USAID/PEPFAR Ethiopia In-Country Reporting System (IRS)

Reporting Template

Jhpiego

ANNUAL PROGRAM RESULT

FOR

FISCAL YEAR 2015

(OCTOBER 1ST, 2014 TO SEPTEMBER 30TH, 2015)

CONTACT INFO FOR THIS REPORT:

DR. DAMTEW WOLDEMARIAM

CHIEF OF PARTY
0911 807 682
0912 613 897

22 October, 2015 Page 1

LIST OF ACRONYMS

ANC Antenatal Care

BSC Balanced Score Card
COC Certificate of Competence
CPD Continuing Professional Development
EAA Ethiopian Association of Anesthetists
EMwA Ethiopian Midwives Association
EMT Emergency Medical Technician
ENA Ethiopian Nurses Association
EPA Ethiopian Pharmaceutical Association
EPHO Ethiopian Public Health Officer Association
EPHA Ethiopian Public Health Association
ESC Education Strategic Center
ETS Effective Teaching Skills
FMOH Federal Ministry of Health
FMOE Federal Ministry of Education
FMHACA Food, Medicine and Healthcare Administration & Control Authority
HAPCO HIV/AIDS Prevention and Control Coordination Office
HEIs Higher Education Institutions
HERQA Higher Education Relevance and Quality Agency
HEWs Health Extension Workers
HMIS Health Management Information System
HR Human Resources
HRDM Human Resources Development Management
HRH Human Resources for Health
HRIS Human Resource Information System
HRM Human Resources Management
HSEDC Health Sciences Educational Development Center
HSTP Health Sector Transformation Plan
IMNCI Integrated Management of Newborn and Child Hood Illness
INQAAHE International Network for Quality Assurance Agencies in Higher
Education
ISS Integrated Supportive Supervision
JD Job Description
LMU Ludwig- Maximilians-Universitat Munchen
MCQ Multiple Choice Questions
MNCH Maternal, Newborn and Child Health
NBE National Board Exam
NIMEI New Innovative Medical Education Initiative
OSCE Objective Structured Clinical Examination
PMTCT Prevention of Mother to Child Transmission
QA Quality Assurance
RHB Regional Health Bureau

22 October, 2015 Page 2

RHSC Regional Health Science College
RMNCH Reproductive, Maternal, Newborn and Child Health
SNNPR Southern Nations, Nationalities and Peoples Region
TVET Technical and Vocational Education and Training
TWG Technical Working Group
WoHO Woreda Health Office
WASH Water, Sanitation and Hygiene

22 October, 2015 Page 3

TABLE OF CONTENTS

2. Publications/reports......................................................................................................... 5
3. Technical assistance ........................................................................................................ 6
4. Travel and Visits ............................................................................................................. 7
5. Activity ........................................................................................................................... 9
6. Accomplishments and successes during the reporting period (October 2014 – March
2015) ................................................................................................................................. 10
7. Challenges and Constraints and plans to overcome them during the reporting period 91
8. Data Quality issues during the reporting period ........................................................... 92
10. Environmental compliance ......................................................................................... 94
12. Issues requiring the attention of USAID Management ............................................... 94
13. Data Sharing with Host Government: ......................................................................... 94
14. Appendices .................................................................................................................. 95

22 October, 2015 Page 4

1. Reporting period

From To
01 October 2014 30 September 2015

2. Publications/reports
Did your organization support the production of publications, reports, guidelines or assessments
during the reporting period?

No/Not Applicable
Yes If yes, please list below:

Title Author Date

Work Climate Improvement Program – Creating Ummuro Adano, Management October 2014
a Work Climate that Motivates Staff and Sciences for Health,
Improves Performance – Draft Concept Note Strengthening Human
Resources for Health (HRH)
Project
Revitalizing the Quality Assurance System for Higher Education Relevance October 2014
Education of Health Professionals in Ethiopia and Quality Agency (HERQA),
FMOH, HRH Project
Undergraduate Emergency & Critical Care Federal Ministry of Health December 2014
Nursing Curriculum (FMOH), HRH Project,
Ethiopian Public Higher
Educational Institutions
Curriculum for Bachelor of Sciences in Neonatal Federal Ministry of Health December 2014
Nursing Program (FMOH), Strengthening Human
Resources for Health (HRH)
Project, Ethiopian Public Higher
Educational Institutions
Post Basic Bachelor of Science in Operation Federal Ministry of Health December 2014
Theatre Nursing Curriculum (FMOH), Strengthening Human
Resources for Health (HRH)
Project, Ethiopian Public Higher
Educational Institutions
National Accreditation and Quality Improvement HERQA, FMOH, HRH Project December 2014
Standards - Anesthesia
National Accreditation and Quality Improvement HERQA, FMOH, HRH Project December 2014
Standards - Midwifery
National Accreditation and Quality Improvement HERQA, FMOH, HRH Project, December 2014
Standards - Medicine Ethiopian Medical Association,
Addis Ababa University

National Accreditation and Quality Improvement HERQA, FMOH, HRH Project, December 2014
Standards - Pharmacy Addis Ababa University –
School of Pharmacy

22 October, 2015 Page 5

National Accreditation and Quality Improvement HERQA, FMOH, HRH Project, December 2014
Standards - Nursing Ethiopian Nurses Association,
Addis Ababa University School
of Nursing, University of
Gondar Department of Nursing
National Accreditation and Quality Improvement HERQA, FMOH, HRH Project, December 2014
Standards – Medical Laboratory Science Ethiopian Medical Laboratory
Association, Haromaya
University, Addis Ababa
University
National Accreditation and Quality Improvement HERQA, FMOH, HRH Project, December 2014
Standards – Public Health Officer Ethiopian Public Health Officer
Association, University of
Gondar
Job Satisfaction and Factors Affecting Health Strengthening Human December 2014
Worker Retention in Ethiopia’s Public Health Resources for Health Project
Sector – Technical Report Draft
Employee Satisfaction Survey Report – Revised SNNP Regional Health Bureau March 2015
and Updated (Amharic)
National Guideline for Recognition of Foreign HERQA and HRH Project March 2015
Qualifications
Amhara National Regional Health State Bureau – Amhara RHB with technical July 2015
Regional Human Resources for Health (HRH) support from the HRH Project
Annual Profile/ Report
If Yes, Please attach an electronic copy of each document as part of your submission.

3. Technical assistance
Did your organization utilize short-term technical assistance during the reporting period?
No/Not Applicable
Yes Please list below:

Consultants/TDYers
Name Arrival Departure Organization Type of Technical assistance provided
Dr. Catherine 17 Nov 14 22 Nov 14 Jhpiego Provide technical assistance for the
Carr conduct of a manuscript writing workshop
to develop draft manuscripts using data
from the Task Analysis for Midwives,
Anesthetists and Health Extension
Workers Study
Dr. Mark Childs, 25-Jan-15 4-Feb-15 Open To conduct in-depth interviews and gather
Consultant University information that will guide the
Dr. Susan development of a case study for the post-
Fawssett, graduate programs in human resources
Academic for health management/health economics
Project Manager
Hannah Tappis, 1-Mar-15 7-Mar-15 Jhpiego Provide technical support for the
Sr. Research development of an Impact Model
Advisor

22 October, 2015 Page 6

Lauren Borsa, 25-Feb-15 13-Mar-15 Jhpiego Provide programmatic support for cost-
Sr. Program share documentation and due diligence
Coordinator and review of sub grants and
procurements in light of the updated
USAID regulations
Dr. Susan 9-Mar-15 20-Mar-15 Open Support co-teaching of the human
Fawssett, University resources management post-graduate
Academic program, as part of faculty capacity
Project building and on-the-job mentorship
Manager
Dr. Cristina
Santos, Lecturer
Dr. Jane King,
HRM Expert
Dr. Susan 22 Jun 15 26 Jun 15 Open Support co-teaching of the human
Fawssett, University resources management post-graduate
Academic program at Gondar University, as part of
Project faculty capacity building and on-the-job
Manager mentorship
Dr. Mark Childs,
Consultant
Dr. Jane King,
HRM Expert
Dr. Karin Sep 14 Sep 26 Volunteers* Train pediatricians, general practitioners,
Davies, Dr. midwifery instructors, nursing instructors
Patricia and neonatal nurses at Gondar University
Bromberger, on post-resuscitation care for neonates
Elise Imonti,
Kathy Johnson,
Fary Moini,
Carole Leland
Dr. Susan Sep 30 Oct 2 Open Train faculty at Gondar University to
Fawssett, University supervise post-graduate HRM/HE
Academic students during implementation of the
Project thesis module.
Manager
*costs shared with Rotary Club Funding
If Yes, Please attach an electronic copy of the TA report as part of your submission.

4. Travel and Visits

Did your organization support international travel during the reporting period?

No/Not Applicable
Yes Please list below:
International Travel (All international travel to conference, workshops, trainings, HQ or meetings).
Name Destination Departure Arrival Host Purpose of the travel
from Organization
Ethiopia
Dr. Tegbar Amsterdam, 26 Nov 14 30 Nov 14 Dutch Working Present findings from the
Yigzaw Netherlands Party on Safe Student Competency
Motherhood Assessment Study conducted

22 October, 2015 Page 7

 and under the HRH Project;
International Presentation titled: “How well
Child Health does pre-service education
prepare midwives for the
world of work: competence
assessment of midwives at
the level of graduation”
Dr. Zerihun Illinois, 30-Mar-15 3-Apr-15 International Present at, and participate in,
Wolde, Sr. Chicago, Network for the INQAAHE Biannual
Education USA Quality Conference (theme –
Quality Assurance Changing Landscape of
Advisor, Agencies in Higher Education: New
Jhpiego Higher Demands on Quality
Education Assurance)
(INQAAHE)
Dr. Tesfaye Illinois, 30-Mar-15 3-Apr-15 INQAAHE As above
Teshome, Chicago,
Director, USA
Higher
Education
Relevance
and Quality
Agency
(HERQA)
Yewulsew Kigali, 24-Jun-15 26-Jun-15 Eastern Africa Participate and present in the
Assaye, Rwanda Health third annual conference of the
Education Professions EAHPEA
and Training Educator's
Officer, Association
Jhpiego (EAHPEA)
Dr. Tegbar Kigali, 24-Jun-15 26-Jun-15
Yigzaw, Rwanda
Deputy Chief
of Party,
Jhpiego
Sharon Boston, USA 30 May 15 13 Jun 15 Harvard Attend the Strengthening
Kibwana, University Human Resources for Health
Program School of Certificate Course
Manager, Public Health
Jhpiego
Zeine Boston, USA 30 May 15 13 Jun 15
Abosse, HRM
Advisor, MSH

22 October, 2015 Page 8

Have any Monitoring Visit/supervision been made to your program in during the reporting period?
Yes

Description of Start date End date Sites visited Written recommendations

Monitoring team provided
USAID SIMS Visit 29 Dec 2014 29 Dec 2014 FMOH - HRDA
Directorate
USAID SIMS Visit 3 Sep 2015 3 Sep 2015 Minilik Health
Science College
USAID SIMS Visit 1 July 2015 1 July 2015 Addis Ababa Provide guidance to site
Regional Health about the importance of
Bureau identifying a staff member
with overall responsibility for
QM/QI system activities.
Ensure that QM/QI duties are
incorporated into the position
description of the identified
position.

5. Activity
Program Area Activity ID Activity Title ( Please write the title of the activity)
(Tick all which apply)
01-PMTCT
02-HVAB
03-HVOP
04-HMBL
05-HMIN
07-CIRC
08-HBHC
09-HTXS
10-HVTB
11-HKID
12-HVCT
13-PDTX
14-PDCS
15-HTXD
16-HLAB
17-HVSI
18-OHSS Strengthening Human Resources for Health

22 October, 2015 Page 9

6. Accomplishments and successes during the reporting period (October 2014 – March
2015)

Result 1: Improved Human Resources for Health Management

Human Resources Management (HRM) in the context of the health sector is the
integrated use of procedures, policies, and practices to plan, recruit, deploy, manage,
motivate, develop and retain health workers in order to meet health sector goals. An
effective human resources for health management system improves availability and
performance of health workers to reduce maternal, neonatal and child morbidity and
mortality; prevent and treat communicable and non-communicable diseases including
malaria, tuberculosis, HIV, AIDS, cardiovascular conditions, and endocrine and mental
disorders.
The Strengthening Human Resources for Health (HRH) Project is working in
partnership with the Federal Ministry of Health (FMOH) and Regional Health Bureaus
(RHBs) to improve HRM at all levels of the health system by improving human resources
leadership and governance structures, increasing the number and technical capacity of
Human Resource (HR) leaders, managers and staff, developing and implementing
contextually appropriate motivation and retention schemes, strengthening HR policies
and practices, enhancing coordination and collaboration among stakeholders who play
key roles in HR development and management, and improving management of staff
training.

IR 1.1: Improved Human Resources Management (HRM) Capacity at Federal, Regional

and Local Levels
Strengthening the capacity of HRM units
Key Interventions – HRM Rapid Capacity
and professionals is critical to improve Assessment Action Plans
planning and management of HRM 1. Strengthen HR structures and staffing
functions in the context of broader health 2. Improve recruitment, orientation and
systems strengthening, which in turn is deployment practices.
critical to achieve health development goals. 3. Enhance performance planning and
In Year one and two, the HRH Project management including Balanced
supported the FMOH, the Food, Medicine Score Card (BSC) systems
and Healthcare Administration & Control 4. Facilitate data-driven decision making
Authority (FMHACA), all RHBs, the Ethiopian
Association of Anesthetists (EAA), and the Ethiopian Midwifery Association (EMwA), to
conduct HRM rapid capacity assessments, and develop and implement action plans
based on assessment findings. During this reporting period, the HRH Project continued
to provide support for implementation of these action plans as highlighted below:

Provide technical support for the implementation of Human Resource Management

(HRM) Capacity Assessment Action Plans.
The use of regular meetings to facilitate follow-up and technical support is an effective
mechanism to enhance the competence of Human Resource (HR) managers and staff

22 October, 2015 Page 10

and sustain good performance. HRH Project staff in Afar, Amhara, Benishangul gumuz,
Dire-Dawa, Harari, Gambella, Oromia, Somali, SNNPR regions conducted follow-up
meetings with HR staff at the Regional Health Bureaus (RHBs) to monitor progress
against human resource capacity assessment action plans (developed in Year One), and
annual HR operational plans. During the meetings, key challenges were identified and
addressed.

In each region, significant improvements were

Improved Human Resource
observed in HR planning, recruitment, selection
Management capacity will enable
regions to plan, develop, attract, and hiring of health professionals and other
support and retain essential healthstaff; HR data collection, personnel file
professionals required to provide organization and management, and
Reproductive, Maternal, Newborn performance appraisal system and practices
and Child Health (RMNCH), have also improved when compared to year
HIV/AIDS, Tuberculosis (TB), Malaria
one of program implementation. In addition,
and other health services in a the visibility of the Human Resources
responsive and equitable manner Development and Administration (HRDA)
Support Process is steadily growing and being
recognized as an important organizational function. Specific examples include:

- In Oromia, HRH Project staff regularly participate in “one-to-five” daily and weekly
staff meetings. The aim of these meetings is to facilitate discussions on HR plans
versus achievements, recognize successes, and identify areas that need
improvement. Successes have included salary adjustments for Health Information
Technicians, as well as ambulance drivers.
- In Benishangul-Gumuz RHB these meetings have now been fully integrated into a
regional initiative (“change army team”), which meets weekly to review
achievements against plans for all health related issues. Having HR related issues as
part of the agenda for these meetings will facilitate sustainability of Project inputs;
- For the first time, a comprehensive HR plan was developed and integrated into
woreda-based health sector plans in Oromia, Amhara and SNNP.
- In Harari, the HRDA unit has shown progressive improvement in the development of
comprehensive annual HR plans that contain numbers and qualifications of health
workers, management and support staff; professional development needs and HR
systems strengthening activities. Their plans are costed and budgets for HRM
activities secured from the government treasury. Resource mapping exercises also
improved partners’ support to HRH. For example, partners working in the region
such as US Center for Disease Control and Prevention (CDC) provided financial
support for staff orientation, supervision and HRM staff training.

Follow-up meetings have also identified ongoing challenges, including gaps in meeting
planned targets to recruit and place staff due to various reasons such as lack of
adequate budgets, regional restrictions on hiring new staff, inconsistent application of
HR policies and procedures at regional and sub-regional levels, and inadequate linkages

22 October, 2015 Page 11

between the Human Resource Development and Administration (HRDA) support
process and other RHB functions.
These challenges call for continued efforts to improve capacity and performance of
the HRDA at the regional level, including advocating for and increasing the HRDA profile
at all levels. Regionally appropriate solutions to overcome challenges were deliberated
with technical support from HRH staff.

