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Evaluation report

2016 Ethiopia: Evaluation of Mobile health teams in Afar and Somali Regions



Author: Breakthrough International Consultantacy PLC

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report, and the executive feedback summary labelled as 'Part 3'.

Background:

Mobile health and nutrition teams (MHNTs) were initiated to respond to and meet the growing challenges of meeting the health needs of the pastroralist community. It started in the Somali region on a small scale in 2004. Since its initiation, the number of MHNT deployed in Ethiopia has continued to rise in response to emergency situations. By 2009, there were 20 government run teams in Somali region expanded and by 2011 it again increased to 24. Alongside government run MHNTs, international NGOS (INGOs) working in Somali have deployed aditional NHNTs, generally operating in a similar manner, but often with specific project defined variations.

Eventhough data on effectiveness of the MHNT were not avaible, both the regional Health Bureaus and UNICEF staff argued that mobile health teams provide better services for pastoralists, and have lower recurrent costs, than fixed facilities, although this would need to be empirically tested. Both stated that MHNTs have played key roles in reaching previously unreached populations in 20 of the 53 woredsas in Somali and three woredas in Afar. For making the decision to scale up the programme there is a need to understand more on the efficiency and effectiveness of the MHNTs.

Purpose/Objective:

The overall objectives of this study is to evaluate the current and future contributions of MHNT in Afar and Somali regions with answering 1. What is the effectiveness and efficiency of MHNT for providing emergency health and nutrition services; 2. What is the perception of the communicy accessibility, availability, completeness of quality of service provided by MHNTs. 3 What is the current and unrealized potential contributions and/challenges of MHNTs towards the development of effective pastoralist health care delivery services and 4. What are the major recommendations that will help guide the evolution of the MHNT in the medium term.

Methodology:

The evaluation used OECD DAC evaluation creteria as a methodology. The evidences used to reach on the conclusions and recommendations were collected through key informant interviews DPS, regional health bureaus, and active implementing parnters as well as actual visit is selected MHNTs. The evaluation team had also a chance to undertake FGDs with communities that were found using the MHNts during the visit.

Findings and Conclusions:

Overall the MHNTs are relevant to the pastoralist and weak health infrastructure context of Somali and Afar regions and could be considered as a transitional alternative strategy for health service delivery in these two regions. MHNTs were effective as compared to the static facilities in creating access to previously unreached population groups for health services.

But the investment of MHNT on maternal health is not been effective due to deep rooted cultural barriers that hindered utilization. Service uptake rate is not as good as other services. MHNTs reached in Somali region about 46,000 pregnant women with TT4 vaccination in the last four years, of which only 4400 pregnant women took TT4, and 2042 mothers have been assisted with delivery services showing the inefficiency of the systems as 90% of mothers dropped out from ANC 1 to ANC 4 and delivery.

The MHNTs has also been effective in responding to health emergencies and saving lives. However, clear triggers of entry and exit from the emergencies are not always known. MHNTs has been also effective in capacity building of pastoralist HEWs in Somali region, while this is not the case in Afar. The MHNTs objective to strengthen health posts and woredas in Somali regions is good initiative but the environment within which it is operating hamper the realization of graduating woredas and health facilities after building their capacities.

The services provided by the MHNTs to the community by and large remain adequate in terms of scope and address priority health services especially in Somali region. The perception of the community about the effectiveness and reach of the MHNTS is quite positive. There is universal acknowledgement of the value of MHNTs in reaching the unreached by the RHBs, woreda health officials, facility heads, community discussions and their role in some cases in introducing modern health care services. The community is willing to contribute for the continuity of the MHNTs.

Recommendations:

  1. Consider MHNTs as an alternative PHC service delivery strategy for medium term in the next regional health sector transformation plan.
  2. Ensure buy-in of the alternative service delivery strategy by the regional cabinet and FMOH.
  3. Look for alternative strategies for strengthening woreda and HP systems instead of using MHNTs.
  4. Revise the MHNTs package based on the visions and directions of the FMOH as alternative services delivery strategy
  5. Exit strategy: the RHBs should work with the main partners to develop an exit strategy that will outline on how government will take increasing responsibility of financing MHNTs and allow some partners either to exit from the financing and reduce the scale of their investment in the medium and long term.
  6. Responsible withdrawal: The MHNTs were effecting in saving lives and reach marginalized population groups. Immediate reductions of external resources are like to reduce the gains made so far in proving OTP, immunizatin and consultation services. The support given to the MHNTS should continue until its status, as an alternative model of service delivery is known.
  7. Continue ensuring the regular essential drug kit and nutrition supplies: UNICEF has been able to ensure that the needed kits and nutrition supplies are available for MHNTs. All MHNTS stated that the supplies are by and large available to runt the services. It is therefore necessary for UNICEF to contineu investing on ensuring the availability of kits and supplies.
  8. Advocate and negotiate with RHBs to make MHNTS as transitional strategy and for more resource allocations. UNICEF and other DPs supporting MHNTs should enhance their engagement and advocacy with the FMOH and regional health bureaus to help MHNTS evolve as alternative strategy for service delivery.


Full report in PDF

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Report information

Year:
2016

Country:
Ethiopia

Region:
ESAR

Theme:
Health

Type:
Evaluation

Partners:
UNICEF, FMOH and regional health bureaus of Afar and Somali Regions

Language:
English

Sequence #:
2016/032

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