Target Setting Procedures for Immunisation Services in Ethiopia

Abstract

This study identifies the problems related with target setting for immunisation service in Ethiopia. We adopted qualitative case study and drew concepts from institutional theory to collect data and analyse our findings. The findings showed that the plan of district health offices depends on the population data projected from census. Peripheral level health workers, on the other hand, enumerate the number of population in their respective localities. Subsequently, the ambiguity occurs from mismatch between the target from census and number of eligible children counted by health workers. Health facilities are expected to follow the target given from district health offices, which is higher than the local count in most cases. Thus, we found most peripheral level health workers considered that the inflated target given from the projected census lowers their achievements, since their performance should be calculated against the given target. This in turn affects the incentive given, thus, has implication on job satisfaction and performance. The need of considering the reality at the ground, rather than following only the formal institutional rules is emphasised in order to address the identified impediments.

The Extent of Integration of Community Health Worker Programs Into National Health Systems: Case Study of Botswana

“…40,48,50,51 Although there were more females than males selected into the program, most study participants indicated that gender, was not specified as a condition for this selection. This finding contrasts other CHW programs in the region where female gender inclination as a selection criterion was specified for Ethiopia 38-40,52,53 and Zambia. 48,50,51 Gender mix was indicated for Malawi 48 and Rwanda.…”

“…These findings are not farfetched from practices in other reviewed CHW programs in the region. In Ethiopian HEWs are trained through the Technical Vocational Education and Training institutions 39,40,52,53 in Ghana CHOs are trained at accredited health training institutions, 41 Malawi’s HSAs are trained at PHC training centers, 48 Nigeria’s JCHEWs and CHEWs are trained through state schools health technology, while CHOs are trained at state teaching hospitals, 66,68 Rwanda’s ASMs and Binomes are trained by MOH 57 and Zambia’s CHAs are trained at existing MOH training institutions by MOH senior management team. 51,58 This resounded with endorsements from research, that governments must assure that a fundamental set of skills and information is provided to CHWs, given the extensive role that they CHWs play in primary care.…”

“…In addition, the systematic routine home and community visitation during field-based learning created the much-needed platform of community engagement, mobilization and empowerment. The core competent of promotive and preventive services, identification of family health and social needs and risk in particular, is unique in the sense that it runs across other CHW programs in SSA like Ethiopia's HEWs, [38][39][40]52,53,60,73,74 Ghana's CHOs, [41][42][43][44]64 Malawi's HSA's, [45][46][47][48]56,[75][76][77] Nigeria's JCHEWs, CHEWs and CHOs, 49,[65][66][67][68]78 Rwanda's Binomes and ASMs 40,54,55,57,79,80 and Zambia's CHAs. 40,48,50,51,58,59,[61][62][63] It is worth noting though that the CSS implementers' scope of practice does not include the curative services, hence CHW curriculum does not have the WHO's 37 additional diagnostic and treatment competency.…”

Community Health Worker programmes’ integration into national health systems: Scoping review

“…9 Although the female gender of CHWs was linked to effectiveness in client counselling and enablement compared to the male gender, 91 this was contradicted in other studies that found no relationship between sex and performance. 92 In this context, Table 2 shows that female gender preference as a selection criterion was a requirement for CHWs in Ethiopia 57 , 58 , 59 , 64 , 66 and Zambia 61 , 74 , 75 while gender mix was indicated for Malawi 77 and Rwanda. 51 , 52…”

“…Ethiopia’s HEWs work under the National Health Extension Programme 57 , 58 , 59 , 66 ; Ghana’s CHOs operate under the country’s Community-based Health Planning and Services (CHPS) 65 , 71 , 72 ; Malawi’s HSAs implement the National Health Surveillance Agent (NHSA) Programme 73 , 76 , 77 ; JCHEWs, CHEWs and CHOs of Nigeria drive the country’s National (and state) Primary Health Care Development Agency (NPHCDA) 54 , 78 ; Rwanda’s binomes and ASMs work within the National Community Health Programme 51 , 52 , 53 , 66 and lastly the CHAs of Zambia that function within the National CHW Programme. 64 , 66 , 74 , 75 Figure 4 maps the selected CHW programmes by region, country, and name of CHWs.…”