Strengthen HR structure, budget and staffing levels at the Federal Ministry of Health
(FMOH), Regional Health Bureaus (RHBs), Zonal and Woreda Health Offices
Well-functioning human resource management systems and practices to attract,
motivate, and retain health professionals depend on the availability of an adequate
number of well qualified HR staff in the health sector. The HRH Project has continued to
provide technical and financial support to RHBs to review existing HR structures, and to
create new HR positions to increase the number of HR staff at all levels. An increased
number of qualified HR staff will improve health workforce planning, recruitment,
selection, orientation, deployment and performance management to ensure availability
of the required number of health professionals who provide RMNCH, HIV/AIDS,
tuberculosis and malaria prevention, care and treatment services. In this reporting
period, the HRH Project provided support to regions – selected accomplishments are
highlighted below:

Region Accomplishment
Amhara Development of an 8-hour shift proposal for 18 hospitals, with the aim of
improving staffing levels. In the past there were two shifts, one with
standard 8 hours (called “a day-time” shift) and another 14-16 hour shift
(“evening time shift”) schedule. This new three 8-hour shift scheme is
aimed at dividing 24 hours of a day into three equal eight hour shifts and
assigning staff on a rotation basis. The new scheme will improve the
quality of health care as health professionals will rest from physical
exhaustion, and be more responsive to the needs/demands of their
patients/clients. As per the proposal, a total of 2,121 new health workers
will be deployed to these hospitals and a total of Birr 44 million
($2,130,750.60) additional salary budget will be allocated.
Tigray Revision of the existing Woreda HR structure for the Western zone - one of
the potential corridors for future economic development in the country
and a high flow of migrant workers. The zone is endemic to malaria,
leishmaniasis and other communicable diseases, and will benefit from
improved HRM capacity to support availability and performance of the
health workforce.
Oromia Recruitment, selection and timely deployment of health professionals who
will manage or facilitate access to health services in the region, including a
Human Resources Information System (HRIS) Officer, a Multidrug
Resistant TB (MDR-TB) program Technical Advisor, a TB/Leprosy-HIV

22 October, 2015 Page 12

 Program advisor, a Biomedical Engineer, and a Senior Monitoring and
Evaluation Expert for a Water, Sanitation and Hygiene (WASH) project
being implemented in the region.
Approval for the deployment of 1,310 midwives, based on existing health
center staffing needs
Many special Town Health Offices (THOs)1 requested for an increase in
existing positions to cope with increased health service demand. The RHB
established a team to review the existing structure at these Offices; and
with technical inputs from the HRH Project, a revised structure with
additional positions was developed and submitted for approval. These
positions, which will be permanent and fully financed by the government,
include HR process owner, health facility support and reform process
owner, maternal and child health expert, communicable disease
prevention and control expert, regulatory service expert, and emergency
medical technician.
Somali Technical support provided to the RHB in organizing and conducting a
meeting with WoHO heads in Fafan Zone to discuss the redistribution of
health workers who are highly concentrated (for example, 18 midwives in
a single health center) in Jijiga and the surrounding zones and towns, to
health facilities with critical shortage. Agreement was reached on the
importance and significance of health worker redeployment and
relocation. The redistribution is underway.

Provide ongoing technical support to the FMOH and RHBs to fill newly created/vacant
HR positions at all levels (at least 55% of 1100 positions created in Year 2)
HRH Project staff provided technical assistance to RHBs in filling vacant HR positions,
including working with the RHB’s HR staff to advocate for budgets, revising job
descriptions, preparing and posting vacancy announcements, shortlisting and selecting
suitable candidates, and facilitating orientation of newly hired staff, thus transferring
skills and capacity to the RHB staff.
These newly hired HR staff are expected to support recruitment of health workers,
facilitate timely employee compensation payments, facilitate educational opportunities
for health workers, support employee performance appraisals, and handle job-related
grievances, amongst other activities, which will result in improved service delivery and
health outcomes. 9 regions were supported to fill a total of 277 HR positions as below in
Table 1. In summary, a total of 890 positions out of 1100 approved in Year 2 (80.9%)
have been filled to date.

1
These are self-governing town structures in various regions in the country. These towns include all towns selected by the Regional
Councils except Addis Ababa and Dire Dawa, who are already under the government administration. Depending on the size, these
Towns Administration have Zonal or Woreda status. For the health sector, they are named as Town Health Offices. Unlike WoHOs,
they report directly to the RHBs. This status makes them different from WoHOs.

22 October, 2015 Page 13

 Table 1: HR Positions Filled, 0ct 2014 – Sep 2015
Region HR Positions Filled
Afar 24
Addis Ababa 35
Amhara 28
Beninshangul-gumuz 75
Gambella 1
Harari 3
Oromia 104
Somali 3
SNNPR 4
Total 277

In addition to recruitment of HR staff, the HRH Project provided technical support for
the recruitment and deployment of the following health service providers, resulting in
increased access to RMNCH, HIV/AIDS, Malaria, Tuberculosis and other services. The
technical support for this particular activity included identifying vacant positions in
health facilities and matching the positions with the existing supply of the health
professionals and available budget. HRH Project staff worked closely with the RHBs’ HR
staff to build their capacity to undertake similar activities on their own to ensure
sustainability of such practices long after the HRH Project ends.

Table 2: Health Provider Positions Filled, Oct 2014 – Sep 2015

Region Health Provider Remarks
Positions Filled
. Amhara 434 Includes medical doctors, health
Beninshangul-gumuz 74 officers, nurses, midwives,
Dire Dawa 29 laboratory technicians, health
Gambella 108 information technicians,
Harari 20 emergency ambulance
Oromia 1651 technicians, nurses, and
Somali 328 administration staff.
SNNP 710
Tigray 399
Total 3753

Improve HR planning & budgeting capacity at RHB, Zonal and Woreda level
The HRH Project provided ongoing technical support to RHBs to improve planning and
budgeting capacity at all levels. The following support was provided during the reporting
period:
 At the FMOH, HRH Project staff supported the development of an HR Core Plan for
EFY 2008 (2015/2016) by identifying key HRH areas that the FMOH and RHBs should

22 October, 2015 Page 14

 include into their annual plans. This plan was shared with the RHBs and HRH
implementing partners during the Third National HRH Forum Meeting. It is expected
that the FMOH, RHBs and implementing partners will develop their plans based on
this core plan.
 In Gambela, Oromia and Somali the HRH Project provided technical support to the
RHBs for the preparation of a Five Year Health Sector Growth and Transformation
Plan. Core HR indicators were included from the national level and additional region
specific indicators were incorporated.
 In Benishangul-Gumuz, in addition to developing the EFY 2008 (2015/2016) plan,
HRH Project staff facilitated the development of a five-year Balanced Score Card
(BSC) implementation plan to improve the existing performance management
system. As a result of ongoing advocacy and negotiation, the RHB allocated 2 million
Birr ($100,000) for the non-salary recurrent HR budget, which will support training
of health workers, (including HRIS, HRM refresher and BSC training), and running
costs (stationery, transportation, etc.)

Support the FMOH to initiate the process of conducting a National Human Resource
Information System (HRIS) Rapid Assessment
A stakeholder meeting was organized by the FMOH to discuss HRIS related
recommendations from the experience sharing visit to Uganda which was supported by
the HRH Project in the previous project year. Participants, who included representatives
from USAID, CDC, Tulane University, the HRH Project and IntraHealth International,
discussed the lessons learned, and agreed upon the need for a rapid HRIS assessment.
The FMOH then revitalized an HRIS technical working group (which includes the HRH
Project) to lead the HRIS assessment. A series of meetings were held in the first quarter,
and a concept paper and scope of work for the assessment was developed, reviewed
and finalized. In subsequent discussions, the FMOH decided to cancel this activity.

Provide ongoing technical support to reinforce and facilitate HR data use for decision
making
The HRH Project has been providing ongoing technical support to RHBs to improve HR
data collection, analysis, reporting and local decision-making. Selected achievements in
the regions are summarized as follows:
 In Somali, HR data from all health facilities were entered into the HRIS software
and analyzed, resulting in the finding that there was uneven distribution of
health workers. Using this data, the RHB held discussions with WoHO and facility
heads and agreed to re-assign workers as per the health facility minimum
standards, which will result in more equitable access to critical health services.
The RHB decided to redeploy 12 Midwives and 19 Clinical Nurses from one
health center to 11 health centers. This has improved health professionals’
distribution and access to health services to the rural communities.
In quarter four, technical support was provided for HR data collection,
entry and updating from all 149 health centers and 7 Hospitals. The total number
of the health workforce in the region was 5,557 including 709 midwives, 9

22 October, 2015 Page 15

 Anesthetists, 1,972 HEWs, 253 Medical Laboratory Technicians, 5 Biomedical
technicians and 2,609 other health workers (Clinical & non-clinical).
 In Tigray, HR data was collected from both public and private health facilities in
the region. A total of 9732 health workers are currently providing health services
in the region (89.5% in the public sector and 10.5% in private health facilities).
The data indicated that the number of nursing and pharmacy personnel is higher
than the standards, while the number of physicians is below the recommended
standards. This information can be used by the region to determine and plan for
the health workforce staffing and ensure that the distribution meets the
population needs.
 With the aim of documenting the existing health workforce in Amhara region,
HRH Project staff supported the preparation of a regional HR profile in quarter
four (see attached), including size, composition, professional categories and
geographical distribution. There were a total of 37,144 health workers in the
region, including administrative staff, serving a population of 20,516,547. The
profile was used during annual and strategic HRH planning and forecasting
exercises.
 In Addis Ababa, HRIS database training was provided to 125 HR personnel from
all health facilities and health offices in collaboration with Tulane University.

Provide ongoing technical support to RHBs to organize Personnel files

Well organized personnel files are critical to document administrative records such as
promotions, transfers, salary increments, training and professional development
opportunities received by staff, performance appraisals etc. Having this information
easily available improves management of health workers, which in turn can improve
employee job satisfaction and enhance performance and quality of health services. In
the reporting period, HRH Project staff worked with RHBs to improve personnel file
management practices, including:
- The HRH Project provided shelves and filling cabinets to Addis Ababa, Benishangul-
Gumuz, Dire-Dawa, and Tigray regions.
- In Amhara, all personnel files in 17 existing Hospitals were organized and a standard
labeling system was developed to improve overall filing system. This practice by the
hospital’s HR units is being scaled up to other units in the hospitals.
- In Tigray, 393 employees’ files were organized using a checklist developed by the
HRH Project and approved by the RHB, with the aim of facilitating easier
management and retrieval of files. In Afar, Amhara, Oromia and Somali, similar
support was provided to organize files.

Improve performance management systems and practices – support RHBs to review

and update Job Descriptions
The Ethiopian Civil Service Performance Management Guideline stipulates semi-annual
performance appraisals. However, understanding of the performance management
system varies among the regions, resulting in inconsistent application of the policy
guidelines. The lack of individual job descriptions (JDs) and/or the fact that copies of the

22 October, 2015 Page 16

existing JDs are not provided to the employees is another major challenge to improving
performance management systems.
In this reporting period, the HRH Project continued to provide technical and
financial support to all regions to develop/update JDs for health workers, provide copies
to the staff, and orient staff on their respective roles.
Approximately half of all staff working in Benishangul-Gumuz RHB received copies
of their JDs. In Amhara, JDs were revised, signed, and given to all (20) HR staff in the
RHB and a copy of each JD was kept in their respective personnel files. HRM best
practices were also shared with 5 hospitals supervised in the quarter with the aim of
strengthening HRM in the hospitals to improve health workers motivation and
performance. In Oromia, 486 HR staff (27 RHB, 48 ZHDs and 411 WoHO) received their
respective JDs.
JDs were also updated for eight job positions in Dire-Dawa RHB. However, copies
were not given to the staff due to the direction given from Regional Bureau of Civil
Service that restricts distributing copies to staff. Similar restrictions are in place for the
SNNP Regional Health Bureau and the HRH Project is working with the regional civil
service bureaus to revise the policies that prohibit distributing the copies of JDs to staff.

Provide technical and financial support to RHBs to conduct training on the Balanced
Score Card (BSC) system, to reinforce implementation of the system.
Balanced Score Card is a strategic planning and management system used to align
business activities to the vision and strategy of the organization and to monitor
organizational performance against strategic goals. One of the elements of
implementing the system includes using it as a means for joint planning, performance
measurement and improvement in which staff and supervisors work together to
improve performance.
The Balanced Score Card (BSC) performance planning and management tool was
adopted by the FMOH and has been in use for the last 4-5 years. However, the pace and
quality of its implementation has been a challenge due to lack of understanding of the
process. In this reporting period, the HRH Project provided financial and technical
support to regions to help with implementation of the BSC system by providing training
as below in Table 3:

Table 3: BSC Training Provided, Oct 2014 – Sep 2015

Region Number Trained
Dire Dawa 30
Amhara 39
SNNP 44
Harari 36
Addis Ababa 30
Total 179

In addition to the training, a team of HR and health services experts from Afar (5) and

22 October, 2015 Page 17

Somali (6) RHBs and Civil Service Bureaus visited the Oromia region with support from
the Project. Similarly, experts from Gambella (4) and Beninshangul-gumuz (5) visited
the SNNP region. For the both teams, the experience sharing visits focused on
implementation of the BSC system, including visits to the RHBs, civil service bureaus,
and hospitals. The participants learned about the requirements for effective
implementation of the system, and observed that in the hospitals, professionals were
providing better quality RMNCH, HIV/AIDS, TB, Malaria and other services through
applying the BSC principles of “one-stop-shopping”(i.e. streamlined service delivery
through regularly reviewed and improved workflow) that reduces missed opportunities
and increases service utilization by the clients. At the end of the visits, the participants
agreed to share reports to the RHB leadership and develop BSC strategy and
implementation plan for their respective regions.

Review and update the existing Integrated Supportive Supervision checklist (to
include new HRH- related indicators) and conduct quarterly supportive supervision
Checklists to guide supportive supervision of HR activities by the FMOH were developed
in Year 2, and later adapted by the RHBs. In regions where Integrated Supportive
Supervision (ISS) is regularly practiced, HR checklists were fully integrated into the
existing ISS checklists. As programmatic and HR priorities may change over a course of
the year, it is important to check the
Supportive supervision (guided validity/sensitivity of existing checklists to monitor
by well-designed checklists) current HR activities at various levels of health
can provide coaching, guidance systems. Thus, existing ISS checklists (HR sections)
and motivation for staff, need to be reviewed and updated as needed
resulting in better before quarterly supervision takes place.
performance, and ultimately In the second quarter, the HRH Project
better provision of health supported the FMOH HR Directorate staff and
services. Tigray RHB to review and update the checklists by
adding items to strengthen tracking of HRIS.

Provided technical support to the Amhara Region HIV/AIDS Prevention and Control
Coordination Office (HAPCO), for the World AIDS Day Celebration
To increase the awareness of the community on HIV/AIDS prevention and control, the
Amhara regional HAPCO office celebrates World AIDS annually. In the first quarter, the
HRH Project provided technical support for organizing the meeting (action plan
development, identification of potential partners, resource mobilization, topic selection
for panel discussion, etc.). The day was celebrated with panel discussions and other
social mobilization activities in Bahir Dar City.

IR 1.2: Improved HRH Motivation and Retention Schemes according to the country
context
Motivation, along with competency and resources, is a prerequisite for a high
performing health workforce. However, low staff motivation and turnover continue to
be key health workforce challenges in Ethiopia. The HRH Project is working closely with

22 October, 2015 Page 18

the FMOH and RHBs to improve motivation and retention schemes.

Finalize and disseminate Retention Study findings

Global evidence suggests that the way health care providers are managed, motivated
and supported is not only central to the quality of health services that they provide, but
also enhances job satisfaction, retention and productivity. In the second year of
program implementation, the HRH Project conducted a national retention study to
inform a range of recommendations and options for effective health workforce
motivation and retention strategies at national, regional and local levels. In this year,
major findings from the Retention Study were disseminated to key stakeholders during
the Third National HRH Forum held from 31 May- 1 June 2015. FMOH and RHBs agreed
to start implementation of Work Climate Improvement recommendations based on the
study findings and recommendations. Subsequently, RHBs shared the key findings with
their respective senior management teams in preparation to start implementing the
recommendations presented during the National HRH Forum.

