Improving family health:
IFHP’s Experience From SNNPR
Saving Children’s Lives
Making Services Available at a Walking Distance
A
yelech Kakabo, a 40-year-old mother living in
Walana village of Kachabirra Woreda, recalls
a difficult past. When a child became ill, the
neighbors gathered around, put the child on a wooden
cot, and carried the cot on their shoulders all the way
to the health center, a day long trek from the village.
“When the children got sick, we traveled long distances
on foot, four hours walking from our village to reach
Hosanna Health Center. As the health facilities are
very far, we had to stay at relatives’ house for days
until the child finished treatment. It was very hard
and we usually didn’t prefer to go to the health center.
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women
Integrated Family Health Program
Frenesh Meseret
with her child
Instead, we tried to treat them at home with what we
learnt from our forefathers.”
Degefech Ayana and Tigist Abuha, health extension
workers of Walana Health Post, also recall challenging
times when they were without the skills to treat
even mild childhood illnesses. “It was embarrassing
for us to be considered as health extension workers
who can do nothing in front of a desperate mother
with a sick child. When we couldn’t help other than
referring them to distant health centers, the trust of
the community in us (HEWs) started to fed away,’’
said Degefech, who has been helping the community
for the last five years. Next page
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Now, things have changed for the better. A year
ago,the USAID-funded Integrated Family Health
Program (IFHP) organized a seven-day training on
integrated community case management (ICCM) for
HEWs in collaboration with Kembata Tembaro Zonal
Health Department and Woreda Health Offices in the
zone. In ICCM, HEWs learn how to identify, classify,
and treat sick children with mild symptoms of malaria,
pneumonia, diarrhea, and malnutrition. The Ministry
of Health led the process and IFHP partnered with
the government to support the initiative. IFHP also
conducted mentoring and post-training follow-up
visits, and supported review meetings each quarter
to facilitate experience sharing among HEWs. Women
development armies and mobile vans, vehicles
equipped with audiovisual materials, mobilize
communities on the availability of treatment services
for the specific childhood illnesses.
Frenesh Meseret, 25, has two children, the older
Samuel is four years old and the younger Eyerusalem
2
Integrated Family Health Program
is two years. Two months ago, Eyerusalem was very
sick. She had fever and was not eating anything. “I
took her to the health post; the health extension
worker checked everything and told me it was
malaria. She gave me medicine, she explained to me
how to give the medicine to my daughter. By the time
I went for the second appointment, my daughter has
already recovered from her illness. She was eating,
playing and laughing,” she continued. “It is because
the service is close to my home that things are easier
now; had it been like the old days, it could have been
very difficult.”
IFHP has trained more than 11,500 HEWs in ICCM
from over 5,400 health posts in 264 woredas of
Amhara, Oromia, Tigray, and SNNP regions of
Ethiopia. Following this training, it is estimated that
more than half a million children received services at
their doorsteps from HEWs.
Ayelech Kakabo
recalls a difficult past.
 Integrated Family Health Program

