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Improving Access to NCD Services in Rural Ethiopia
We will decentralise diagnosis, treatment and care for the major non-communicable diseases – hypertension, diabetes, chronic respiratory and epilepsy – from hospitals to health centres in the Jimma and Gondar regions. By doing so we will greatly increase access to these services for the rural poor.
January 2018 - July 2018
Charity information: Tropical Health and Education Trust
NCDs account for a rapidly growing burden of disease in Ethiopia particularly in poor, rural areas. In 2015 they caused 285,000 deaths and disabled many others across the country. Care is only accessible at hospitals, requiring rural populations to travel long distances, incur costs and lose income. Conditions such as hypertension can exist sub-clinically for years before causing life changing or ending health events, e.g. stroke. Ill health causes poverty for sufferers and their dependents.
The project will see the increased provision of NCD care at rural health centres. This will be achieved by the education of health centre nurses in NCD care through 15 3-day courses delivered by Ethiopian clinicians in collaboration with clinical colleagues from the UK. The trained nurses will then be mentored in practice at the rural health centres both during and beyond the project duration to enhance skills further in practice and to enable feedback and data to be collected.
Health centre nurses are delivering effective NCD diagnosis, treatment and care to rural patients
Activities» Train 433 nurses in providing NCD diagnosis, treatment and care in rural settings using locally appropriate training tools and handbooks
» Provide clinical mentorship to trainees in their workplace, utilising expert clinicians from the UK and Ethiopia
What success will look like
Following nurse training we will collect data from patient registers on patient numbers and treatments provided. We will also observe nurses in service delivery.
The capacity of the Ministry of Health to roll out decentralisation of NCD services is increased
Activities» Regularly meet with and report to the Ministry of Health with our progress and learning
What success will look like
The Ministry will have received our reports and from these will have indicated their future plans for further decentralisation of the services.
We will have embedded sustainable and locally owned NCD services at the health centres, led by NCD champions. There will be an increase in the number of patients receiving ongoing NCD care at the 36 rural health centres. These will be demonstrated by baseline and end of project data collection that includes a focus on the attitudes and motivations of the trained nurses and mentors. Community health in these targeted areas will improve, demonstrated using interviews with patients receiving care.
Staff turnover could be an issue in future, with staff being reposted to other areas. We do mitigate this by incentivising them to stay through identifying champions at the hospitals who will continue to mentor, and offer motivation. Low community uptake of services could also negatively impact success. We address this through community engagement and the training of health extension workers that raise awareness and understanding of the services as well as of NCDs within the community.
THET would provide updates every month on our progress to donors. These will include progress against each of our aims as well as stories from the staff trained, the patients treated and their families.
Budget - Project Cost: £37,412Loading graph....
Amount Heading Description £26,270 Nurse training Holding 15 training sessions for 433 nurses £8,200 Staff Costs of project managers, clinical coordinators and other support staff £1,951 Administration and overheads Costs of overheads, communications and other administration £991 Monitoring and evaluation Costs of conducting data collection and analysis
Ethiopia has a population of around 100 million. It is one of the least developed countries in the world with a Human Development Index ranking of 174 out of 188 UN recognised countries surveyed in 2015. It is facing an increasing double burden of disease primarily due to the increasing prevalence of NCDs. Areas of focus for this project are the rural areas in Jimma and Gondar. In these areas there is little in the way of health infrastructure and many communities live below the poverty line.
The primary beneficiaries will be the rural poor who are unable to access NCD services because it is expensive for them to reach health services, which are currently located far away at district hospitals. Health centre nurses will also be beneficiaries as they will develop additional knowledge and skills that will enhance their service delivery. The Ministry of Health will also benefit from this project as it will contribute to its learning on delivery of a decentralised model for NCD services.
THET has been working in partnership in Ethiopia for over 20 years to address the problem of NCDs and we have recently worked with the Ministry of Health in creating their national Guidelines on Clinical and Programmatic Management of Major NCDs. In the last 3 years alone we have trained 242 health extension workers and 134 nurses in referring patients for screening and delivering NCD care at 17 rural health centres. As a result over 7,500 patients are now registered for long term treatment.
Read more about the Charity running this project.
Dr Yoseph Mamo
Dr Yoseph, a medical doctor, has played a key role in designing the NCD model and in providing technical assistance to the Ministry of Health.
Dr Shitaye Alemu
Dr Shitaye, a diabetes expert, has championed the programme in Gondar to date and will coordinate the training and provide ongoing trainee mentorship.
Dr Tadesse Gemechu
Dr Tadesse, a medical doctor, has championed the programme in Jimma to date and will coordinate the training and provide ongoing trainee mentorship.
Louise is Head of Programmes and Development at THET. She brings a wealth of programme and project management expertise in the field of health.