Develop a concept paper for a Work Climate Improvement Program

A conducive work environment is essential for effective delivery of health services.
Conversely, a poor work climate is a source of low morale, poor job satisfaction,
unsatisfactory health-worker performance and low productivity. In Year 2, the HRH
Project supported all RHBs and the FMOH to conduct employee job satisfaction surveys
and exit interviews. Ideally, the data generated by these surveys should be analyzed and
used to design and implement small-scale pilot interventions to strengthen health
worker satisfaction and facility environment (work climate) and contribute to
performance improvement.
The HRH Project drafted a concept paper for a work climate improvement
program, which was approved by the FMOH for piloting. The concept paper was based
on findings from employees’ job satisfaction surveys at national and regional levels,
preliminary findings from the Retention Study and desk review of international
literature. A two-day consultative meeting on work climate improvement was held with
24 participants from the DHRDA and 7 other directorates, where work climate concepts
and practices of organizational changes (reforms) to create conducive work climate
were discussed at length. A task team led by the DHRDA was identified to follow up the
implementation of proposed actions.

Provide Technical and financial support to the FMOH and RHBs to design and
implement contextually appropriate motivation and retention schemes
Continuing professional development is important not only to improve health worker
competence but also to increase motivation to perform better. In Oromia, the RHB
management team decided to recognize best performing staff with opportunities for
further education. The HRH Project provided technical support to the RHB to prepare
the implementation guideline which will support the implementation of the reward
scheme throughout the region. Accordingly, a total of 124 health professionals were
selected and offered educational opportunities at Haromaya and Arsi Universities

22 October, 2015 Page 19

through summer programs. In addition, 100 best achievers with the qualification of
Diploma Midwifery were selected to join Bachelor’s degree program with financial
support from HRH Project (tuition fee payment).

Provide ongoing support to the FMOH and RHBs to document, analyze and act upon
staff exit interview findings
Exit interviews are intended to document factors affecting health workforce stability
and attrition. In this reporting period, all regions routinely conducted staff exit
interviews, and findings are expected to generate additional evidence that RHBs can
utilize in designing and implementing staff retention for better health system
performance. Examples of findings include:
 In the first quarter, staff exit interviews were conducted in Afar and Dire-Dawa
regions. A total of 34 employees (22 from Afar and 12 from Dire-Dawa regions)
resigned in the quarter. Information received from the interviews was combined
with other feedback received from outgoing employees, analyzed and presented
to RHB senior management teams to help them understand and act upon the
factors affecting health workforce job satisfaction, motivation and retention, and
improve the work place in their respective organizations.
 In the second quarter, a total of 53 employees (16 from Oromia, 3 from Amhara,
4 from Harari, 22 from Afar and 8 from Gambella regions) resigned and
completed exit interviews.
 In the fourth quarter, staff exit interviews were conducted in Oromia, Somali,
Gambela and Tigray. A total of 113 employees (60 from Oromia, 40 from Somali,
3 from Gambela and 10 from Tigray) resigned. Information received from the
interviews was combined with other feedback received from outgoing
employees, analyzed and presented to RHB senior management teams.
 In Amhara, a focal person was assigned to gather information using the exit
interview tool. The HRM Officer seconded to the RHB by the HRH Project
coached and supported the focal person to analyze data collected from July 1,
2014 to June 2015. Accordingly, a total of 1,771 health workers: 142 Midwives,
180 HEWs, 13 anesthetists and 1,436 other Clinical & non-clinical health workers
resigned. Three key reasons for resignation included opportunities for further
education, better working environment and better income. The RHB has included
appropriate measures into its plan to take actions in the coming year to alleviate
the situation. Such actions include identifying resources to create opportunities
for education and professional development as well as improving the work
climate for the health workforce.

Technical support to Oromia RHB to develop a health professional incentive package

The FMOH developed a health professionals’ incentive package to improve health
workforce motivation, retention and performance. The incentive package includes
allowances for duty, acting, transport, housing and professional risk/hazard. In Oromia,
there were challenges faced with implementing the incentive package, which led the
RHB to establish a team of experts (including HRH project staff), who were tasked with

22 October, 2015 Page 20

reviewing and examining the challenges and adapting the package into the regional
context for better implementation. Efforts by the team resulted in an implementation
guideline to clarify and inform implementation of the packages at ZHD, Woreda and
town health offices. The guideline was endorsed by the Oromia Regional Cabinet and
implementation of incentive packages started. It is expected that this will have a
significant effect on health worker motivation and retention.

Support Oromia RHB to effect a salary adjustment scheme for professionals working
at the Senior Management level
In July 2014, the government made adjustments to the salary of all civil servants and a
special merit-based salary adjustment was provided to health professionals. However,
there were issues that required clarification, given the need to make salary adjustments
for staff at senior management levels in Oromia RHB and sub-regional levels. The
Oromia RHB organized a team of experts to generate ideas to address staff complaints
related to the management structure. The RHB then negotiated with the Regional Civil
Service and Good Governance Bureau, resulting in a salary adjustment for staff at senior
management positions at the regional and sub-regional levels. HRH Project staff served
as core members of the team and provided technical advice and direction during the
negotiations.

Provide technical assistance to RHB HR Support Processes for the implementation of

the 5s-Kaizen-total quality management (TQM) process
One of the scientifically accepted tools used to improve the work environment and
processes is the 5s-KAIZEN-TQM. In response to a need identified in Amhara RHB, the
HRH Project has been providing financial and technical support for the implementation
of this quality management process. HRH project staff worked closely with the RHB’s
HRM unit to create a better working space and a clean environment, including changing
the office set-up and filing systems to increase motivation of HR staff and their
efficiency at work by reducing time spent on searching for files.
43 participants (office management staff at the RHB and HRM coordinators in
hospitals) also received 5s-KAIZEN-TQM training with technical and financial support
from the HRH Project.
In the third quarter, training on this approach was provided for 133 participants
from Amhara, Oromia, Tigray and Addis Ababa Regions. In the fourth quarter, in
Oromia, a facilitation committee of 5 members from the HRDM Work Process (including
the 2 HRH Project staff seconded to the RHB) was established. This committee is actively
involved in 5s-KAIZED-TQM startup activities including collecting and documenting
baseline data, identifying areas for future interventions, finding mechanisms to involve
all HR staff in the process, etc.

Motivation and Retention Festival - Amhara

The second motivation and retention regional festival was conducted in Amhara in
collaboration with the HRH Project and other stakeholders on August 21, 2015. Health
workers, health managers and support staff selected by the RHB based on transparent

22 October, 2015 Page 21

criteria, and Health organizations including ZHDs, Hospitals and Health Centers were
recognized and rewarded based on their performance. A total of 264 individuals, and 55
health facilities were recognized.

IR 1.3: Improved Human Resources for Health Policies and Practices

Addressing the complex challenges of HRH requires putting in place comprehensive HRH
policies and plans and implementing them consistently. The HRH Project continues to
provide support to strengthen availability and use of HR policies and procedures at
various levels of health system.

Support the FMoH and other key implementing partners to update, finalize and
disseminate the national HRH strategic plan
His Excellency Dr. Keseteberhan Admassu (Minister of Health) and His Excellency Dr.
Amir Amane (State Minister of Health) reviewed and gave comments on the draft
National HRH Strategic Plan. The plan was then reviewed and updated based on their
comments and a final draft was submitted to the Director of the FMOH HRDA
Directorate (attached). The HRH strategic plan will guide HR development and
management strategies and actions in the country for the coming decade.

Provide technical and financial support to RHBs to adapt/develop and implement

regional HRH Operational Plans based on National HRH Strategic Plan.
The Tigray RHB established a Technical Working Group (TWG) comprised of experts
from the RHB, the HRH Project, Mekelle University’s School of Public Health, Regional
Civil Service Bureau and Health Science Colleges to develop a 5-year regional human
resource for health strategic plan based on the draft National HRH Strategic plan. The
HRH Project provided financial support and facilitated a workshop to develop the draft
HRH Strategic Plan, which is currently under review by the RHB management. Once
finalized, the regional HRH operational plan will guide and facilitate stronger and well-
coordinated health workforce planning, implementation and evaluation at the regional
level, which will contribute to the achievement of national HRH and service delivery
targets.

Improve access to and compliance with HR Policies and procedures

There are various civil service proclamations, HR guidelines and standard operational
procedures formulated by the Federal Ministry of Civil Service and regional bureaus of
civil service. The health sector is expected to implement these policy documents and
guidelines for day-to-day human resource management functions. However, these
policy documents are not easily available and accessible to HR managers and officers. In
Year 2, the HRH Project worked closely with the RHBs to identify appropriate
documents, and collect, print/photocopy, bind, and distribute these documents. The
effort created access to the policy documents at RHBs. In Year 3, the following ongoing
support was provided:

22 October, 2015 Page 22

 Table 4: HR Policies and Procedures distributed in regions
Region Copies Comments
Dire Dawa 50 distributed to staff working at the RHB,
Woreda and health facilities
Amhara 327 Distributed to RHB work processes and ZHDs
and health facilities
Afar 28 Distributed to woreda health offices
Beninshangul- 40
gumuz
Somali 82 Distributed to RHBs, 9 zonal and 72 WoHOs

Provide ongoing technical and financial support to develop and distribute leaflets and
newsletters on HR topics to improve HRM knowledge among staff
The HRH Project is supporting RHBs to improve their staff knowledge about the existing
civil servant policy documents. In the first quarter, Benishangul-Gumuz RHB developed
and distributed a quarterly HR newsletter focusing on paid leave utilization, discipline
and grievance handling procedures, to 26 health centers and newly hired district health
office HRM officers. In Dire Dawa, a leaflet focused on employee transfers (explains
briefly about the existing transfer policy and procedures and its application) was also
developed and distributed at the RHB.
In the second quarter Harari and Amhara RHBs developed a quarterly HR
newsletter focusing on discipline and grievance handling procedures and recruitment
and selection respectively. Leaflets were also developed in Tigray, Afar and Dire-Dawa
regions with thematic areas of discipline and grievance handling procedures, selection
and recruitment, the importance of orientation for newly hired staffs and staff transfer
policy.
In the third quarter, the HRH Project provided technical and financial support to
Afar, Benishangul-Gumuz, and Dire-Dawa regions to develop leaflets on training &
development guidelines, types of leave, and discipline handling mechanisms. A total of
560 copies of the leaflets were distributed to 10 health centers and 7 WorHOs in
Benishangul-Gumuz region. In the fourth quarter, Afar RHB translated a leaflet on
employee orientation and induction, and in SNNP, a flyer on the HRH profile in the
public health sector and key HRM procedures was prepared and submitted to the RHB
for review and comment

Provide orientation to HR staff to improve utilization of Regional HR Policy

documents.
In the second quarter, a 3-day training on Civil Service Proclamations, Regulations and
Directives was provided to 34 HR staff at the FMOH. Participants included HR managers
and HR officers from the FMOH, FMOH Agencies (FMHACA and the Ethiopian Public
Health Institute) and Federal Ministry Hospitals (ALERT, St. Peters TB Specialized
Hospital, and St. Paul Hospital). This will improve understanding of HR staff and proper
application of the policy in health workforce planning, development, deployment and
administration.

22 October, 2015 Page 23

 In the third quarter, in Harari, during supportive supervision, health facilities
expressed the need to receive trainings on specific HRM policies and procedures (e.g.
Harari Regional Government Civil Servant Proclamation No. 34/1996, Harari Regional
Government Disciplinary and Grievance Policy Guide No 18/1999, etc). With continuous
support from the HRH Project staff, the regional HR Support Process secured a budget
and prepared comprehensive training material.

Provide financial resources for printing and dissemination of orientation manuals

(employee Hand books) at regional levels
A generic Employee Handbook (also called Employees Orientation Manual) was
developed at national level for use by the FMOH. In Year 2, this generic document was
reviewed and adapted by each RHB to reflect the regional contexts. In this reporting
period, technical and financial support was provided to the following regions to orient
new staff using the handbook (see table 5 below) Ensuring that new employees are well
oriented prepares them to quickly integrate into their work environment, and improves
motivation and performance of the new employee.

Table 5: Orientation of new staff using employee handbooks

Region Staff Remarks
Oriented
Gambella 108
Amhara 63 Including 25 midwives & 25 general practioners
Harari 20 8 clinical nurses, 6 emergency medical technicians, 4
ambulance drivers, 2 laboratory technicians
Beninshangul- 60 Handbook distributed to 21 WoHOs and 35 health
gumuz centers
Somali 428
Oromia 19
Total 698

Provide technical and financial support to the Food, Medicine and Healthcare
Administration and Control Authority (FMHACA)

Support FMHACA to improve strategic planning and budgeting capacity

In the third quarter, the HRH Project provided
Regulating the competency and
technical support to the FMHACA to identify
ethical conduct of health
relevant strategies and initiatives for
professionals could contribute
Ethiopia’s five year’s regulatory sector
towards decreasing medical errors
transformation plan. A synthesis of global
arising during provision of RMNCH
research findings on regulatory practices in
services, and safeguard the
ten countries was developed and shared with
population from consequences of
FMHACA, and additional inputs related to the
unethical maternal and neonatal
design of strategies and an implementation
health care practices.
mechanism were provided. During the

22 October, 2015 Page 24

development of the plan, the HRH Project ensured that women and child health issues
were considered.

Scope of Practice
A legal framework defining scope of practice of health professionals is an important
regulatory mechanism to ensure public safety by delineating the limits of what a given
cadre is qualified to do. The HRH Project supported the development and updating of
Scopes of Practice for 26 professional categories in year two. In this reporting period,
the final version of the scope of practice directive was submitted to the management
council of FMHACA for signature and approval. The approved document will be a
national legal reference for delineating the scope of practice of health professionals for
public/client protection and regulatory function.
The HRH Project also supported FMHACA during the review of disputes on the
scope of practice for four cadres – radiology, radiography, nursing and midwifery. The
disputes were brought to the attention of the national CPD committee, which includes
the HRH Project, and the committee reviewed the curricula or graduate profiles for
these cadres and reviewed the scopes of practice accordingly. The revised documents
have been submitted to FMHACA leadership for endorsement through the Customer
Services Directorate.

Support FMHACA to roll out the scope of practice and ethics policies to the regional
level.
The HRH Project provided financial and technical support for the conduct of a workshop
to advocate for both the health professionals Scope of Practice (SOP) and the Facility
Competency and Ethics Review policy. Over forty participants attended the workshop
including representatives from national and regional FMHACA offices, RHBs and
Professional Associations. During the workshop, reports on the magnitude of medical
errors showed that most of the errors were related to maternal and newborn health
and associated with surgical interventions. Participants also provided inputs to further
strengthen the national directive on ethics, which were subsequently incorporated and
submitted to leadership at FMHACA for approval.
In SNNPR, the HRH Project collaborated with the RHB and the SNNP Health
Related Services and Products Quality Control Authority to conduct a one-day
consultative workshop to review the national health workers ethics committee
guideline and to contextualize it to the SNNP region. Participants discussed the need for
establishing a regional health worker ethics review committee in order to safeguard the
public from unethical behaviors/practices and the health workers from unwarranted
client reactions and negative consequences. At the conclusion of the meeting, it was
agreed that a working group will adopt the national guideline to the regional context.

Health professionals’ competence and ethics review system

Health professionals’ fitness to practice in terms of ethics and competence is a critical
issue that requires regulation. In the first quarter, a draft ethics and competence
committee directive was developed by the medico-legal department of FMHACA, and a

22 October, 2015 Page 25

workshop was organized to review the draft directive. Representatives from the
medico-legal department of FMHACA, Addis Ababa and Oromia regional regulatory
bodies, professional associations and the HRH Project participated in the workshop and
developed a final model ethics committee directive. Furthermore this model directive
will be used as a reference by regional regulatory bodies to develop their own ethics
committee directives.
In the second quarter, the HRH project provided technical and financial support
to organize a forum involving all regional regulatory bodies, with the purpose of
reviewing the draft directive and customizing it to the regional context. All regions
(except Benishangul Gumuz) were represented, and participants developed action plans
focused on customizing the directive. They also developed plans to nominate regional
committees who will be charged with ethical reviews.

Strengthen health professionals’ registration and licensure system

The registration and licensure system both at the federal and regional levels faces
challenges with keeping records of health professionals. In response to this identified
need, the HRH Project procured and distributed sliding shelves which will help the files
to be stored in a more organized way and retrieval more efficient. The shelves were
distributed to the federal FMHACA office, Addis Ababa FMHACA and the Oromia
regulatory body in the first quarter.