Taking Health Services

Where There is Need;
Expanding Family Planning Options
at the Community Level

W
Bizunesh Ayanaw
ednesday is a market day in Shinshicho
area of Kachabirra Woreda, Southern
Nations, Nationalities and Peoples (SNNP)
region of Ethiopia. Misrak Wube, a nurse at Shinshicho
Health Center, clad in her white gown, is expecting
and removal. Based at Shinshicho HC, she is currently
clients to show up at the health center (HC)for family
supporting Mino health post twice each week under
planning (FP) services as they travel back home from
the back-up support scheme. “Now,70 women of
the market.
Mino village have received IUCD through the back-up
Shinchicho HC has seen a major increase in the support in just nine months.”
utilization FP services particularly the uptake of long-
Bizunesh Ayanaw, 35, a mother of six children is the
acting methods since the USAID-funded Integrated
first in Mino village to choose an IUCD. Before the
Family Health Program (IFHP) launched its back-up
IUCD, she was using an injectable contraceptive.
support initiative. The back-up support initiative builds
‘When I get very busy, I usually forget my appointment
on a government decision to allow health extension
for my next shot. After I took IUCD however,I don’t
workers (HEWs) to insert the one rod implant,
have to worry about my appointment.” Bizunesh
Implanon®, at the community level. Through back-up
also managed to convince eight mothers from her
support, trained health workers from health centers
neighborhood to follow suit. Then, the word spread
visit health posts to support HEWs in the provision of
throughout her village and 35 mothers are now using
FP services, and offer insertion and removal services
the IUCD.
for Intrauterine Contraceptive Devices (IUCDs) and
Implants. Previously, Implanon® and IUCD insertions ‘’Every week before the back-up support, HEWs
were available only at hospital and HC levels. As a identify women that need Implants and IUCDs in
result, few women managed to get the service. the community, they also counsel the women, give
them short-acting FP methods, if they chose to use
IFHP organizes the trainings for health workers and
for the time being, and appoint them to come back
provides technical, material, financial, and logistics
on the date of the back-up support. In so doing, the
support to the back-up support initiative. Since the
HEWs pave the way for the success of the back-up
back-up support began in 2011, a total of 1,367 rounds
support initiative,’’ says Dr. Yewondwossen Tilahun,
of back-up support has been conducted, benefiting
IFHP’s Senior Advisor. “Currently, the back-up support
more than 25,000 FP clients in rural communities in
has created better access to wider FP options at
Amhara, Tigray, SNNP, and Oromia regions.
the community level. Women, who couldn’t afford
“When IUCD was offered at the health center, only 12 or don’t have the time, don’t have to travel long
clients were served from Mino village for the whole distances anymore. They can get the service in their
year. But as word spread about the back-up support, own settings.”
demand increased for FP services,”said Misrak, who
Currently IFHP is supporting the backup service in 139
participated in one of IFHP’s training on IUCD insertion
woredas of its intervention regions.

