Full Time, Quality Health Services In Malga Woreda

Baseline situation

Malga Woreda is situated about 26 kilometers from Hawassa town of Ethiopia. Before the ESAP2 project started, the health centers faced various service provision problems, for instance the Wejigra health center had no access to tap water, and the Haro and Tenkaro health centers were not accessible by road. The professionals were renting homes from the communities outside the health centers. Consequently, the Tenkaro health professionals lived in Wotera and were travelling 14 kilometers to their work place and back home on foot, since the road was not accessible for public transport. Similarly, Haro health center is 10 kilometers from the main road, and its dry weather road was not accessible with public transport. One can imagine the rate of absenteeism in these health centers.

Due to such situations communities were not able to get proper services from these health centers. W/ro Worke Banta, women representative from Tenkaro kebele explains: “Due to absence of residence for staffs in the health center, we used to face difficulty in getting health services, especially at night”. Ato Kebede Keyamo, Tenkaro kebele SAC chairman adds: “There was no ambulance service in Haro and Tenkaro due to the lack of accessible roads, and the people and health center of Man-icho town used pond and stream water for cleaning and drinking. All these situa-tions were worse for women, People Liv-ing with HIV/AIDs (PLWHA), children, and People   with   Disabilities   (PWD).”

Results after Social Accountability

Social accountability initiatives have resulted in a huge number of service improvements in Malga Woreda.

The following significant service improvements have been observed in the health sector:

•         Five midwifes and three health officers deployed in the three health centers as per the standard.

•         Six toilet rooms constructed for service users in Haro Health Center.

•         Five health professionals’ residence rooms constructed in Tenkaro health center, and Haro health center professionals’ residence is under construction.

•         Three ICT equipped staffs recruited for the registration section of Tenkaro and Manicho health centers.

•         Medical supplies purchased.

•         Two motorbikes purchased for Manicho and Tenkaro Health Centers.

•         The compound of the health centers cleaned.

•         Awareness of mothers to deliver in the health centers improved.

Newly constructed residences for Tekaro health professionals, June 2015

Changes have also occurred in the water and rural road sectors, such as the construction of accessible rural roads towards Haro and Tenkaro health centers, and the installation of tap water in Malga woreda. There were several enabling factors that contributed to the realization of these improvements, but various stakeholders, service users as well as service providers, including the Malga woreda government officials, are crediting the SA initiatives for significantly contributing to these outcomes.

The significance of the improvements for various stakeholders

The service improvements are very significant as it concerns essential services that support a healthy human existence with dignity. For instance, the construction of Tenkaro health center professionals’ residence has resulted in the provision of quality services for women, PLWHA, children, and PWD. W/ro Tigist Duguna, women representative from Camo Yangala kebele, which is served by Tenkaro health center, explains: “Previously, we were not able to get proper services for emergency deliveries and other cases, especially at night as the professionals lived in Wotera. Last year, my neighbor’s son was sick at night and we brought him to the health center, but there was nobody there. These days we are getting proper services from the health center at any time, because the professionals are living in the newly constructed residences. I got proper care and support when I delivered my child in the health center.”

Ato Muse Garo, Malga Woreda Health Expert gives an interesting example of benefits for health staff. “Following the construction of the professionals’ residence due to the SA initiatives, staffs are now punctual and respect office time. Absenteeism of health professionals became zero. Instead of travelling 14 kilometers per day on foot, the professionals are now living in the health center and can serve everyone for 24 hours. Senior professionals who had requested a transfer to the town based Wijigira health center are so impressed with the quality of the new residences that they cancelled their transfer request,.”

The woreda health office report indicated that the community capacity enhancement processes of SA, the recruitment of health professionals, the fulfillments of health amenities, and the collaboration among stakeholders has helped the three health centers to attract higher numbers of outpatients. Ato Birahanu Samuel, Malga Woreda SAC member and Woreda Health expert said: “Before most mothers in Malga woreda delivered with the traditional system, which exposed them to death and other harmful incidences. With the SA project they gained knowledge on their entitlements, and confidence in the services of the health center. The number of women seeking to give birth at health facilities in Malga woreda has increased from 17% to 50% compared with the previous years. They are also coming to receive antenatal care and bringing their children for immunizations.”

Ato Abdela Shume, SAC member and service provider of Wejigra health center said: “the hand pump of Malga woreda was not working for the last three years due to a technical problem. The community and health centers used pond and stream water for cleaning and drinking purposes, so that everyone was affected by water born disease. Following SA initiatives and SAC members’ pressure, the government installed proper tap water with an estimated cost of 3,237,200 ETB. The SA project brought us from darkness to brightness. It created great opportunities to solve various problems of our health center, and simultaneously solved the water problem in Manicho Town.”