Support the FMOH to revise the National Health Policy

Upon request from the FMOH, in the second quarter the HRH project contributed to
revision of the national health policy. The HRH Project staff served in the national
steering committee and led the revision of the HRH section. Although draft, the revised
health policy comprehensively addresses strategic HRH issues including evidence-based
HRH planning, quality pre-service education, need-based and managed Continuing
Professional Development (CPD)/in-service training, effective and efficient HRH
regulation, and improved HRH leadership and management. Once finalized and
approved, it is expected that the updated policy will facilitate political commitment to
avail adequate, competent and motivated HRH for the strengthening of the health
system to address priority health problems such as RMNCH, HIV/AIDS, TB, and Malaria.

Support the FMOH to develop a National e-Health Strategy Document

A preliminary situational review indicates that e-Health initiatives in Ethiopia are
characterized as fragmented, with duplication of efforts, inadequate information,
communication technology (ICT) infrastructure and insufficient enabling environments
such as e-health standards. The FMOH is developing a national e-Health strategy to
coordinate and streamline the various initiatives underway in the health sector as well
as to guide sustainable e-Health implementation.
In the second quarter, the HRH project provided technical support for the
development of the draft strategy, which will be aligned with the Health Sector
Transformation Plan (HSTP). The draft strategy considers implementation of national e-
Health systems (electronic Health Management Information System, Electronic Health

22 October, 2015 Page 26

Records; Mobile Health (m-Health), Tele-education and Telemedicine); access to health
information and knowledge-sharing, planning and decision making; and health system
capacity building in terms of creating an enabling e-Health environment (human
resource, legal framework, privacy and compliance and funding);

1.4 Enhanced Human Resources for Health Forums at Federal and Regional Levels
HRH challenges are numerous and require multiple actors and multifaceted approaches.
The HRH Project supported the Federal Ministry of Health to establish and maintain
multi-sectoral national and regional HRH forums to strengthen coordination,
collaboration, partnership and accountability among different stakeholders.

National HRH Forum Conducted

The third National HRH Forum was conducted from May 31- June 1, 2015 with technical
and financial support from HRH Project. The meeting was opened by H.E. Dr. Amir
Amane, State Minister for FMOH, and attended by representatives from all RHBs
(except Tigray), FMOH, TVET Agency and Implementing partners. Key agenda items
included follow up on the action plans developed by the FMoH, RHBs and implementing
partners during the previous forum, and a presentation and discussion on the National
Health Workforce Motivation and Retention Study. The FMOH also presented the Core
HRH Plan for EFY 2008 (2015/2016) that consists of priorities, new initiatives and
emerging challenges. The forum participants discussed and shared responsibilities to
support various components of the Core HRH plan as well as agreed strategies to
overcome the anticipated challenges.

Provide technical and financial support to strengthen existing HRH forums through
regular meetings
During the reporting period, regular HRH forum meetings were held at Benishangul-
Gumuz, Afar, Gambella, SNNP and Dire-Dawa, Oromia, Tigray, Amhara and Somali
regions, with financial and technical support from the HRH Project. The forums brought
together stakeholders to create synergy and deliberate collective solutions for HRH
challenges. Selected highlights from these forums include:
- Alignment of work plans and identifying priorities for synergy among HRH partners.
For example, the HRH Project aligned its plan for improving quality of medical
education and institutionalization and standardization of in-service training with
ICAP (Columbia University) and MEPI (Medical Education Partnership Initiative). The
collaboration matrix was submitted to the Human Resource Development and
Administration Directorate of the Ministry of Health.
- In Benishangul-Gumuz region, partner achievements related to HRH were reviewed
and promising achievements discussed. For example, in the past, the RHB could not
determine how many health professionals had taken the Certificate of Competence
(COC) examination and how many of them passed or failed. Now the RHB has
adequate data about the COC exam which has helped them to plan adequately.
- In Tigray, meeting participants agreed to develop guidelines and checklists to
improve health professional ethics in the region, and assigned three training

22 October, 2015 Page 27

 institutions/hospitals (Adigrat, Mekelle and Axum) to develop ethical criteria on
professional dress codes, self-identification, personal hygiene and the use of
mobile phones;
- The HRH project also continued to participate in regular HRH Technical Working
Group meetings at the FMOH, where priority HRH issues were discussed. This
included discussions related to planning a national HRIS assessment, as well as
planning for the first African HRH Forum held in Addis Ababa.

Preparation for and Participation in the Africa HRH Meeting

The HRH Project served as members of a technical working group, led by the FMOH,
which was tasked with preparations for a high level ministerial meeting on HRH, which
took place following the 3rd international conference on financing for development. The
HRH Project contributed to developing the concept note and agenda for the meeting,
participated in planning discussions, and attended the meeting, which was held on 17
July 2015. The meeting resulted in a call to all Africa member states to:
Substantially increase domestic financing for recruitment, development, training
and retention of the health workforce as per target 3.c of the Sustainable
Development Goals, and as a catalyst to achieve other goals and targets on
education, employment, gender equality and poverty
Support and optimize the capacity of the existing workforce to improve
performance and productivity, including at community level.
Invest in national community health care services with relevant resources
including domestic resources to enhance equity in access and to achieve
universal health coverage
Encourage South-South learning collaboration for human resource development,
including the establishment of Africa regional training centres with toolkits for
human resources for health development, capacity building and knowledge
management
Commit to work collaboratively within governments to create national fiscal
space for investing in human resources for health for sustainable development.

IR 1.5 Improve Management of Staff Training for HRM professionals at FMOH, RHBs,
Woredas and Zones
In-service training in HRM as well as various other professional development activities is
essential for improved skills and capacity of HR leaders, managers and staff. The HRH
Project continued to provide support to ensure that in-service trainings are addressing
the health sector priorities and staff development needs, are need-based, well planned,
coordinated and monitored for impact.

In-Service Training Needs Assessment

A health workers in-service training (IST) needs assessment was conducted in Addis
Ababa and Dire-Dawa, and findings used to develop a comprehensive staff training
plan, which was incorporated into the HRDA annual plan for EFY 2008 (2015/2016). In
SNNPR, the RHB HRM support process with technical support from the HRH Project,

22 October, 2015 Page 28

selected 4 General practitioners for medical specialty trainings, 25 candidates for
training in Biomedical technician level IV, and 13 Health workers (from different Health
Science Categories) for training in field epidemiology. The region is also working to
harmonize and align IST for health workers with government and implementing partner
plans, and to implement the trainings at regional IST centers.

Advocate during HRH and health sectors stakeholder forums to institutionalize and
standardize In Service Training (IST)
The National IST Guideline and Directives were presented during regional HRH forum
meetings in Afar and Dire-Dawa RHBs. An assessment to identify potential centers for
IST was conducted in Gambella region using IST assessment tools, and Gambella
Hospital was identified as a potential IST center to replace the Gambella Regional Health
Science College which had been selected previously.

Roll Out HRM training at National and Regional levels

Building the capacity of HR leaders and managers on HR functions at all levels is vital for
promoting professionalism in human resource management, and improving availability
and performance of health professionals. A five-day HRM in-service roll out training was
provided for 898 participants during the reporting period, including HR managers and
staff from the FMOH, FMOH agencies and hospitals, RHBs, regional hospitals, Regional
Health Science Colleges, Regional Civil Service Bureaus, zonal health departments,
WoHOs and Health Centers.
The training was guided by a standardized HRH Management In-service training
curriculum developed with support from the HRH project and approved by the FMoH.
The Standardized curriculum contains 8 modules: Global and National HRH Context,
HRM Policies and Practices, HR Planning and Staffing, Performance Management,
Motivation and Retention, HRIS and Data Driven Decision-Making, and Leadership,
Governance and Management. At the end of each training, action plans were
developed.

Finalize, print and disseminate a guideline and checklists for post HRM training follow
up, mentorship and on-the-job support. Identify and select HRM mentors in Afar and
Beninsghangul-gumuz.
To institutionalize the process of providing routine HRM post training follow-up,
mentorship, and on-the-job support, in this quarter the HRH project developed a draft
guide which outlines key elements and considerations that RHBs and other stakeholders
should follow to ensure that trained staff are adequately supported. In addition, a pool
of mentors, who will be used to cascade trainings in the future, as well as provide
follow-up, were identified in Afar and Beninshangul-Gumuz regions.

Conduct quarterly mentorship, evaluation and on-the-job support on HRM training

Post-HRM in-service training follow-up was conducted in all regions, to assess
knowledge, skills and current HRM practices of HR managers and staff, and provide on-
the-job support to fill gaps identified on HRM functions. Improvements were observed

22 October, 2015 Page 29

in areas such as making policies accessible to their staff, preparing HR plans, updating
HR data and training and staff development.

Result 2: Increased Availability of Midwives, Anesthetists, HEWs and

other Essential Health Workers
Improving maternal and child health outcomes and reducing the burden of infectious
diseases such as HIV/AIDS, TB and malaria requires the availability of a sufficient
number of health workers, especially midwives, anesthetists, health extension workers,
specialized nurses, emergency medical technicians, biomedical technicians, human
resource management professionals and health economists. Ethiopia is currently facing
critical shortages in the availability of these cadres, mainly due to a limited capacity for
production. The HRH project has continued its support to increase the supply and
availability of these cadres through strengthening the capacity of educational
institutions to increase production while assuring quality.

IR 2.1: Increased Availability of Anesthetists

Anesthetists are essential to provide comprehensive emergency obstetric and newborn
care for mothers with obstetric emergencies. The availability of anesthetists in sufficient
number and quality directly impacts maternal and newborn health outcomes. Thus, the
HRH Project supported the FMOH to increase the number and quality of anesthesia
professionals graduating from training institutions.

Support Printing of 12 Level V Anesthesia Training Modules and 1 Pocket Guide

The HRH project provided financial support to the FMOH to print 300 copies each of 12
Level V2 anesthesia training modules. The 12 modules were developed to support
teaching of essential topics given the scarcity of relevant and contextually appropriate
teaching materials in the universities and health science colleges. The following modules
were printed:
1. Obstetric and pediatrics anesthesia
2. Basic skills in air way management
3. Preparing the anesthesia work environment
4. Physical health status
The HRH Project also provided financial support
for printing 300 pocket guides, which will be 5. Drugs, adjuvant and fluid
used by both students and deployed graduates used during anesthesia
as a reference during clinical practice. The 6. Management of general
pocket guide includes common procedures and spinal anesthesia
performed by this cadre, including provision of 7. Anesthesia for emergency,
obstetric and pediatric anesthesia, with the trauma and shocked
expectation that this will ultimately lead to an patient
improvement in the quality of MNCH services 8. Anesthesia for a patient
provided with common coexisting

2
Level V training is the highest level of training in the Ethiopian Technical Education and Vocational
Training (TVET) system.

22 October, 2015 Page 30

 problems
9. Emergency and disaster medicine
10. Plan, monitor and manage quality in anesthetic nursing
11. Maintain effective health work environment, occupational health safety and
ethics
12. Policy development, establishing and conducting business relationship,
facilitating and capitalizing on change and innovation.

Support the FMOH to Develop Post-Basic Bachelor of Science (BSc.) Anesthesia

Curriculum
The HRH Project provided technical and financial support to the FMOH to conduct a
curriculum development and standardization workshop to review and develop a draft
competency-based curriculum for the post-basic BSc. in Anesthesia program. (Unlike the
‘generic’ BSc. program where candidates are admitted directly from high school, the
post-basic program admits diploma nurses with 2 years clinical experience and trains
them for 3 years, resulting in a BSc. degree. The post-basic program also provides a
career path for Level V anesthetists, thus addressing retention and motivation.
Representatives from the FMOH, the Federal Ministry of Education (FMOE), the
Higher Education Relevance and Quality Agency (HERQA), Universities, the Ethiopian
Anesthetists Association and the HRH Project participated in the workshops, where the
curriculum was developed using global anesthesia standards, and results from the task
analysis study conducted by the HRH Project. Consensus was reached on broader
program goals and core competencies, and 17 competency-based modules were
designed following instructional design standards.
During development, it was ensured that Tuberculosis, Malaria and HIV were
adequately addressed in the modules. As an example, clinical diagnosis of malaria is
included in the “investigation interpretation module”, focusing on hematology and
parasitology. It is expected that the curriculum will be implemented starting in January
2016.

Master of Science (M. Sc) in Anesthesia Curriculum Strengthening

The critical shortage of faculty with advanced anesthesia teaching skills is a barrier to
the expansion of anesthesia teaching schools and increased student intake. Increasing
the number of qualified faculty and advanced anesthesia professionals who can train
midlevel anesthesia service providers, is therefore a priority, and will result in the
increased production of anesthesia professionals available to provide essential services
to women, children, and the population as a whole.
The HRH Project provided technical and financial support to the Ethiopian
Association of Anesthetists (EAA) to conduct a curriculum development and
standardization workshop. During the workshop a draft competency based curriculum
for M.Sc. in Anesthesia program was developed by strengthening the existing Addis
Ababa and University of Gondar curriculum. Twenty six experts from the FMOH, FMOE,
HERQA, Universities, EAA, and the HRH project participated in the workshops.

22 October, 2015 Page 31

Anesthesia Professionals Code of Ethics and Conduct Printed and Distributed
In line with FMHACA’s regulation guidelines for health professionals, the HRH Project
supported the Ethiopian Association of Anesthetists (EAA) to develop a code of ethics in
Year 2, which set the ethical standards to which anesthetists must adhere in order to
provide the public with safe, effective and ethical perioperative anesthetic care. In this
reporting period, the HRH Project provided financial support for the printing of 500
copies of the code, and distribution to stakeholders and anesthetists across the country.

Program Level Standards Developed – Anesthesia

To ensure that higher education institutions have a robust and transparent quality
assurance system, the HRH project supported the FMOH, the Higher Education
Relevance and Quality Agency (HERQA), and EAA to finalize the development of
National Accreditation and Quality Improvement Standards for anesthesia programs.
The standards will serve to facilitate a culture of continuous quality improvement in
education institutions and promote effective and efficient accreditation system in the
country. HERQA is committed to the process and will publish and disseminate the final
standards to both public and private higher education institutions throughout the
country.

Support FMOH in the Development of Anesthesia Level V (Advanced diploma)

Program Level Standards
To ensure the quality of anesthesia education and training, the HRH Project supported
the FMOH, and the Technical and Vocational Education and Training Agency (TVET) to
develop Anesthesia Level V accreditation and quality improvement standards.
Anesthesia tutors currently working at RHSCs participated in the workshop, and using
resources such as curricula, TVET guidelines, FMOH priorities, HERQA BSc level program
standards and standards from the Council on Accreditation of Nurse Anesthesia
Educational Programs, they developed draft national standards for TVET level (RHSC)
anesthesia education. The standards will facilitate systematic continuous quality
improvement and promote effective and efficient accreditation systems in the country.

Mentorship and Coaching to Anesthesia Teaching Institutions

The HRH Project provided an orientation on the national anesthesia education
accreditation and quality improvement standards developed by HERQA, to 12
anesthesia teaching schools (3 in Amhara, 3 in SNNP, 4 in Oromia, and 2 in Tigray).
Utilization of these standards will facilitate continuous internal self-assessments and
quality assurance by the institutions, leading to improved quality in anesthesia teaching,
and ultimately in the production of a workforce that is competent and adequately
prepared to provide essential surgical services.