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Verifying the Truth and Ensuring Quality
through Integrated Supportive Supervision (ISS)
T
here are many examples where supportive
supervision has been used to improve health
workers’ performance. Kembata Tembaro Zone
Health Department conducts its quarterly-integrated
Supportive Supervision (ISS) to follow-progress,
identify challenges, verify reports, and provide on-
site technical support at woreda, health center, and
health post levels.
“When we need to have an honest assessment
of what we achieved, it is through the integrated
supportive supervision that we verify facts, identify
different bottlenecks and propose solutions,” said
Elias Mamo, head of Kembata-Tembaro Zone Health
Department.“Previously, some of the statistics that
were reported from woreda health offices to the zonal
health department were exaggerated. For example,a
certain woreda reported 100% achievement for first
antenatal care visit. But through ISS, we found it to be
less than what was reported. There was also a 100%
immunization coverage report from another woreda;
however, there was also epidemic report from the
same woreda.”
“Through ISS, we also identify the reasons for such
inconsistencies,”said Ato Elias.‘’Such reports used to
mislead the reader to believe that more has been
accomplished than is actually the case. However,
after the ISS was started five years ago, things have
changed a lot. These days, the zonal ISS team spends
a lot of time trying to verify the accuracy, consistency,
and timeliness of monthly reports that it receives
from all levels through various means including ISS,’’
Ato Elias explains.
4
After the ISS
was started
five years ago,
things have
changed a lot.
Ato Elias Mamo
The USAID-funded Integrated Family Health Program
(IFHP) currently supports ISS in Amhara, Oromia,
SNNP, Tigray and Benshangul Gumz regions of
Ethiopia with the aim of improving the coverage and
quality of health services.
The ISS team not only checks numbers, but also
program quality.“For example, during supervision,
we (supervisors) check whether insecticide treated
nets distributed are actually utilized at household
level,” said Ato Elias.“The majority of households
have at least one net. However, during supervision we
learnt that some of them were not using it properly.
The reason identified during our visit was lack of
awareness on how to properly use the nets. Some
nets were also torn and dirty. Thus, we noted that we
still need to work more on educating communities to
bring desired behavioral changes and replace the nets
that were rendered useless.”
Moving from traditional and hierarchical supervision
systems to more supportive one requires innovative
thinking and time to change attitudes, perceptions
and practices at all levels. In Kembata-Tembaro Zone
Health Department, IFHP has supported the training
of health workers and the provision of financial,
logistic, and material support to the conduct of ISS.
“IFHP is one of our trusted partners. The program
works with us during the planning of ISS and also gives
us technical and material support. Thanks to IFHP that
our regular ISS is currently implemented at all levels
regularly,” said Ato Elias.
Increasingly number of zones and woredas in IFHP
supported regions are now allocating their own
budget to conduct ISS by themselves.
 Serving My Peer, Serving
My Community:
Using Local Innovations to
Reach Larger Audience
“Hey!!!!!!!!!! This is FM 105.2 and I am your host
Mikias from your mobile studio,” said the soft voice
of Mikias, one of the peer educators (PEs) at Wondo
Secondary and Preparatory school of Aleta Wondo
Town in Southern Ethiopia, followed by a stream of
sweet local music. Mikias is one of the 15 PEs trained
by the Integrated Family Health Program (IFHP) in the
school of more than 3,000 students.
The PEs use morning and afternoon breakfast at
the school to announce health messages through
in-school FM radio. Tsegazeab, an enthusiastic PE
trained by IFHP, started the radio program at Wondo
School. The FM radio transmits different live programs
covering a wide array of topics including reproductive
health and the students and the local community tune
in using mobile phones and radios. The producers
also use the school’s megaphone to reach students
without mobile phones.
“Most students in the school have limited knowledge
on sexual and reproductive health issues,” said
Tsegazeab. “There are also misconceptions concerning
pregnancy and HIV/AIDS. As a peer educator, this is
worrisome, so one day, I asked myself, why don’t we
(PEs) have a radio program to help us reach students
with health information?”
“The answer was not easy,” he continued. “However,
I started to refer different sources to know better
about FM transmission and finally came up with this
small device. I made it from scraps and second hand
radio parts.” Although the FM program is not legally
registered to transmit radio programs,the regional
Few of the peer educators
education bureau awarded him for his efforts and
gave him recognition during the Young Students’
Scientific Innovation Contest. .
The main role of the PEs in the school is to educate
and counsel fellow students and young people in the
community on a variety of sexual reproductive health
issues. They (PEs) also refer their colleagues to youth-
friendly health services at a nearby health center.
The USAID-funded Integrated Family Health Program
(IFHP) provides five days basic training on peer
education,follows their performance, and provides
them with refresher trainings once a year for three
days.
PEs cover topics such as family planning, unwanted
pregnancy, sexually transmitted infection including
HIV, substance abuse, and life skills, which help
young people to make informed decisions about
reproductive health. They also distribute condoms
and behavior change materials to their peers. “The
training helped me a lot to improve my confidence
to make public speeches and develop self-esteem,”
Tsegazeab said.
“The information I received from the local FM radio
helped me protect myself and my friends from different
unhealthy practices such as use of substances,” said
Biruk, an eleventh-grade student. The PEs use various
methods to communicate health messages. “Every
Friday, we have a question and answer contest. We
give small prizes such as pen and exercise books to
Cont... P6
5