The head of Tenkaro health center, Ashebir Mengstu said, “we have had an ambulance for years, but it was unthinkable to use it due to the lack of accessible roads. As a result, the community transported patients to the health center by carrying them on their shoulder – through ‘Karesa’. Due to the construction of a road towards Tenkaro health center, it has become possible for patients to use the ambulance service.”

The social accountability approach offers a number of particular benefits for PLWHA and PWD. Ato Dawit Amerew, representative of vulnerable groups explains: “Due to SA interventions, the woreda council has now increased the annual medical budget of the three health centers. As a result of this, the drug stores of the health centers are full of anti- retroviral drugs and the centers are able to provide appropriate services to PLWHA and others. The special needs of PWD have also been considered during the construction of service users’ toilets in Haro Health Center. Besides, the woreda administration has planned to consider special needs of vulnerable groups in all basic service provision systems.”

How the service improvements happened

AFSR conducted a Citizen Report Card (CRC) survey to take into account the needs and concerns of service users and providers, and to prioritize the desired service improvements. Before conducting the CRC survey, AFSR organized extensive training for citizens, service providers, government officials and SAC members on the concept of SA, its tools and how to use the tools to build up evidences for dialogue. Women, men, vulnerable members of the community, and service providers participated in the survey, in order to get a complete evidence base. The communities, government officials and service providers conducted an interface meeting on the CRC survey findings which resulted in the identification of ten major problems Then, a Joint Action Plan (JAP) was developed, which act as service improvement plan agreed by communities, government officials and service providers.

The JAP was handed over to SAC to follow up during implementation. AFSR and SAC members disseminated the findings of CRC survey and the content of the JAP at kebele, woreda, zonal, and regional levels for advocacy with relevant stakeholders. For example, woreda and kebele SAC members together with other representatives from service users and service providers organized meeting and discussed the JAP with Malga woreda council and other relevant sector offices. These actions lead to:

•         Woreda water office allocating 3,237,200 ETB for the construction of Tap water in Manicho town and health centers.

•         Woreda council approving a budget of 940,000 ETB for the construction of health professionals’ residence in Haro and Tenkaro health centers.

•         Woreda and kebele SAC members, woreda health office, health centers professionals and 1:5 development armies together conducting awareness raising campaign on the importance of delivering in the health

•         centers by using 1: 5 development army, Iddir and religious meetings within 26 kebeles of Malga Woreda.

•         Woreda health office purchasing two motor bikes with a total price of 200,000 ETB for Wejigra and Tenkaro health centers.

•         The woreda council increasing the annual medical budget of the health centers from 40,000 to 170,000 ETB.

•         Woreda health office allocating 100,000 ETB to construct new toilet facilities in Haro health center.

•         Woreda rural road program allocating 2,700,000 ETB for the construction of accessible road towards Haro and Tenkaro health centers.

•         Communities developing a sense of ownership, demanding quality services, and contributing to the improvements. 

Getachew Tumura, Eddir representative believes that: “we are seeing these service improvements because as service users we were able to voice our concerns. Now, we are giving very good feedback for service providers, and we are contributing our time and resource to improve the service provision. For instance, the community fenced Tenkaro Health Center with an estimated cost of 12,500 ETB, and the employees of Manicho health center together with the citizens are now cleaning the health center compound every 15 days.


How Social Accountability will continue

Various stakeholders from the health center, including the Malga woreda administration and service users have recognized SA as an important instrument to ensure the improvements of basic service delivery. The results encourage them to sustain SA in the future. A representative of Malga woreda council, Ato Beyene Godano, sees it this way: “The SA initiative has directly assisted the woreda council and sector offices to allocate resources based on the needs

and priorities of communities, and it improves synergies among government’s development initiatives. Previously, the communities were not able to explain their needs and concerns on service dissatisfaction, but now they are able to identify their problems so that we are under pressure to deliver and if we don’t, we have to explain why. We have planned an annual SA day celebration as a strategy to continue SA in the future.” Kebele SAC member, Ato Dawit Amerew, adds: “The woreda and kebele SACs have created strong linkages with FTA, the local media, Iddir, and Gudmale (cultural gathering event) as a strategy to continue SA in the future, for wider dissemination of the SA practices, and to keep the momentum of SA going on.”