Need-based Trainings – Anesthesia Faculty, Preceptors and Anesthetists

The HRH Project designed and conducted the following need-based trainings for
anesthesia faculty, preceptors, and anesthetists:

22 October, 2015 Page 32

Table 6: Anesthesia trainings for faculty, preceptors and anesthetists
Training Topic Participants Remarks
Safe spinal anesthesia 53 Performance checklists on difficult airway
for cesarean delivery, Level V management, adult resuscitation and
timely recognition and anesthetists newborn resuscitation were also reviewed
resuscitation of a sick working and standardized. The capacity of the
mother, and provision across the Ethiopian Association of Anesthetists (EAA) to
of advanced newborn country provide similar trainings in the future for its
resuscitation members was also strengthened.
User level anesthesia 65 Participants provided with the knowledge and
machine maintenance preceptors skills to troubleshoot and provide appropriate
care for anesthesia machines, ultimately
providing safe general anesthesia to clients
undergoing operative delivery.
Simulation Training 16 Training designed to enable participants to
anesthesia establish simulation centers and effectively
faculty use simulation-based training for clinical
learning and assessment. The training was
very useful to ensure effective operation and
utilization of recently donated high fidelity
models to the training institutions.
Effective Teaching 47 Training strengthened participants’ teaching
Skills anesthesia skills including effective planning, use of visual
faculty aids, delivering interactive presentations,
creating and facilitating group learning
activities, demonstration and coaching for
development of healthcare delivery skills, and
preparing and conducting student
assessment.
Clinical Training Skills 9 anesthesia The clinical preceptors support student
preceptors practice at affiliated health facilities -
improving their clinical teaching skills will
enable them to effectively plan and conduct
clinical teaching and to implement effective
assessment of student’s clinical skills and
competencies

22 October, 2015 Page 33

Strengthened Skills Laboratory
The availability of a skills lab (simulation
center) for student practice and mastery of
essential competencies before moving to
clinical practice with patients is an important
aspect of competency-based training and
humanistic training principles. In this
reporting period the HRH Project supported
Arbaminch HSC, Hossana HSC, and Dilla
University to establish anesthesia skills labs
Student practicing administration of spinal
(including setting up the labs and designing anesthesia in skill lab, Dilla University
the layout). The skills labs will provide
anesthesia students with the opportunity to
repeatedly practice essential lifesaving obstetric emergencies and other anesthesia
skills.

Advancing Anesthetists’ Career Structure and Professional allowances

Given the critical shortage in the availability of qualified anesthetists in the country, the
EAA has continued to advocate with the FMOH to ensure that the career structure and
professional allowances for this cadre are fair and equitable, with the aim of attracting
and retaining competent anesthetists who can provide quality services that will
ultimately reduce maternal and child morbidity and mortality. In this quarter, as a
result of ongoing discussions, the FMOH accepted the proposed career structure and
benefit packages, and a request letter was sent to the Civil Service Minister for
approval.

Champion Anesthesia Students Identified from 14 Higher Education Intuitions (HEIs)

Students are an integral part of the teaching learning process, and can play a significant
role in the internal quality assurance of their education. Recognizing this, the Ethiopian
Federal Ministry of Education (FMOE) through the Higher Education Relevance and
Quality Agency (HERQA) has emphasized the importance of ensuring appropriate
participation of students in the design, management and evaluation of curricula and in
other matters relevant to their education. In line with this strategy, the HRH Project
supported 14 anesthesia training institutions to identify 19 anesthesia student
champions who will be participating in key discussions related to higher education
quality improvement efforts by the government, the EAA (Ethiopian Association of
Anesthetists) and other stakeholders. A 1-day meeting was conducted with the students
to review the expectations regarding their role in improving the quality of anesthesia
education.

Advisory Workshop on the Need to Establish an Anesthesia Student Association

An anesthesia student association can play an important role in creating a forum for
anesthesia students, through which various activities such as educational quality
improvement, professional association membership and leadership, and student

22 October, 2015 Page 34

attraction and retention can be facilitated. The HRH Project provided support for the
conduct of a one day workshop to discuss the need, requirements and processes for
establishing an anesthesia students association. The workshop included 19 anesthesia
students from 14 Universities and health science colleges, and 8 EAA staff, and
discussions focused on HERQA’s anesthesia program level standards and the potential
role that a student’s association could play in improving quality of education. Finally,
consensus was reached on the broader students’ association role, its establishment and
structural organization.

Capacity Building – Ethiopian Association of Anesthetists (EAA)

Strong professional associations can play key a technical and advocacy role in increasing
the quantity and quality of health professionals. As part of ongoing support to
strengthen its capacity, the EAA expanded its office to include a multipurpose
Continuing Professional Development (CPD) training hall, and purchased the necessary
teaching materials and supplies required for a standard training hall based on the
national CPD guideline requirement for providers. The EAA also obtained internet access
to enhance communication with member professionals, partners, and stakeholders.
In preparation for the provision of In-Service Training (IST) and CPD for its
professionals, the association used findings from the anesthesia task analysis and data
from a needs assessment conducted by the Association, to identify priority areas for the
training. The following 8 areas were identified as the current priorities for anesthesia
professionals to ensure that they remain fit for practice:

 Obstetrics and pediatrics  Regional anesthesia and pain

anesthesia management
 Basic and advanced cardiac life  Trauma anesthesia
support  Anesthesia machine maintenance
 Critical incidents management  Medico legal issues in Anesthesia
 Airway management

Instructional Design Training and Development of a Draft In Service Training Package –

EAA
In preparation for the development of high quality IST and CPD training materials on the
selected 8 topics mentioned above, the HRH project supported the EAA to conduct
instructional design training, during which participants developed draft training
packages.
The 10-day training was conducted for 23 EAA subject matter experts, and it
prepared them to develop effective training objectives, select relevant content,
teaching methods and materials, identify and establish appropriate formative and
summative assessment methods both for knowledge and performance, and to establish
training quality assurance mechanisms. As a result of this training, draft training
materials on Obstetrics and pediatrics anesthesia, Basic and advanced cardiac life
support, Critical incidents management, Airway management, Regional anesthesia and

22 October, 2015 Page 35

pain management, Trauma anesthesia, Anesthesia machine maintenance, and Medico
legal issues in Anesthesia were developed and are ready for review and further
comment. Once finalized these materials will be used for training and will contribute to
standardizing anesthesia education and practice.

Strengthen Capacity of the Ethiopian Association of Anesthetists (EAA): Meeting

Conducted with EAA’s Regional Representatives
The EAA is a fairly new association, thus requiring support to strengthen its systems, and
prepare it to become a visible and effective advocate in all parts of the country for
anesthesia professionals, particularly as it relates to education, practice and regulation.
The HRH Project continued to support EAA to expand coverage and accessibility of its
management to member anesthetists through opening of regional chapter offices. A
meeting was conducted with 21 participants (11 regional representatives, 5 Executive
board members and 5 EAA staff), to discuss the structure and functional organization of
regional chapter offices, and next steps in establishing these offices.

EAA National Annual Conference

The HRH Project provided technical and financial support to conduct the 11th national
EAA annual conference, whose theme was ‘Quality Anesthesia Care for Better
Maternal and Neonatal Health’. During the conference, 450 anesthetists from training
institutions and health facilities were provided with updates on clinical practice
guidelines, with an emphasis on anesthesia services related to maternal and child
health. Executive board members of the Association were also elected, and an annual
plan for the Association activities reviewed and approved.
During the conference, findings from the Task Analysis Study conducted by the
HRH Project were also disseminated, providing an opportunity for participants to
discuss the findings and their relevance to strengthening education and training
curricula, licensure exam content, and scopes of practice for the profession.

IR 2.2: Increased Availability of Midwives

Availability of midwives remains vital for the provision of basic reproductive health,
family planning, antenatal care (including PMTCT), labor and delivery care, postnatal
care and child health care services. The shortage of midwives in Ethiopia is due to low
enrollment and low output of midwifery training programs, thus creating a supply gap.
The HRH project has continued its support to the FMOH in strengthening the capacity of
midwifery training institutions to increase the quantity and quality of midwives.

Program Level Standards Developed – Midwifery

To ensure that higher education institutions have a robust and transparent quality
assurance system, in the first quarter the HRH project supported the FMOH, the Higher
Education Relevance and Quality Agency (HERQA), and EMwA to finalize the
development of National Accreditation and Quality Improvement Standards for
midwifery programs. The standards will serve to facilitate a culture of continuous
quality improvement in education institutions and promote effective and efficient

22 October, 2015 Page 36

accreditation system in the country. HERQA is committed to the process and will publish
and disseminate the final standards to both public and private higher education
institutions throughout the country.
In the second quarter, 13 midwifery higher education institutions were provided with
on-site orientation on the standards and they committed to use them for continuous
quality improvement.

Support FMOH in the Development of Midwifery Level IV (Diploma) Program Level

Standards
To ensure the quality of midwifery education and training, the HRH Project supported
the FMOH, and the TVET to develop Midwifery Level IV accreditation and quality
improvement standards. Midwifery tutors currently working at RHSCs participated in
the workshop, and using resources such as curricula, TVET guidelines, FMOH priorities,
and International Confederation of Midwives (ICM) standards, they developed draft
national standards for TVET level (RHSC) midwifery education. The standards will
facilitate systematic continuous quality improvement and promote effective and
efficient accreditation systems in the country.

National Midwifery Competencies Assessment Tool Development

The HRH project supported the FMOH to organize a 5-day midwifery competencies
assessment tools development workshop. A total of 22 participants from the FMOH,
teaching institutions (universities and regional health science colleges), and Ethiopian
Midwives Association (EMwA) Chapter offices collaborated to develop evidence-based
and standardized tools, which will be used to support learning and assessment in all
midwifery training institutions. The major areas addressed in the tool include
reproductive health and family planning, Antenatal Care (ANC), labor and delivery,
Post Natal Care (PNC), newborn and child care, HIV, TB and common infections. The
draft tools will be finalized in the coming quarter.

Support the FMOH to Conduct Instructional Design Training and Develop Modules for
Level IV Midwifery Training
The HRH project provided financial and technical support to the FMOH to conduct
instructional design training for 22 midwifery module writers from health science
colleges, universities and the Ethiopian Midwives Association (EMwA). The 3-day
training was specifically tailored to module development with emphasis on
development of effective teaching materials and assessment tools. Following the
training, participants developed 6 draft modules for Level IV midwifery training. These
were:
 Focused Antenatal Care (ANC) Labor and Delivery (L&D)
 Postnatal Care (PNC) Family Planning (FP)
 Gynecology (GYN), and Reproductive Health (RH)

Subsequently, in the fourth quarter, the FMOH was supported to conduct a workshop
where the modules were reviewed and validated. During the review process, it was

22 October, 2015 Page 37

ensured that critical midwifery competencies in Malaria, Tuberculosis and HIV service
delivery were included in the learning modules. The experts also ensured that updated
management protocols and suitable student assessment methods were incorporated.
The modules will serve as a standard reference for midwifery students during training
and clinical attachment, particularly when they are assigned to institutions and facilities
with limited access to educational resources.

Need-based Trainings: Midwifery tutors and midwives

The HRH Project designed and conducted the following need-based trainings for
midwifery tutors and preceptors:

Table 7: Midwifery trainings for Midwifery tutors and midwives

Training Topic Participants Remarks
Integrated 72 The training objective was to equip midwifery
Management of Midwives, faculty (60) and health workers who serve as
Newborn and Child nurses, tutors and preceptors with the basic skills
Hood Illness (IMNCI) physicians and related to the case management process and
health officers provision of IMNCI services
Syndromic 51 Training provided using national STI training
Management of Midwifery tutors materials
Sexually
Transmitted
Infections (STIs)
Effective Teaching 10 The training strengthened participants’ skills
Skills (ETS) Training Midwifery tutors as facilitators of this training, which includes
of Facilitators effective planning, use of visual aids,
delivering interactive presentations, creating
and facilitating group learning, etc.
Effective Teaching 169 The training provided faculty members with
Skills (ETS) Training Midwifery tutors the skills to effectively design, conduct and
assess their students.
Simulation Training 79 Midwifery The training enabled faculty members to
tutors establish simulation centers and more
effectively use simulation-based training for
clinical learning and assessment. The training
was very useful to ensure effective operation
and utilization of recently donated high
fidelity models to the training institutions
Clinical Training 39 midwifery The clinical preceptors support student
Skills preceptors practice at affiliated health facilities -
improving their clinical teaching skills will
enable them to effectively plan and conduct
clinical teaching and to implement effective
assessment of student’s clinical skills and
competencies

22 October, 2015 Page 38

Gap Assessment – Midwifery Mentorship Program
To document the number of existing midwifery mentors, and to better understand the
quality of midwifery services provided by recent graduates, the HRH project conducted
on-site gap assessments at 28 health facilities in Tigray, Diredawa, Harari, Benishangul-
gumuz, Somali and Afar region. Some key findings included:
 The number of midwives providing services is not enough and is lower than the
standard set by the FMOH;
 Lack of access to a consistent water supply has resulted in poor infection
prevention practices in many health facilities;
 The referral linkage system to the HEWs is weak and is not properly
documented.
 Many midwives have limited capacity/knowledge on areas such as long-acting
family planning, which has affected service provision.
These findings will be used to inform future activities to strengthen the implementation
of the mentorship program, resulting in improved provision of MNCH and FP services.

Midwifery Mentoring Training

The HRH project conducted a 3 day competency based midwifery mentoring training,
whose objective was to provide midwifery
The ultimate aim of the mentors with the required knowledge, skills and
mentorship program is to attitude to enable them to implement a
ensure that the quality of structured mentoring program, and transfer
MNCH services provided by adequate skills and knowledge to midwife
midwives in health facilities is mentees in their respective institutions. A total of
improved 16 mentors were trained from Afar, Diredawa,
Harari, and Tigray regions.
In the third quarter, similar training was provided for 17 senior midwives from 6
regions, (an additional 5 mentors from Beninshangul gumuz were trained by the
UNFPA).

Mentor 61 Accelerated Midwifery Program Graduates at Health Facility Level

The HRH Project supported the conduct of a three week midwifery mentorship visit to
61 accelerated midwifery program graduates at 23 health centers in six regions (Afar,
Benishangul Gumuz, Harari, Somali, Tigray and Dire Dawa). During the mentoring visits,
the midwifery mentoring tool developed by the HRH Project and national reference
materials were used.
A number of MNCH service delivery gaps were identified such as poor
documentation and referral linkages, poor Infection Prevention (IP) practices, and lack
of adequate care provided for newborns during delivery and in the postnatal care room.
The mentors immediately addressed gaps identified during the visit, and worked with
the new graduates to establish newborn corners, use partographs for laboring mothers,
improve the overall sanitation and cleanliness of the environment, and support the
Health Management Information System (HMIS) and documentation systems.

22 October, 2015 Page 39

Figures: Senior midwife mentors conducting mentorship visits and addressing gaps
found in MNCH service provision.

Midwifery Teaching Institutions Experience Sharing and Networking Workshop

To improve the quality of Midwifery education, the HRH Project provided support for a
2-day workshop whose aim was to create an opportunity for midwifery teaching
institutions to network, share their experiences and best practices, identify challenges
and discuss solutions. Participants from the FMOH HRH directorate unit, the FMOE,
HERQA, and 25 midwifery teaching institutions (18 Universities and 7 Health Science
colleges) attended the workshop.
During the workshop, midwifery departments presented their institutional staff
profiles, student profiles, graduate profiles, and their teaching management system
(class room, skill labs and clinical practice sites). Discussions resulted in plans to improve
capacity at skills labs, provide more time for students to practice their clinical skills, and
assign preceptors and tutors to guide students during clinical practice.
Participants also identified variations in the curricula used at each of the schools,
and it was recommended that schools adopt and use the standard curriculum
developed by the FMOH and FMOE.
The EMwA used this opportunity to distribute relevant midwifery reference
documents such as the professional code of ethics and conduct for midwives, standards
of midwifery care practice in Ethiopia, and management protocols on selected
obstetrics topics for health centers. The Association also asked the institutions to send
information on newly graduated midwives to facilitate updating of a database which is
being developed to track midwifery data.

Orientation of Volunteer Tutors and Preceptors

The HRH Project supported the temporary recruitment of volunteers (4 midwifery tutors
and 10 midwifery preceptors), with the intention of placing them in teaching institutions
facing critical shortages in the availability of qualified faculty. In the second quarter, the

22 October, 2015 Page 40

HRH Project, with guidance from the FMOH, selected 6 universities and 3 RHSCs, where
the volunteers were placed, and subsequently conducted a one day orientation
workshop. The orientation ensured that the volunteers were adequately prepared to
support the institutions where they will be placed, and ensure that the institutions are
committed to and aware of their roles and responsibilities related to hosting the
volunteers. During the orientation, key donor compliance issues were also discussed.
Availing these tutors and preceptors will help students to gain essential midwifery skills
that ultimately lead to improved RMNCH services.
The HRH Project continued to support these volunteers for the rest of the
program year (though the number reduced to 9 as a result of attrition). The supported
institutions have realized the importance of hiring highly skilled midwifery tutors and
preceptors to improve the quality of education, and it is anticipated that in the coming
project year they will provide financial resources to support these positions.

