern health care facilities and this causes inadequate care and insufficient response to needs of the population.
In order to deal with the many health problems, the Government is working with remarkable efforts, both at national and regional level: consequently National Health Service is strongly decentralized and has extended also to rural areas. The health institutions are dealing with various obstacles and challenges to reach their objectives.
The Ethiopian Government has drafted the National Health Policy in the 1993. This policy aims to address needs of populations in less privileged rural areas, that constitute around 85% of Ethiopia total population.

"Health Policy" is particularly focused on :

• Democratization and decentralization of health system;
• Development of preventive medicine;
• Accessibility to health care for all population;
• Promotion of collaboration among sectors, involving Non Government Organizations and private associations;
• Promotion of health development, through mobilization and effective use of internal and external resources.
The new health policy has identified priority areas of intervention and strategies that need to be developed for reaching objectives. Development of primary health care services, National Strategy for child's survival, National Reproductive Health Strategy, Prevention and Control of HIV / AIDS, National Health Communication Strategy, etc. are some of the strategies implemented in the country

The general objective of the project is to improve Health Service in the zone of Shire Endaselassie, with particular attention to AIDS patients and to the poorest.
To reach this goal, the project foreseen support activities to be implemented in the St. Augustine Dispensary.
The building of the Dispensary consists of 3 rooms for medical examination of outpatients, pharmacy and storeroom for medicines, laboratory, room for injections, reception, registration counter, room for herbal medicines preparation (Moringa), waiting room for mothers and malnourished children, lounge with TV, DVD and Videos for health education sessions, changing room, toilets and bath rooms for staff and for out door patients.
Some rooms are already available for extending activities. The objective of the project is also to increase preventive activities in order to reduce the most frequent health problems. Prevention also remains the best strategy to reduce AIDS diffusion.
Staff: at the end of 2010 staff included 18 members: 3 Clinical Nurses, 2 Nurse Bachelors of Science, 2 Laboratory Technicians, 1 Pharmacist, 1 Growth Monitoring, 1 Sister, 1 Registrar, 1 Translator, 1 Casher, 1 Door keeper, 4 Cleaners.
To enhance the quality of the Dispensary the Congregation has invested in formation enabling staff members to improve and complete their training as Pharmacist (1), Medical Doctor (1- formation ongoing), Clinical Nurse (2), Nurse Bachelor of Science(1), Laboratory Technician (1) and Assistant for Children Growth Monitoring (1).

In 2009 and 2010 over 20.000 new patients, including over 2.000 malnourished children, have attended the Health Centre. Malaria, malnutrition, intestinal infections, respiratory infections, skin diseases and gout (in 2009) are the most frequently reported diagnosis. Staff is very competent and patients have noticed there is a great care of patient-staff relationship.
Along with outpatients care, everyday 2 or 3 people (1 qualified member of the staff, accompanied by 1 or 2 young sisters in formation) visit patients at their home, for regular follow up.

Specific objectives of the present project are:
1. To extend population access to primary health services, strengthening number and quality of services, in particular nutrition, care and support of AIDS patients, and implementing preventive activities.
2. To offer support to children orphans of AIDS patients or whose mothers are AIDS patients.
3. To offer health education sessions to a large number of people in order to promote a healthier life-style both at family and at community level.

The activities foreseen are:

• organization of medical examinations, analyses (including AIDS screening test) and treatment of patients;
• regular standardized follow up of patients
• care, feeding programme, growth monitoring of undernourished children;
• care and financial support to poor and AIDS5 patients, supported by a fund managed at dispensary level
• ongoing formation of health centre staff (3 months courses) on care and treatment of most widespread illnesses: infections, malaria, respiratory illnesses, infestation by intestinal parasites, skin infections, gullet, sexually transmitted diseases and HIV / AIDS.
• Counselling of mothers and orphans in difficulty;
• Creation of a database with their cases;
• Financial support for the poorest.
• Health education sessions will be held at dispensary level for patients, at school level for students and at village level for families on hygiene, infectious diseases, in particular HIV infection, nutrition, mother and child care, infections screening, vaccinations, importance of toilet facilities etc.

This project, which received a grant from the NPF, aims to:

• Increase of patients accessing the dispensary for medical care
• Improved capacity of health staff to deal with local health problems 12
• Improvement of dispensary capacity to meet patients' needs
• Increase of children monitored with medical/nutritional care and decrease of cases of undernourishment.
• Improvement of maternal healthcare in the zone of reference.
• Increase of population awareness on hygienic - health and nutritional matters
• Increased access of HIV positive patients to screening and care
• General improvement of living conditions for HIV positive patients.
• Improved prevention of transmission of infectious diseases.


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