I asked myself,
why don’t we
(PEs) have a radio
program to help
us reach students
with health
information?”
Tsegazeab
Seizing Missed Opportunities
for Family Planning at
Delivery:
Post-Partum Intrauterine
Contraceptive Devices (PPIUCD)
Giving Rural Women Long Term Relief
M
eseret Hussein is a 20-year-old mother of
two children, one four years old and the
other eight months. She is a hard-working
woman who lives in a small village in rural Aleta Chuko
Woreda. After the birth of her first child, Meseret and
her husband did not want to have another child until
they were more economically stable. She started to
take oral contraceptive pills and later shifted to an
injectable contraceptive. “I started taking the first
shot of injectable. But, I forgot to take the second—
then,became pregnant,”she recalls.
“It is not uncommon for a rural woman to forget
appointment dates and face unwanted pregnancy,”
said Tigist, a midwife nurse who met Meseret during
her antenatal care visits at Chuko Health Center. “The
women in the woreda are always busy. They look after
6
Cont... from P5
winners of the contest,” said Mikias.
“Serving my peers gives me great satisfaction.
Our number is not enough; we are trying to
include new members, as we are about to
complete high school and join universities
next year,” Tsegazeab explained. “We need
to have successors. The peer education
activities should not be discontinued.” Said
Tsegazeab. IFHP has trained more than
10,500 PEs in Amhara, Tigray, Oromia, SNNP,
Beneshangul Gumz, and Somali regions of
Ethiopia to increase access to health service
for young people.
Meseret Hussein
their babies, fetch water and firewood and do all
other household chores-washing, cleaning, cooking,
etc. They also work in the field and support their
husbands.”
When her menstruation stopped, she didn’t suspect
pregnancy. She thought it could be because of the
injectable. However, after few weeks, her belly started
to grow bigger. “I went to Chuko Health Center to
learn that I was pregnant. It was frustrating moment. I
didn’t know what to say.” Her husband, a cobbler, was
not happy either and they often fought. “He blamed
me for not being careful about my appointment
and persuaded me to abort it,” she remembers the
Cont... P7
 Integrated Family Health Program
Cont... from P6

situation sorrowfully. ‘’Despite the pressure from my
husband, I insisted on continuing the pregnancy.”
Tigist, a midwife nurse, met Meseret during her
antenatal care visits at Chuko Health Center “She
(Meseret) told me the entire story about her second
pregnancy. I comforted her and counseled her on the
available family planning methods including IUCD,”
Tigist said.“When she came for delivery at the health
center, I counseled her again and she finally decided
to take IUCD immediately after her second birth even
before she was discharged.’’
Tigist received family planning training from the
USAID-funded Integrated Family Health Program
(IFHP), which has allowed her to offer the IUCD. “In
addition to the skill in IUCD insertion and removal,
I have also learned how to communicate, convince,
and win the trust of my clients,” said Tigist. IFHP has
provided in-service training on post-partum IUCD
(PPIUCD) to health workers from six rural health
centers in SNNPR including Aleta Chuko Health Center.
So far, about 35 health professionals have received
the training.
“After IFHP’s training, impressive achievements have
been recorded,” said Mr. Mareg Mekuria,Head of
Chuko Health Center. “We were able to serve 95 clients
with postpartum IUCD since we started the service
nine months ago, of which,45 clients were served in
the last three months.’’IFHP is a pioneer, supporting
the initiation of postpartum IUCD service in the public
sector for women attending skilled delivery service at
health centers.”
“Availing contraceptives like IUCD that would prevent
unwanted pregnancy as long as 12 years gives relief
for women like Meseret’’ said Tigist.
After eight months with postpartum IUCD, Meseret
speaks out with a great sign of relief: “Now, I am
relieved. I have nothing to forget and get unplanned
pregnancy. When things get better for my family, I will
have the IUCD removed and get pregnant right away.”
Meseret has also planned to start a small business to
support her husband who brings home the bacon.
“I have shared my experience to my friends in the
neighborhood and many of them are planning to do
the same and get free of worries,’’ she said happily.
Currently IFHP is supporting 49 health facilities in
Amhara, Oromia, SNNP and Tigray regions to provide
PPIUCD service.