Midwifery Curriculum Gap Assessment: RHSCs in Amhara Region

Periodic curriculum review and harmonization strengthens the capacity of educational
institutions to meet emerging educational needs, address priority health needs and
ensure consistency in training programs. The HRH Project technically supported four
RHSCs in Amhara Region to conduct a targeted needs assessment and identify gaps
using a standardized tool. Some gaps identified included poorly designed course syllabi,
assessment methods not clearly indicated, some courses not logically sequenced, and
lack of focused content in some of the curricula. It is expected that with future funding
through the Fixed Amount Awards, the RHSCs will use findings of the assessment to
inform and guide implementation of curricula strengthening activities.

Midwifery Curriculum Review – BSc Program, Medawelabu University

The HRH Project supported the Medawelabu University to review its midwifery
curriculum through organizing a five-day curriculum review workshop. The revisions
resulted in a strengthened midwifery curriculum that includes revised essential
competencies in line with the future job expectations of the graduates, and grading
scales revised as per the harmonized academic policy of Ethiopian public higher
education institutions. It is expected that with this revised curriculum, midwifery
graduates will be adequately prepared to provide high quality RMNCH services upon
deployment.

Midwifery Curriculum Review – Level IV Program

The TVET model curriculum for Midwifery Level IV training was revised for 3 regional
health science colleges in Oromia and Amhara region with the support of the HRH
Project. The review resulted in strengthened curricula that are aligned with government
policies and guidelines, and are based on the actual tasks that the cadre will be
expected to perform upon deployment. Examples of changes made include sequencing
of learning modules based on logical sequence as well as level of difficulty, and review
of content to ensure that each module is aligned with performance criteria.

22 October, 2015 Page 41

Problem Based Learning Training – Debre Tabor University Midwifery Program
One of the key interventions to improve quality of pre-service education of health
workers is faculty development in evidence-based teaching and learning methods. In
response to a gap identified during an internal monitoring assessment of
implementation of the new midwifery program at Debre Tabor University, and using its
own resources, the Health Science Education Development Center (HSEDC) organized a
4 day problem based learning (PBL) training aiming to help faculty develop realistic and
contextually relevant PBL cases, equip them with effective facilitation skills for PBL
sessions, and mentor faculty in implementing PBL. During the training 26 faculty were
trained and 10 PBL cases were developed and made ready for use from the following
modules in the midwifery curriculum:
 Reproductive health and family planning module,
 Antenatal care module,
 Labor and delivery module,
 Postnatal care module, and
 Newborn and child health care module
The HRH project provided technical support (trainers) for this activity.

Ethiopian Midwives Association (EMwA) - General Assembly

The HRH Project provided technical and financial support to EMwA for the conduct of its
23nd General Assembly held on 5th and 6th December 2014. Over 330 midwives and
invited guests participated in this meeting, where the key note message delivered by a
delegate of his Excellency State Minister Dr. Kebede, reiterated that reducing maternal
and child mortality is a priority for FMOH, and the role of midwives in achieving this
goal is vital. During the assembly, technical updates on maternal and child health,
family planning and reproductive health, and HIV were presented. A documentary film
on improving maternal and neonatal health was also launched for the public.

EMwA Regional Chapter Office Meetings – Tigray, Somali & Addis Ababa
Through the support of the HRH Project, the EMwA held a meeting of its Tigray region
chapter office for 135 participants including midwives working in the region,
representatives from the Tigray RHB, board members, and student associations. During
the meeting, 9 regional board members were nominated, members registered, an
environmental sanitation campaign conducted at the Wukro Health Centre and
Hospital, and satellite offices in teaching institutions in the region established.
Similarly, the Somali Chapter office held a meeting for 102 participants from the
region, including midwives, representatives from student associations and board
members. During the meeting, new association members were recruited, and a facility
gap assessment on midwifery mentorship conducted in five health centers. 10 regional
board members were also nominated, and zonal focal persons selected.
A meeting was also held for the Addis Ababa chapter office for 170 participants,
including midwives, representatives from the Addis Ababa RHB, and board members.
Areas of discussion included MNCH best practices, EMwAs revised strategic direction,

22 October, 2015 Page 42

and accomplishments made by the chapter office.
It is expected that these meetings will contribute towards expanding the profile
of the association at the regions, with the overall aim of strengthening the midwifery
profession.

Celebrate International Day of Midwives

The HRH Project supported the celebration of the 23rd International Day of the
Midwives on May 7 and 8, 2015 in Addis Ababa, where a meeting with the theme of
"Midwives: for a better tomorrow" was held. Approximately 400 midwives from all
regions of Ethiopia, and other stakeholders attended the workshop, during which the
professional code of ethics of midwives and a number of abstracts were presented. In
addition, the Ethiopian Midwives Association (EMwA) in collaboration with the Addis
Ababa EMwA chapter office organized hospital visits to 10 Addis Ababa based (private
and government) hospitals. The visit was made with the objective of reinforcing the
unity of midwives in working together to improve the lives of women, babies and
families through pregnancy and childbirth, advocate for and represent the midwifery
profession, raise the profile of midwives and draw attention to midwifery in a positive
way.

Capacity Building – EMwA

As part of ongoing efforts to strengthen the capacity of the EMwA, a research and
development advisor, communication expert, and Information Technology officer were
recruited to strengthen the Association’s functions related to generation of relevant
midwifery research data, communication, and data management efforts, which will
support sustainability of the Association.
The HRH Project also provided support to the EMwA to implement the following
activities related to providing Continuing Professional Development (CPD) for its
members:
- Developed two in-service courses on post natal care and midwifery courses;
- Develop CPD activity assessment tools, which will be used by the Association
during its general assembly to gather/identify innovative ideas of making the CPD
courses easily accessible to all midwives. The tools will also obtain information on the
tasks which most midwives have difficulty performing.

IR 2.3: Support Health Extension Worker (HEW) training (Level III and IV)
The health extension program is the FMOH’s flagship program to ensure primary health
service delivery and quality of care through the effective implementation of essential
packages including family health (reproductive, maternal, newborn and child health)
and disease prevention and control (HIV/AIDS, tuberculosis and malaria). The HRH
Project continued its support to HEW level III and IV training to maintain coverage and
improve quality of the health extension services.

HEWs Level III Modules Development and Revision

The HRH Project provided technical and financial support for the conduct of a 12-day

22 October, 2015 Page 43

HEW level III training module writing and review workshop, with the aim of developing
modules for all (16) health extension training packages. A total of 19 experts from the
FMOH, Regional Health Science Colleges (RHSCs), the HRH project and AMREF
participated in the workshop, resulting in the development of 14 modules which will
address the critical lack of relevant and contextually appropriate books for this training
program. The modules developed are: Family Planning, Expanded Program for
Immunization (EPI), Antenatal Care, Labor and Delivery, Postnatal Care, Integrated
Community Case Management (ICCM), Adolescent Youth Reproductive Health,
Communicable Diseases, Nutrition, First Aid, Health Education, Hygiene and
Environmental Health,; Emergency Preparedness and Response, Non-Communicable
Diseases, , and Community Health Service and Management.

The FMOH provided with technical support to develop Generic Urban Health
Extension Workers (UHEWs) Level III & IV Curricula
The FMOH plans to start a new Urban Health Extension Worker program and enroll 200
students in October 2015 at the Menilik Health Science College. This program differs
from the previous Urban Nurse Health Extension Program (UNHEP), because it admits
10th grade students who will undergo a one year program and become level III UHEWs.
They can subsequently enroll in the Level IV UHEW training program.
As part of this effort, the HRH Project provided technical support for the development
of curriculum for this new training program. 14 level III and 13 level IV modules were
identified, and content developed following standard instructional design principles.

Support the FMOH to Conduct Curriculum Development to Upgrade Level IV HEWs to

Family Nurses
To further improve skills, motivation and retention of HEWs, the FMOH has planned to
upgrade level IV HEWs to family nurses. The family nurses will enhance family health
and wellbeing through the provision of focused preventive, curative and rehabilitative
health services. In response to this initiative, the HRH Project provided financial and
technical support to the FMOH for the development of curriculum for family nurses. The
Bachelor of Science (BSc) family nurse competency based curriculum was designed with
the aim of upgrading level IV health extension workers to provide accessible and quality
primary health care services to women, families and the larger community.

Support FMOH in COC Assessment Tool Development and Validation

Valid and reliable assessments upon graduation can serve as a mechanism to ensure
that graduating students have the necessary knowledge and skills. The HRH Project
supported the FMOH in the development and validation of Certificate of Competence
(COC) assessment tools for HEWs (Level III and IV) training. During the workshop, 47
subject matter experts and other participants invited from the FMOH, RHSCs, and
central and Regional TVETs reviewed and finalized the assessment tools.

Support Oromia RHB to print and distribute 6,600 Level IV HEW modules
As part of the continuing support for regional health science colleges, the HRH Project

22 October, 2015 Page 44

distributed a total of 6,600 HEW level IV training modules to four RHSCs in Oromia
Region (Shashemene-572, Negele-1705, Mettu-1606 and Nekemete-2717) based on the
number of students currently enrolled (Table 1 below). The donated modules will
improve the critical shortage of references and textbooks, and support teaching of key
competencies required for service delivery, including control of communicable diseases,
integrated management of newborn and childhood illnesses, provision of family
planning and MNCH services.

Table 8: List of HRH Distributed HEW Level IV Training Modules - Oromia region
No Modules Shashemene Negelle Mettu Nekemte
HSC HSC HSC HSC
1 Adolescent and Youth Reproductive 52 155 146 247
Health
2 Communicable Disease Control Part 1 52 155 146 247
3 Communicable Disease Control Part 2 52 155 146 247
4 Communicable Disease Control Part 3 52 155 146 247
5 Integrated Management of Newborn 52 155 146 247
and Childhood Illnesses/IMNCI Part 1
6 Integrated Management of Newborn 52 155 146 247
and Childhood Illnesses/IMNCI Part 2
7 Antenatal Care Part 1 52 155 146 247
8 Antenatal Care Part 2 52 155 146 247
9 Labor and Delivery Care 52 155 146 247
10 Postnatal Care 52 155 146 247
11 Family Planning 52 155 146 247

Effective Teaching Skills Training – HEW Instructors

The HRH project conducted Effective Teaching Skills training for 23 HEW faculty. The
training was tailored and designed based on the pedagogic skill gaps identified by the
faculty. The improved pedagogic skills of the faculty are expected to strengthen the
quality of training provided to students, resulting in the production of competent health
professionals available to provide high quality health services to the Ethiopian
population.
In the second quarter, the HRH project delivered ETS training for 43 health
extension worker faculty from health science colleges in emerging regions. The training
aimed at improving teaching skills of the new health extension worker faculty and
orienting them on the TVET HEW curriculum.

Clinical Training Skills – HEW Preceptors

The HRH project conducted clinical training skills trainings for a total of 11 HEW clinical
preceptors. The clinical preceptors support student practice at affiliated health facilities
- improving their clinical teaching skills will enable them to effectively plan and conduct
clinical teaching and to implement effective assessment of student’s clinical skills and
competencies.

22 October, 2015 Page 45

Simulation Training – HEW Faculty
The HRH project conducted simulation training for 42 HEW faculty in the first quarter.
The training was designed to enable faculty members to establish simulation centers
and more effectively use simulation-based training for clinical learning and assessment
The training was very useful to ensure effective operation and utilization of recently
donated high fidelity models to the training institutions, and to stimulate the training
faculty to look for ways to further strengthen the use of simulation for health
professional education.

Review of Health Extension TVET Curriculum – Shashemene and Negele Regional

Health Science Colleges
In the first quarter, through the Fixed Obligation Grant mechanism, support was
provided to the Shashamene and Negele RHSCs to revise the TVET model curricula of
the Health Extension Level III & IV training programs. During the workshops, which
included a representative from the Oromia TVET commission, the TVET curriculum was
revised to address gaps identified during teaching, resulting in a strengthened
curriculum that will support the production of qualified health extension workers.

Conducted Coaching and Mentoring Visits to SNNP HEW training institutions

As part of the HRH Project support for HEW training, coaching and mentorship on-site
visits were conducted at 5 HEW training institutions in the SNNP region. Through these
follow up visits, gaps were identified and corrective actions were taken. Specific gaps
identified included the absence of updated national guidelines which are relevant and
important for HEW training. In response to this gap, the Project collected the following
guidelines and shared them with the training institutions (Table 9 below).

Table 9: List of HRH distributed Relevant National Guidelines - SNNPR

List of shared guidelines with health extension training institutions
1. Drugs Management Handbook for Health Extension Workers
2. Guideline on Home Delivery Free Kebele (ቤቤ ቤቤቤቤቤ ቤቤ ቤቤቤ ቤቤቤቤቤቤ
ቤቤቤቤቤ ቤቤቤቤቤቤቤ ቤቤቤቤ)
3. Guideline on Pregnant Mothers’ Conference (ቤቤቤቤ ቤቤቤቤቤቤ ቤቤቤቤ
ቤቤቤቤቤቤ ቤቤቤቤቤ ቤቤቤቤቤ ቤቤቤቤቤ ቤቤቤ ቤቤቤ)
4. Trainers Manual, Safe and Clean Delivery Training for HEWs (ቤቤቤቤቤቤ ቤቤቤቤ
ቤቤቤቤቤ ቤቤቤቤቤቤ ቤቤቤቤ ቤቤቤ ቤቤቤቤቤቤቤ ቤቤቤቤቤ ቤቤቤቤቤ ቤቤቤቤቤ
ቤቤቤቤቤቤቤ ቤቤቤቤ)
5. Deworming Guide For Teachers And Health Extension Workers

Supported FMOH to Conduct Advisory Meeting with Semera University

The HRH Project supported the FMOH financially and technically in the conduct of an
advisory meeting to solve challenges related to HEW training in Semera University,
which has been conducting HEW training for 234 Level III HEW students through the
support of RHB since the Semera RHSC did not have adequate space and instructors.
The purpose of the advisory meeting was to review the status of the training and make

22 October, 2015 Page 46

recommendations to guide the transfer of the training to Semera RHSC. Accordingly,
consensus was reached that the Semera HSC will take over the training program and run
it with financial support from the Afar RHB, while the Semera University will continue to
assist the RHSC with the necessary infrastructure and teaching staff until the RHSC is
strengthened.

IR 2.4: Pre-service Education of Other Essential Health Workers Promoted

IR 2.4.1 Support Training of Emergency Medical Technicians (EMTs)

The Ministry of Health has identified developing a new cadre of emergency medical
technicians as a priority in order to improve pre-hospital emergency care for managing
all emergencies including maternal and newborn emergencies. Consequently, the HRH
Project continued to support the FMOH in meeting this priority through training and
deployment of emergency medical technicians.

Effecting Teaching Skills Training and Curriculum Orientation for EMT Instructors
The HRH project supported the FMOH to provide effective teaching skills training and
TVET curriculum orientation with the aim of improving pre-service education quality for
this essential cadre. The training was provided for 16 participants from 5 institutions.
During the training, participants discussed and practiced essential teaching and
assessment skills in line with the EMT curriculum; moreover, standardization of the ETS
and TVET curriculum orientation training package was done in consultation with the
FMOH and TVET agencies (elements from the two trainings were combined into one
package).

Provide Financial Support to the MOH/Amhara RHB to Train EMT Graduates on

Ambulance Driving Skills
The HRH Project provided financial support to the Amhara RHB for the provision of
ambulance driving skills training for 56 EMT graduates. The training enabled EMT
technicians to obtain driving skills that will help them to provide safe transportation
services to mothers and patients receiving emergency care. It is expected that this will
contribute towards preventing and managing complications and reduce preventable
maternal and newborn deaths.

Support FMOH in Assessment of an Emergency Management Institute

The HRH Project supported the FMOH in the assessment of an emergency management
institute, which has been newly established under the Addis Ababa City Administration
to train students in interventions related to emergency situations (firefighting, drowning
etc.). Based on the assessment results the institution was found to be an ideal place to
train emergency medical technicians on some essential competencies, and the FMOH
and the city administration agreed to collaborate in the training of EMTs moving
forward.

Competency Based Assessment Tool Development

22 October, 2015 Page 47

The HRH Project supported the Nekemte Health Science College to develop competency
based learning/assessment tools and a checklist for the Emergency Medical Technician
(EMT) department. The developed tools are expected to be used by EMT students and
instructors to improve the skills learning process, resulting in the production of EMT
professionals who are qualified to provide the necessary emergency support while
transporting critical patients to seek care at health facilities.

IR 2.4.2 Support Biomedical Technician Training

Equipment maintenance has long been a
Healthcare providers cannot provide
huge problem for service delivery mainly
life-saving and high impact MNCH,
due to lack of trained personnel. In
HIV/AIDS, tuberculosis and malaria
response to this need, the FMOH identified
interventions without functional
training of biomedical technicians as a
infrastructure
priority and the HRH Project has continued
to support biomedical technician training accordingly.

