Overview of HEPO roadmap

02/21/2024 HEP Optimization Roadmap 2020-2035 2

Brain storming
1. What is Status/Approach of health service delivery during pre
HEP evolution? Think 20 yrs. back
2. How you express 1st and 2nd Generation HEP implementation?
• Strength
• Weakness
3. What is your personal recommendation for existing 1st and 2nd
Generation HEP?
4. Have heard any information about HEP Optimization
roadmap?
02/21/2024 HEP Optimization Roadmap 2020-2035 3

Presentation Outline
• HEP evolvement : Key millstones
• Theory of change in HEPO
• Major changes to HEP and the rationale for developing
and revising HP s standards
• Outline of CHP standards
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 02/21/2024 HEP Optimization Roadmap 2020-2035 5

Rationale for HEP Optimization Roadmap

• Changes in the HEP need a more structured guidance
• Socio-economic changes - challenges and opportunities
• Changes in causes of preventable morbidity and mortality
• Increasing community expectations
• Commitment to UHC and expansion in essential health service packages
• Need to address the implementation challenges of HEP
• Increasing numbers and types of targets
Roadmap 2020-2035
 02/21/2024 HEP Optimization Roadmap 2020-2035 7

Goal and strategic objectives

a l
• Overall goal:
G o

To accelerate the realization of UHC through which all Ethiopians

will have reliable access to needed health services, including
prevention, promotion, treatment, rehabilitation and palliation of
sufficient quality to be effective while preventing financial hardship
from the use of these services.
SI
6

46
SO
Goal
August 2020

Ensure equitable access to

7
essential health services

Improve quality of health

19
services provided through
the HEP

Ensure sustainable

6
financing and eliminate
financial hardship from
HEP services
G o a l

Strengthen community
engagement and
empowerment
3

Ensure resilience of HEP to

natural and manmade
disasters –
3

Strengthen political
leadership & MSEP
8
 02/21/2024 Roodmaappi Fooyya'iinsa SEF 2020-2035 9
Kaayyoole Tarsiimowaa Roodmaappi Fooyya’iinsa SEF
Tarkaanfii Tarsiimowaa-46 Tarkaanfii Tarsiimowaa-46

7 Qaqqabamummaa Walgitiinsa Tajaajila

Fayyaa Murteessoo Ta’anii Mirkaneessuu

19 Qulqullina tajaajila SEF tiin

kennamu fooyyessuu
Gaggeessummaa
Tajaajila SEF tiif faayinaansingii siyaasaa, qooda
fayyaa ittifufiinsa qabu fudhanna
6 mirkaneessuu fi rakkoo hanqina seektarootaa fi
faayinaansii hiikuu michoomina
ittifufiinsaan cimsuu

Abbummaa fi qooda-fudhannaa
8 hawaasaa cimsuu

Tajaajilota fayyaa murteessoo ta’an

3 yeroo muddamsuu keessatti ittifufiinsaan
kennuun dandamannaa balaa tasaa
mirkaneessuu
3
 10
Theory of change Problems Improvement Plan Result
 Major changes to HEP
As Is
• Services
• Service delivery systems
• Service Packages
• HR
• Infrastructure CHP: SD
• Logistics

• Others (LMG, Finance, HIS,

Community engagement)
 12

Assumptions for service package recommendations

• Universal Health Coverage is the aspiration of the Ethiopian Health Sector
• Urbanization will continue to increase in the coming years. However, the population
will stay predominantly rural-dwelling for the coming few decades.

• Changes in burden of diseases related to MNCH, communicable diseases, and NCDs

including mental health conditions, and accident and injuries.
• Growing community demands. (equitable access to quality care )
• The recently developed EHSP has been good opportunity to define
HEP essential health packages
 02/21/2024 HEP Optimization Roadmap 2020-2035 13
HEP Service delivery System

Out reach SD
HPB SD

Mobile SD
Household SD
 14

HP Services Delivery System and service packages

Three categories of the HPs (MHPs, BHPs and CHPs)
• MHP: those overlapping with the nearby HC or Hospital (will part of HC/PH and
provide promotive and prevention services in integration with the HC`s services
• BHP: HPs located within a reasonable distance from the HC (a walking distance of
one hour and less)
• continue providing the current packages (basic packages)
• Address issues of quality of care
• Strengthen referral linkages, and outreach/mobile health services
• CHP: HPs located far from the HCs and fulfill other categorization criteria will be providing
comprehensive packages
CHPs – cont
• These are HPs in kebeles that have limited access to the HC/ PH
• These HPs will provide comprehensive packages : All BHP service packages plus
additional interventions, including :
1. Comprehensive maternal health care for normal pregnancy, childbirth, and
postpartum period that ensure s continuum of care. I. e. FANC inc PMTCT, labor
& delivery, PNC (maternal and new-born) pre-referral Rx and referrals for
sophisticated cases
2. Treatment of common childhood illnesses . I. e IMNCI (pneumonia, diarhea,
fever, ear infection, malnutrition)
3. Treatment of common adulthood illnesses (based on ten top causes of
morbidity) these cover a range of diseases conditions
4. Prevention and treatment refill for chronic illnesses (community DOTS & ART
drugs refill; counseling on chronic adulthood diseases and BP monitoring)
 16

HR for HEP
• Based on the proposed services to be given at BHP and CHP the HR requirement
has changed in terms of :
• improving number of staffs (6-8 for CHP, 3 for BHP and 2 in MHP)
• Addressing Professional mix and gender mix ( Level 4 HEWs; Nurses;
Environmental Health Professionals; Health Officers; midwives; Family
Health Professionals and Pharmacy & Lab technicians (optional)
• Mix of qualifications (Bachelor degree, Level 4 and others)
• Auxiliary staffs (cleaners, security, cashier)
02/21/2024 HEP Optimization Roadmap 2020-2035 17

• Health Infrastructure (Key considerations)

• Physical structure
• Additional rooms / spaces matching the services being given
@ BHPs and CHP
• Quality of construction
• Standard design

• Tracer amenities (6-7)

• All the required basic amenities required for HP services
 02/21/2024 HEP Optimization Roadmap 2020-2035 18

Health Products (Medical equipment ; Medicines)

• Essential drug and equipment list
• Other non-medical supplies
 02/21/2024 revised: Woldemariam

HEPO Implementation Costs

• Roadmap costed using the costing guideline

• Detailed costing for the first five years

• Indicative costing for the remaining 10 years
• Roadmap costs include:

• HR, Infrastructure, medicine and supplies and other HEP Health –system
related costs
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Total cost of HEP Roadmap implementation, 2020-

2035