Using Performance Data to

Make Informed Decisions:
Making Wise Decisions for Better
Service Quality and Coverage
Ebenezer Bekele

S
oro is one of the eleven woredas in Hadiya
Zone of SNNPR. With a population of more
than 132,000, the woreda has 46 rural and 3 urban
kebeles. “Two years ago, we were the least performing woreda
in the zone,” recalls Ebenezer Bekele, head of the woreda health
office.
The training we received on how to use our performance data to make decision and take action was an eye
opener. We knew very little about using our own data to identify our own gaps and propose solutions. Our
decisions were usually arbitrary and based on anecdote.”
Cont... P8

7
Cont... from P7
Many of the improvements are a result of trainings
conducted by the USAID-funded Integrated Family
Health Program (IFHP). IFHP has trained over 2,000
health workers and health managers in the use of data
for decision making in Amhara, Oromia, Tigray and
SNNP regions of Ethiopia. The program also provides
technical and materials support to encourage data
use for decision making in all regions.
Ebenezer is thankful for the training on data for
decision making. “It is a great help for us. It helped
us change in many ways. This year we have won
recognition award from the regional health bureau
for our outstanding performance, now we are on the
top of the list.”
Use of data for decision making refers to the collection
and analysis of various types of data, including input,
process, and output data to guide a range of decisions
to help improve the success of the health sector.
Health systems require quality data from health
information systems to plan for and ensure that the
workforce is fully funded and equipped with the
necessary commodities, infrastructure, resources,
and policies to deliver services.
“Now, we are completely data-driven”Ebenezer
proclaimed. Every side of the wall in his office is
filled with graphs and tables,reflecting plans and
achievements of the woreda health office (WorHO).
Ebenezer continued,“we get information at arm’s
length for our day to day decisions and visitors also
learn what is going in the woreda very quickly. In
recent times, Soro WorHO has witnessed a growing
Integrated Family
About IFHP Health Program
The Integrated Family Health Program (IFHP) is
Tel. +251 11 320 3501
a USAID-funded program that is implemented
by Pathfinder International (PI) Ethiopia and Nefas Silk Lafto Sub City
John Snow, Inc. (JSI). IFHP supports USAID/
Ethiopia’s strategic objective of “investing in
people” with the overall goal of creating and
consolidating functional and effective network
of well integrated family health services to
communities with in the framework of the
primary health care unit and more specifically
the health extension program. IFHP is
implemented in Amhara, Oromia, SNNPR and
Tigray and in selected zones of Benshangul
Gumz and Somali regions.
8
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interest in the use of performance data for decision
making, making it a cliché in the hearts and minds of
health workers and managers in the woreda. One of
the major challenges to use data for decision making
was its lack of timeliness, accuracy, consistency and
completeness. Currently, the WorHO has successfully
managed to improve all these challenges.
“The improvement in this woreda is due to frequent
supportive supervision and follow-ups at all levels,”
Ebenezer confirmed.
Data handling has improved; this is due to standardized
supervision practices using supervisory checklists.
Supervision has been conducted on a regular schedule
with written and oral feed backs given to supervises.
Performance data are collected, monitored, and
reviewed regularly. The reports are sent timely and
there is continuous follow-up and performance audit
of facilities at woreda level and this has positive effect
on data quality.
The Health Centers and the Health Posts in the
woreda have now started to use performance data for
decision making, “We started to realize our mistakes
in the past,” said Tigabu Abera, head of Kosha Health
Center in the woreda.” Now, we collect reports timely,
check for accuracy, completeness and consistency,
and conduct supervisions regularly. The management
of the health center also analyzes the data and uses it
for decision making.”
IFHP has been supporting the use of locally generated
data to inform decisions and actions within the health
system in its operation regions.
Disclaimer
This publication is
made possible by the
P.O. Box 12655 generous support of
the American people
Kebele 05 through the United States
Agency for International
Del Gebeya Area
Design and Printed by: Master Print +251 111 557 788
Addis Ababa, Ethiopia Development (USAID).
The contents are the
sole responsibility of
Prepared by: Pathfinder International
and JSI and do not
Tariku Nigatu necessarily reflect
Abdusemed Mussa the views of USAID
or the United States
Government.
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