Module Development – Level IV Biomedical Technician Training

The HRH project provided financial and technical support to the FMOH to conduct a 14
day module writing workshop for level IV biomedical technicians training. 20 experts
from the FMOH, Universities, TVET colleges and the HRH project participated in a
workshop designed to develop draft reference modules to be used by all biomedical
training colleges. The reference modules produced will contribute to improve and
alleviate the critical shortage of contextually appropriate reference materials. The
following 8 draft modules were developed:
 Body system and interpretation of biomedical signs
 Installation, configuration and commissioning of biomedical equipment
 Maintenance basics of electrical machines and devices
 Repairing and maintaining biomedical equipment, instrumentation and control
systems
 Troubleshooting techniques for biomedical testing and measuring equipment
 Disposal of biomedical equipment
 Management of biomedical equipment (health technology management)
 Calibration of biomedical equipment

ETS Training and Curriculum Orientation – Biomedical Technician Instructors

In this quarter, the HRH project delivered ETS training for 4 biomedical technician
instructors from the Debre Markos Hunan Bridge Biomedical College. The training aimed
at improving teaching skills of the instructors and orienting them on the TVET
Biomedical Technicians training curriculum.

Support FMHACA in Preparation of a National Standard for Medical Devices

The HRH Project provided technical support to the FMHACA for the preparation of
National Standards for Medical devices. During the development of this national

22 October, 2015 Page 48

standard commonly referred to as the “ISO standards”, an HRH Project staff member
served as the technical committee chairperson, and ensured compliance with global
recommendations and frameworks for developing national standard for medical
equipment.

Conduct Medical Equipment Maintenance and Users training.

The HRH Project provided technical support to the FMOH to conduct various user and
maintenance trainings to ensure efficient utilization of medical equipment, including
ventilators, infant incubators, phototherapy and radiant warmer machines, and
anesthesia machines. The trainings were provided for 29 biomedical technicians and
engineers, and 20 anesthesia machine users.

IR 2.4.3 Support the FMOH to Establish Nursing Specialty Programs

Nurses with specialized skills are necessary to improve access to and quality of services
to women, newborns and other patients that need critical care and surgical
interventions. The HRH Project supported the FMOH in this reporting period to establish
neonatal nursing, emergency and critical care nursing, operation room, pediatrics,
family health, and surgical nursing programs.

Curriculum Development for Nursing Specialties – Neonatal, Operation Room (OR)

and Emergency and Critical Care Nursing (ECCN)
The HRH Project provided technical and financial support to the FMOH in facilitating 2
consecutive curriculum development workshops to develop and finalize draft curricula
for neonatal, OR, and ECCN nursing cadres. 68 experts from the FMOH, Federal Ministry
of Education (FMOE), the Higher Education Strategic Center (HESC), universities,
regional health science colleges, the Ethiopian Nurses Association, regional health
bureaus, the HRH project, and other development partners participated in the
workshops, where global up-to-date evidence was identified, discussed and used to
develop the curricula.
Based on the curriculum developed by the FMOH with the technical and financial
support of the HRH Project, three nursing specialty programs (neonatal, operation
room, and emergency and critical care nursing) were started in 11 institutions (9
universities and 2 regional health science colleges) as follows:
 Mekelle University, University of Gondar, Wollo University and Minilik health
science college – all three programs;
 St Paul Hospital Millennium Medical College and Jimma University – OR and
neonatal nursing;
 Wolaita, Arsi and Haromaya university – neonatal and ECCN;
 Hawassa University – ECCN
 Debretabor University - neonatal
Approximately 400 students have been admitted to the programs.

22 October, 2015 Page 49

Curriculum Development for Nursing Specialties – Pediatrics Nursing and Surgical
Nursing
The HRH Project provided technical and financial support to the FMOH in facilitating
concurrent curriculum development workshops to develop curricula for pediatrics and
surgical nursing cadres. The curricula were finalized, and as a next step, it was agreed
that to start the programs in the coming academic year, training institutions will be
identified and will be prepared by recruiting teaching staff and obtaining required
teaching materials. Recruitment and enrollment of the candidates will also take place.

Support a Training of Trainers (TOT) on Post Resuscitation Care of the Neonate for
Gondar College of Medicine and Health Sciences
The HRH Project provided financial support for the conduct of a TOT training on post
resuscitation care for the neonate. The training was provided at the Gondar College of
Medicine and Health Sciences in collaboration with volunteers funded by the Rotary
Club. The following activities were conducted:
- A TOT for 15 professionals (3 pediatricians, 2 general practitioners, 2 midwife
instructors, 6 nursing instructors and 2 neonatal nurses);
- 5 new instructors were mentored to conduct a training for 38 health providers as
part of their learning;
- A 1-day Neonatal Resuscitation Program (NRP) provider course was provided for 20
newly arrived interns in pediatrics and obstetrics.
- Supplies such as oxygen delivery equipment, intravenous (IV) infusion supplies,
thermometers and stethoscopes, were provided to the college to facilitate
implementation of the techniques taught during the training.

Demonstration of IV infusion pump and practicing techniques for breast milk expression

Competency Based Training on Basic and Advanced Pediatrics Cardiac Life Support
The HRH Project provided a 3-day competency based training on basic and advanced
pediatrics cardiac life support. The training was provided for 19 instructors (7 Neonatal,
3 Intensive Care Unit (ICU) and 9 Pediatrics and child health nursing faculty) from 13
Universities, who were provided updated resuscitation guidelines, and opportunities to
perform advanced resuscitation interventions in a simulated environment.

22 October, 2015 Page 50

IR 2.4.4 Strengthen Supply Chain Management (SCM) Training
One of the major challenges in providing adequate health services (including MNCH,
FP/RH, HIV, TB and malaria) is poor management of logistics required to ensure
continuous availability of supplies including drugs and medical equipment. However, the
content and quality of pre-service education in Ethiopia does not adequately enable
health workers to develop supply chain management competencies. The HRH Project is
providing technical support to address this gap.

Support MSC health supply chain management curriculum development and review
One of the priority areas identified for strengthening HR capacity for supply chain
management was developing a postgraduate program. The HRH Project provided
technical support to the Addis Ababa University School of Pharmacy in the design,
development and review of a draft competency based curriculum for a health supply
chain management postgraduate program. The graduates are expected to possess
knowledge of and perform the following tasks:

 Selection and quantification  Material management

 Procurement (storage, warehousing,
 Resource management inventory, and cold chain)
 Management information  Transportation and
system distribution management
 Professionalism Supply chain and Public health
 Use  Research/scholarship

The HRH Project continued to provide technical support to review and validate the draft
curriculum for this training program and further improved during quarter three. It is
expected that the AAU will finalize the curricula and submit it to the University senate
for approval, and subsequently launch the program.

IR 2.5: Support establishment of postgraduate programs in Human Resources for

Health Management (HRM) and Health Economics (HE)
The need for more health workers is not limited to clinical providers but also includes
public health professionals who can improve human resource planning and
management capacity in the context of broader health sector strengthening. The HRH
Project supported two Public Universities and one private Higher Education Institution
to design and launch post-graduate programs in Health Economics and Human
Resources for Health Management. In this reporting period, the Project provided the
following support:

Support Tuition Fee Payments for Enrolled Students

Since the launch of the programs, 83 students have been enrolled, and currently, 76
students are actively pursuing their studies.
- At the University of Gondar, 30 students have completed the third semester

22 October, 2015 Page 51

 coursework and will begin working on the thesis module. 2 students have dropped
out of the program to date.
- At the University of Jimma, 19 students have completed the 2nd semester. There
has been no attrition.
- At the Addis Continental School of Public Health, 27 students have completed their
second semester coursework. 5 students have dropped out of the program.

Provide technical support for delivery of the courses by bringing subject matter
experts from the Open University (OU) to co-teach along with Ethiopian faculty
As part of program sustainability and education quality assurance, 2 subject matter
experts from the Open University traveled to Jimma and Gondar universities to co-teach
the HRM and HE courses in the first quarter; The experts led the facilitation of face to
face modules, ensured delivery as per the curriculum, and shared their personal and
institutional experiences in provision of high quality blended learning. Additionally, the
co-teaching experience helped to coach the Ethiopian academics on good blended
learning practices.
Similar support was provided in the third quarter, where OU academics co-taught
with 5 Gondar academics through the week and were also joined by 4 other academics
who sat in on sessions to observe. The aim of the co-teaching was to build the capacity
of the Gondar university academics to provide a more interactive and engaging teaching
and learning experience for the students.
During this visit, the HRH Project identified that the entrance exam was exclusively
multiple choice questions which is inappropriate for a master’s program providing
competency based learning. Therefore, the Project supported in designing/developing
some new entrance exam questions to test problem solving skills and level of written
English to identify students who are best prepared to undertake the program in the
future.

Supervisor Training Conducted

A 3-day supervisor training was conducted for 13 supervisors from Gondar University, 1
program coordinator from Jimma University and 1 program coordinator from Addis
Continental Institute of Public health, who have been tasked with providing oversight
for the implementation of the HRM/HE programs. One-to-one sessions were conducted
with the supervisors to explore and discuss their individual experiences with
implementing the program, and address any issues and concerns they had.

Case study Development – Masters in Public Health (MPH) in HRM and Health
Economics
The HRH Project developed a health systems case study entitled “Ethiopia’s
achievements in meeting MDGs 4 and 5: cutting maternal and child mortality” to enrich
the quality and relevance of learning. To collect information required for the
development of the case study, the HRH Project conducted interviews with different
stakeholders at various levels (including the FMOH, RHBs, Zonal Health department,
hospitals, health science colleges and development partners). Policy documents, journal

22 October, 2015 Page 52

articles, personal testimony, film, photographs and maps were also collected – it is
expected that this evidence will result in a complex, nuanced story that captures the
tactical and strategic decisions that health managers take in applying the tools and
approaches taught in the postgraduate health programs to reducing child and maternal
mortality. The case study was finalized and DVD copies made available.
The case study also includes two study guides to enable the learner to make
the most effective use of the case study by making clear links between the case study
stories and the theories, approaches and concepts discussed in the modules.

Conducted Program Monitoring and Evaluation

The HRH Project conducted a program monitoring and evaluation survey at Gondar
University through administering a questionnaire and in-depth interviews with a small
number of students to evaluate the quality of teaching, the student learning experience
and the supervision given by the line manager in the workplace. The survey findings
suggest that the students have continued to be enthusiastic and are complimentary
about the program.

Local Blended Learning Champions Identified and Student Handbooks developed –

Jimma University
To increase the number of program coordinators and advocates of effective blending
learning, 2 champions were appointed at Jimma University to assist the program
coordinator, and engage with new tutors to support them in adapting blended learning
approaches effectively in the institution.
Additionally, to provide the students with basic information on blended learning, 2
adapted student handbooks, one for each of the programs, were developed. At a
meeting with the External Relations Officer, it was agreed that these handbooks would
be uploaded on the university website to encourage new students, and to showcase the
programs to a global audience.

IR 2.6 Support Project Mercy to establish a center of excellence in Midwifery and

Anesthesia training
Since October 2013, the HRH Project has been supporting the Project Mercy Health
Science College to establish and implement a 1-year accelerated midwifery training
program, with the overall goal of producing competent midwives who will be available
to provide priority MNCH services to the population in SNNPR, and the rest of the
country. The following activities were conducted in this reporting period:

Student Admission and Training – Midwifery Program

After repeated discussions with the SNNP Regional Health Bureau and Zonal Health
Departments, a total of 23 female registered nurses with Certificates of Competence
(COC) were admitted and began the one-year Accelerated Midwifery Training program
in November 2014. The recruitment process was coordinated with the SNNP Regional
Health Bureau who allocated a quota for each zone. Many of the zones were not able to
fill their quota of qualified students; however, a decision was made to start the program

22 October, 2015 Page 53

with the 23 available students instead of further delaying the program start.
It was later discovered that 6 of the students had presented fraudulent
Certificate of Competence (COC) documentation and they were consequently dismissed
from the program. The remaining 17 students have continued to attend classes and are
currently in clinical attachment at the Glenn C. Olsen Primary Hospital, Butajera Hospital
and Butajera Health Center for hands on practice.
All 17 students are progressing well and have successfully completed two rounds of
clinical attachment at the Glenn C. Olsen Hospital, Butajera Hospital and Butajera Health
Center.

Establishing Partnership and Coordination with Clinical Practice Sites

To facilitate opportunities for clinical practice, Project Mercy has established close
partnership and collaboration with the Butajera Health Center and Butajera General
Hospital. Preceptors at these facilities provide feedback to the college on student
performance, and identify areas that require further support by the tutors.

Refurbishment - Dormitories, Kitchen and Dining Room

In the main compound of Project Mercy, four km from the Health Science College,
temporary refurbishment and furnishing of dormitories, kitchen and dining room was
completed in the first quarter. These facilities will be used for the next two or three
years until permanent facilities are constructed on the same property of the current
college building.

Updated Reference Books and Broadband Internet Service

Project Mercy obtained an adequate number of the latest versions of reference books
through its health partners in the U.S.A. In addition, discussions with the
telecommunication office in Butajera and Addis Ababa led to successful installation of
Broadband internet services.

College Performance Management Team (PMT) established

Project Mercy established a College Performance Management Team which will be
tasked with providing oversight for the development of the college and implementation
of the agreed upon action plan. The team consists of: a chairperson, deputy chairman
and in charge of clinical instruction and practice, secretary and in charge of educational
management, a member in charge of classroom and practical instruction, member in
charge of assessment approaches, member in charge of school infrastructure and
training materials, and a student representative member.

Obtained Necessary Approvals for the Provision of IST

Project Mercy applied to be recognized as an IST center to the FMOH and in May 2015,
the FMOH reviewed the application, visited the college and recognized Project Mercy
Health Science College as the seventh in-service training center in the region.
Consequently, the Project requested the SNNP RHB for their approval of the FMOH
recognition and to provide trainees to train on priority maternal and neonatal care

22 October, 2015 Page 54

focused ISTs.
Identified In-service Training Courses
In response to the FMOH priority to institutionalize and standardize in-service training,
Project Mercy Health Science College is focusing on improving maternal and child
healthcare. Therefore, the in-service training (IST) unit of the Project identified relevant
areas for in-service training in line with the national agenda and priorities; these are:
BEmONC, Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in
Obstetrics (BLSO) training.

Infection Prevention and Patient Safety In-Service Training

The HRH Project supported Project Mercy to provide in-service training on Infection
Prevention for 32 healthcare professionals from various healthcare facilities in SNNPR.
At the end of the training, participants developed a six month action plan to address
infection prevention related gaps at their respective healthcare facilities, with the
overall aim of ensuring that health facilities are cleaner and free from contamination.

CROSS CUTTING ACTIVITIES

Develop Competency Based Assessment Tools – Anesthesia, Midwifery and HEW

In order to improve the quality of midwifery, anesthesia and HEW education and
student assessment, a 3 day competency based learning and assessment tool
development/adaptation and review workshop was conducted for 73 faculty from 21
universities and 23 regional health science colleges in Somali, Amhara, Beninshangul-
gumuz, Oromia, and Harari. As a result of the workshop, faculty developed and
reviewed 47 performance checklists and job aids, which addressed key technical areas
such as MNCH, FP and RH, HIV/AIDS, Malaria and pregnancy, and TB.

Support the Oromia RHB to resolve challenges related to Certificate of Competence

(COC) Examination in the region
In the Oromia region, the TVET office issued a new guideline for all midwifery level IV,
anesthesia level V, and HEW Level IV courses, which required them to take a COC
examination for lower levels, prior to taking the Level IV exam. As an example, a student
already enrolled in a Level IV accelerated midwifery training course would be required
to take a Level II and a Level III exam, before taking the Level IV exam. The students
were concerned with this new requirement, resulting in confusion and challenges with
implementing it.
To resolve these challenges, a workshop was conducted by the region, with
technical support from the HRH project. Discussions resulted in consensus among senior
management officials from the RHB, TVET and COC center to continue with the previous
practice for current Midwifery Level IV, HEW Level IV and Anesthesia Level V students.
The new guideline will apply to those students graduating in 2007.
Discussions also focused on the EMT students who had graduated in the previous
year, but had not yet had an opportunity to obtain driving licenses which would allow
them to drive ambulances. It was agreed that the RHB would have further discussions

22 October, 2015 Page 55

with the FMOH to identify solutions (supporting ambulance driving classes is included in
the HRH work plan). The workshop also reviewed the student intake plan based on the
approved model TVET curriculum for Midwifery and HEW level III.

