Strengthening primary health care amid COVID-19 in Ethiopia: reaching 5.6 million people in Ethiopia

Ethiopia

Photo: WHO Ethiopia A WHO-supported Mobile Health Team in Fafa, in the Somali Region of Ethiopia, receives a visit from the Health Cluster and Incident Management team during drought response efforts in 2022.

Empowering healthcare

Amid the challenges posed by the COVID-19 pandemic, Ethiopia confronted additional health crises, including polio outbreaks, malaria, and malnutrition, all of which were exacerbated by conflict and contributed to a humanitarian crisis marked by internal displacement. The pandemic further strained the healthcare system, notably affecting women's reproductive health and signalling an impending secondary health crisis.[1][2] To address these complex challenges, a two-year project, funded by Canada's Department of Foreign Affairs, Trade and Development (DFATD), now known as Global Affairs Canada, and led by WHO Ethiopia, was implemented from April 2021 to March 2023 across five regions and one city administration. The initiative prioritized training healthcare workers, implementing supportive supervision and mentorship programs, issuing guidelines and SOPs, and distributing essential medical equipment and supplies. Spanning 16 hospitals, 92 health centres, and 344 health posts, the project benefitted an estimated 5.6 million people. It is anticipated that the project will reduce preventable diseases and deaths and enhance the capacity of the healthcare system to manage multiple crises, particularly strengthening services for women and girls[3], contributing to the health security goal of the General Program of Work (GPW-13). This aligns with one of the strategic priorities of the Country Cooperation Strategy of the WHO Country Office: Boost health systems resilience to protect health and mitigate the impacts of emergencies.

WHO’s Key Contributions

Provided technical assistance for creating COVID-19-adapted health service guidelines and conducting initial evaluations and research.
Ensured alignment with international standards through technical advice for action plans focused on enhancing sexual and reproductive health services.
Aided in the identification and distribution of essential medical supplies worth 4.17 million Canadian Dollars (CAD) through a consultative process.
Delivered training programs in collaboration with Ethiopian universities, benefiting over 1300 healthcare professionals and 800 healthcare workers in clinical mentorship.
Contributed to evidence-based technical support and meticulous documentation, laying the groundwork for replicating the project's success.

How did Ethiopia, with the support of WHO, achieve this?

A robust collaboration was formed between WHO’s Ethiopia country and field offices, six local universities, six regional health bureaus, and various district health and other social sector offices to support the implementation of key interventions. This collaborative effort aimed to enhance governance, strengthen primary healthcare units (PHCUs), and establish a resilient, gender-sensitive health system focused on the six health system building blocks: Leadership and governance; service delivery; health financing; health workforce; medical products, vaccines and technologies; and health information systems.[4]

“Regular stakeholder engagement was key to success as it allowed swift problem-solving during unanticipated challenges. Plans are underway to potentially broaden the consortium to include additional academic institutions for future initiatives.”

- Dr Nonhlanhla Dlamini, acting WHO Ethiopia Representative

To kickstart the intervention, WHO provided technical assistance to create health service guidelines adapted to the COVID-19 pandemic and to conduct initial baseline evaluations, scoping reviews, and operational research to assess PHCU capabilities and shortcomings, particularly in essential and reproductive health services. Consultative meetings engaged Ethiopia’s Federal Ministry of Health, regional health bureaus, district health offices, and academies like the Universities of Gondar, Debre Berhan, Jimma, Ambo, Hawassa, and Dire Dawa.

Upon completing the assessments, PHCUs crafted action plans to enhance sexual and reproductive health services, with WHO providing technical advice to ensure alignment with international standards. The launched interventions focused on strengthening governance, boosting PHCU capabilities, and building a resilient health system with gender integration. WHO aided in the identification of essential medical supplies and equipment through a consultative process involving PHCUs, resulting in the procurement and distribution of medical supplies valued at 4.17 million Canadian Dollars (CAD).

^{Photo caption: A WHO-supported Mobile Health Team in Fafa, in the Somali Region of Ethiopia, receives a visit from the Health Cluster and Incident Management team during drought response efforts in 2022.}Photo credit: WHO Ethiopia

Central to the initiative were training programs collaboratively delivered by WHO and Ethiopian university experts. These programs offered in-service training to over 1300 healthcare professionals and program managers, while clinical mentorship was implemented in 55 facilities, benefitting over 800 healthcare workers. The training covered essential themes such as gender-based violence, psychosocial support, infection control, and antenatal care.

The project's success was affirmed during a national review meeting attended by key Ethiopian health figures, including His Excellency Dr Dereje Dhuguma, Ethiopia’s State Minister of Health, and Dr Nonhlanhla Dlamini, acting WHO Representative in Ethiopia. Effectively addressing critical service gaps, improving the quality of essential services, and integrating resilience and gender equality into regional and federal health strategies, the initiative concluded in March 2023, leaving behind a strengthened healthcare framework, particularly in delivering essential services during health crises like COVID-19.

“Ensuring continuity of essential health services and building resilient health systems remains essential not only to mitigate the impact of COVID-19, but also to ensure readiness for other concurrent and future public health and humanitarian emergencies.”

- Dr Nonhlanhla Dlamini, acting WHO Ethiopia Representative

WHO played a central role throughout the project cycle, providing evidence-based technical support and comprehensive documentation, which will serve as a valuable resource for replicating the project’s success both within Ethiopia and internationally. Looking forward, WHO remains committed to supporting Ethiopia in building a robust, responsive, and resilient health system by working towards universal health coverage and the strengthening of primary healthcare services.

References

Routine Health Information System in Ethiopia.
Ethiopian Journal of Health Sciences Volume 33, Special Issue II. Ethiopian Journal of Health Sciences Special Issue II, accessed 1 February 2024.
End of project report (unpublished).
World Health Organization. Health system building blocks [web portal]. Health System Building Blocks, accessed 1 February 2024.