Result 3: Improved Quality of Pre and In-service Training of Health

Workers
Competent health workers are essential to provide high quality and safe healthcare
services and meet Millennium Development Goals 4, 5 and 6. Ethiopia’s success in
rapidly increasing the number of health workers will not translate into improvement in
population health outcomes if the competence of health workers is not improved. In
this quarter, the HRH Project continued to support the efforts of the Government of
Ethiopia to strengthen quality of pre-service education and in-service training of health
workers with a focus on major cadres (doctors, health officers, midwives, nurses,
anesthetists, pharmacists and medical laboratory technicians) directly involved in
provision of reproductive, maternal, newborn and child healthcare, and HIV/AIDS,
tuberculosis and malaria prevention, care and treatment services.

IR 3.1: Improved Quality of PSE of Health Workers

In the past, the HRH Project has strengthened the capacity of higher education
institutions to improve the quality of education through comprehensive support
including faculty development, curriculum strengthening, infrastructure improvement,
clinical education strengthening, and health science education development center
establishment. The Project also strengthened accreditation, certification and regulatory
systems by supporting the Federal Ministry of Health, the Higher Education Relevance
and Quality Agency (HERQA), the Technical and Vocational Education and Training
Agency (TVET) and Occupational Assessment and Certification Agencies. In this
reporting period, the HRH Project continued its technical and financial support.

3.1.1 Support the Higher Education Relevance and Quality Agency (HERQA)
HERQA is mandated with assessing and safeguarding the quality and relevance of
tertiary education in Ethiopia. Thus far, the HRH Project has supported HERQA to
develop national strategies, standards, and checklists for quality assurance of health
trainings. The project has also provided support for short term trainings to increase the
number of qualified national quality assessors, international exposure visits to develop
HERQA’s staff, conduct of quality audits and spot-checks at HEIs, establishment of a
national quality technical working group, etc. These inputs have enabled the agency to
work on assuring the quality and relevance of health professionals training to meet the
needs of the nation. Specific activities included:

Finalize Development and Dissemination of National Accreditation and Quality

Improvement Standards for Eleven Programs
The HRH Project supported HERQA to develop National Accreditation and Quality
Improvement Standards for eleven health programs, namely Medicine, Public Health

22 October, 2015 Page 56

Officer, Nursing, Midwifery, Pharmacy, Anesthesia, Medical Laboratory Science,
Dentistry, Medical Radiology Technology, Environmental Health Science, and
Physiotherapy degree programs.
The project then supported HERQA to print and disseminate 3500 copies of the
standards (500 copies per health program), to HEIs. The standards were also uploaded
to HERQA website (http://www.herqa.edu.et). The standards will help HEIs to
continuously monitor and improve the quality of programs provided, and will be used
by HERQA to strengthen the accreditation and audit process for health professionals
training. It is expected that this will result in the production of competent graduates
who are prepared to provide high quality RMNCH, HIV/AIDS, TB, Malaria and other
health services.

Developed Regulation Directive for accredited Higher Education Institutions:

The HRH Project has provided HERQA with technical and financial support to improve
accreditation of academic programs through development of standards, strategic
documents and building staff capacity. In the third quarter, the HRH Project continued
its support to HERQA by conducting a workshop to develop a draft directive for
regulation of accredited higher education institutions. The directive includes a list of
possible violations by accredited institutions and equivalent sanctions to be
implemented. When completed, the directive will enable HERQA to undertake timely
sanctions tailored to specific violations, thus strengthening its ability to provide
regulatory oversight to higher education institutions.

Provide Accreditation Assessors Training

HERQA has a limited number of staff (19) that provide accreditation, quality audit and
educational credential authentication services. Given that these staff cannot be subject
matter experts for every academic program running in the 35 public universities and
over 90 private colleges in the Ethiopia, the Agency has to work with health
professionals & instructors as volunteers/consultants. In the second quarter, the HRH
project supported HERQA to conduct accreditation assessors training for 41 participants
from private and public HEIs. The assessors were trained on the newly developed
national health training accreditation and quality audit standards. As a result, the pool
of subject matter experts in health program accreditation and re-accreditation has
expanded. This will enable HERQA to respond to increasing accreditation and re-
accreditation requests from private HEIs.

Provide Quality Audit Assessors Training

The HRH project supported HERQA to conduct a quality audit assessors’ training for 44
participants from private and public HEIs in the second quarter. During the training, the
new national accreditation and quality improvement standards were distributed, and
participants were oriented on how to use them to conduct program and institutional
quality audits. It is expected that the audits will ensure that higher education provided
for health workers will be relevant and of high quality, and will prepare them to
adequately provide RMNCH, HIV/AIDS, Malaria, TB and other health services to the

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population.
Develop a Competency Based Training Package – Assessors Learning:
HERQA has been conducting annual targeted trainings for accreditation and quality
audit assessors to develop their assessment skills and increase the assessors pool. The
trainings prepare the assessors to interpret the standards objectively and measure the
educational performance of HEIs and their programs. The existing learning resource
packages that the Agency is using lack consistency – HERQA therefore requested the
HRH project to improve the training package.
In the second quarter, technical support was provided to the Agency to improve
the existing assessors’ learning resources and upgrade them to a Competency Based
Training Package. All relevant existing resources from HERQA, FMOE, Jhpiego and other
global sources were collected as references, and core competencies for accreditation
and quality audit were defined. An instructional design template was used to inform the
development of the required learning content, teaching methods and assessment
strategies. Based on the template, a course syllabus, modules and presentations were
drafted.

Provide Support to Conduct Spot-check visits at Ten Health Science Colleges

HERQA conducts unannounced visits to private colleges to ensure that accredited
academic programs are maintaining the basic educational quality as outlined in the
national guidelines. In year two of HRH project implementation, program specific
accreditation standards were developed for 7 health study programs. In the first
quarter, the HRH Project supported the HERQA to adapt the standards to shorter
checklists to guide the unannounced visits and conduct spot-check visits for 24
programs (covering medicine, midwifery, nursing and health officer) at ten private
health science colleges in Addis Ababa, Amhara, Oromia and SNNP regions. During the
visits, availability, adequacy and quality of teaching resources, curricula, teaching
processes were assessed including coverage of priority healthcare services such as
RMNCH, HIV/AIDS, TB, and malaria. Oral feedback was provided to the colleges’
representatives at the end of the visit, and detailed reports are being developed and will
be distributed to the colleges and relevant stakeholders (the Federal Ministry of
Education (FMOE) and HERQA). Moreover, this activity also allowed piloting of the
newly developed checklists and inputs for improvement of the tools were obtained.

Support Program Audits at 4 Private Colleges:

The HRH Project provided HERQA with technical support to conduct program audits at 3
private medical schools and 1 dental school, using the national quality assurance
standards. The audits were initiated to investigate issues of compromised quality caused
by large student intakes at the colleges, and the objective of the audits was to verify
whether the private colleges have put in place the required governance, educational
resources, faculty and teaching learning process to match the large number of students
admitted.
After the program audits, onsite feedback and support was provided to the
institutional leadership, and a detailed report was generated and submitted to HERQA

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leadership. As a result of the findings, the Agency suspended the four colleges from
admitting new students for the current academic year. The colleges have been
informed of the gaps identified and advised to address the challenges during the next 8-
month period, at which point they can re-apply for evaluation. This has helped to ensure
that the colleges are accountable for ensuring quality assurance, and ultimately produce
competent health care providers.

Support HERQA to upgrade its data center

At the national level, the Ministry of Communication and Information Technology
recognizes the need to implement electronic government (e-government) to facilitate
the process of increasing public access to government information. In response to this
effort, HERQA is in the process of upgrading its data center to improve its electronic
governance, including implementing IT-related changes to improve its business
processes. The HRH Project provided technical support for a ½ day meeting that was
organized by HERQA to discuss the establishment and organization of the data center,
with the aim of providing a transparent and efficient IT platform which allows public
access to findings from institutional quality audits, quality assurance and accreditation
status of higher education institutions.

Support Institutionalization of Health Sciences Education Development Centers

(HSEDCs) to improve the quality of health training
The Higher Education Proclamation 650/2009, article 22, instructs all higher education
institutions (HEIs) of Ethiopia to establish an internal quality assurance (IQA) system.
Accordingly, the HRH Project supported education institutions to establish a health
sciences education development center (HSEDC) to systematically address challenges
affecting quality of education and to nurture a culture of continuous quality
improvement. In this reporting period, the support to strengthen HSEDCs continued.

3.1.2 Fixed Obligation Grants (FOGs)

Conduct Educational Quality Improvement Activities Through Fixed Obligation Grants
(FOGS) Issued to Health Science Education Development Centers (HSEDCs)
Beginning in Year Two, the HRH Project has been providing direct funding to HSEDCs
through the FOG mechanism, in order to support various activities related to improving
the quality of health education. Using the FOG Mechanism, faculty development
activities have been conducted by HSEDCs to develop and upgrade their own teaching
staffs. The mechanism, through production of a critical mass for educational quality
assurance (QA), has also rapidly facilitated institutionalization the QA processes. It is
expected that these inputs will strengthen the capacity of these institutions to produce
a health workforce that is adequately prepared to provide high quality RMNCH,
Malaria, HIV/AIDS, and TB healthcare services. In the first quarter, the following
activities were conducted (see Table 10 below). In the second quarter, the HRH project
the HRH project provided on-site mentorship and coaching at 43 HSEDCs (13 in Amhara,
8 in Oromia, 6 in Tigray, 10 in SNNPR, 1 in Gambela, 3 in Somali, 1 in Harar, and 1 in
Addis Ababa) to systematically address challenges and nurture a culture of continuous

22 October, 2015 Page 59

quality improvement. In the third quarter, the HRH Project supported 24 HSEDCs (5 in
Tigray, 2 in Amhara, 5 in Oromiya, 11 in SNNPR, 1 in Gambella) through providing
ongoing coaching, supportive supervision and remote phone follow-up.

Table 10: Quality Improvement Activities Conducted with Fixed Obligation Grants, Q1
Activity Number Remarks
Trained
Quality 797 Including instructors from various departments,
Assurance college management, preceptors and management
Training members at clinical practice sites
Effective 348 - From 18 universities and 10 RHSCs
Teaching Skills - Technical support provided to strengthen the
(ETS) Training capacity of the HSEDCs to plan and conduct future
ETS trainings on their own
Clinical 142 - From 8 universities and 8 RHSCs
Simulation - Trainings provided participants with skills to
Training effectively train students using simulation
methods for the development of psychomotor
skills, communication skills, and clinical decision-
making skills.
Clinical Training 191 In addition to the training, participants discussed
Skills common challenges faced by students during clinical
practice, and identified solutions to address these
challenges moving forward
PMTCT Option 146 - From 2 universities and 7 RHSCs
B+ - Updates on comprehensive PMTCT option B+
service provision, ARV medications, Dried Blood
Sample collection for pediatrics HIV testing,
quality HIV testing and counseling, etc
Malaria case 25 Instructors from Harar RHSC
management
Infection 52 Midwifery, Anesthesia, HEW and other instructors
prevention from Hosaina RHSC
Long Acting 12 Instructors from the Midwifery (4), HEW (3) and
Family Planning nursing (5) instructors at the Hosaina RHSC
& Immunization
in Practice
Quality 7 universities, Developed action plans clearly identify the roles of
assessments 7 RHSC the institution, the HRH Project and other
stakeholders, and will be used to guide the process of
strengthening the quality of education provided
Curricula Review 16 39 curricula, 2 Modules, and 21 course syllabi were
universities reviewed. During the review, contents regarding
and RHSCs RMNCH, TB, HIV/AIDS, and malaria were
strengthened. Teaching methodologies for these

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 priority health conditions were improved
Provide Technical Support to the FMOH for revision of the New Innovative Medical
Education Initiative (NIMEI) curriculum
The HRH Project provided technical support to the FMOH to revise and standardize the
New Innovative Medical Education Initiative (NIMEI) curriculum. Supervision visits and
review meetings revealed a number of implementation gaps and inconsistencies partly
due to lack of detailed guidance for delivery of the curriculum. To address this gap, the
FMOH organized a curriculum revision workshop with financial support from ICAP and
requested Jhpiego’s technical assistance to facilitate the workshop. Two HRH staff
provided technical assistance to strengthen and standardize the module syllabi and
assessment policies and strategies.
The HRH project also supported the FMOH and 5 NIMEI schools to build their
capacity for video conference based learning planning and management. HRH staff
provided technical support for 10 instructors and IT staff so that they can identify and
use video conferencing utilities and equipment. The five NIME schools will soon be able
to deliver video conference based courses and manage classrooms in video
conferencing based learning.

Support FMOH to orientate HSEDC focal persons at New Innovative Medical Schools
Upon request from the FMOH, the HRH Project provided technical support to conduct a
meeting with health science education development center focal persons from new
innovative medical schools. The meeting helped to clarify the government’s direction
with regard to establishing strong HSEDCs, share experiences among schools, discuss
challenges and develop action plans to strengthen internal quality systems.

Support the FMOH to strengthen Skills Lab Equipment Installation, Training and
Maintenance in the new innovative medical schools.
In the second quarter, HRH staff led development of the distribution plan for skills lab
models and medical equipment procured by the FMOH and trained faculty on the use of
the models and maintenance. In the fourth quarter, the HRH project provided support
to Yirgalem medical college, and Wolo, Debremarkos, Dilla and Wolaita Sodo
Universities, to install skill lab equipment. The equipment will facilitate practice
opportunities for students, with the overall aim of improving the quality of education.
In addition to the installation, hands-on training was provided for 20 skill lab assistants
on how to adequately use and maintain the equipment.

Support through HRH Project staff seconded to the FMOH:

Through inputs from various HRH staff seconded to the FMOH, the following technical
assistance was provided to the NIMEI Schools:
 Training on Video Conferencing: Given the shortage of instructors in the 13
training institutions, the FMOH organized a one-day training on facilitation of
video conferencing, which will be used to facilitate training on basic science
subjects such as anatomy, pathology, pharmacology, microbiology and
physiology.

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  Organized Consultative Meeting Workshop: The HRH Project provided technical
inputs (develop agenda, facilitate discussion, identify key lessons from
discussion) for the conduct of a one day NIMEI consultative meeting. Challenges
and best practices were discussed and agreed upon by all stakeholders to further
improve the quality of NIMEI training programs.
 Prepared and disseminated Pamphlet: In order to increase awareness of the new
innovative medical education initiative among the general population and
stakeholders, a pamphlet highlighting the training program was developed and
disseminated. The pamphlet contains general background on NIMEI education,
its mission, NIMEI training institutions, what has been achieved so far, and the
total number of NIMEI students per institution (2012-2015).

Develop Checklists, Logbooks and Standard Operating Procedures

The HRH Project supported three universities and two RHSCs to conduct a workshop to
develop competency-based learning/assessment tools and checklists. HRH project staff
provided one-day training on competency-based learning tools development, followed
by technical onsite support to develop the tools. Participants developed standardized
learning tools, standard operating procedures and checklists used to teach basic skills in
the departments of Medicine, Nursing, Public Health Officer, and Medical Laboratory
(Ambo and Haramaya Universities); Environmental Health (Haramaya University);
Pharmacy, Nursing and Public Health officer (Harar HSC); and Health Information
Administration (Nekemte HSC). The standardized learning and assessment tools will
facilitate learning by ensuring that students follow evidence-based processes in learning
new tasks, accumulate sufficient clinical experience and receive feedback for
improvement.

Provide Technical Support to Jimma University to Develop Curriculum on Master of

Science in Health Professions Education
The HRH Project provided technical support to Jimma University to develop curriculum
for master of science in health professionals’ education. Considering the absence of a
similar training program in Ethiopia, the opening of a postgraduate education program
in health professions education is an effective and sustainable strategy to improve
quality of education. The primary targets of this program are leaders or members of
HSEDCs, and the program will produce health professions education experts to
strengthen human capacity of health science education development centers. The
curriculum development workshop was organized by Jimma University with technical
and financial assistance by Ludwig- Maximilians-Universitat Munchen (LMU). The HRH
Project has agreed to coordinate its support with that of LMU, providing a potential
cost-share opportunity.

Develop Exam Banks or review/revise Assessment Tools or Exam Papers

The HRH Project supported Haramaya University and Harar RHSC to organize
standardized exam banks for student assessments. Collection of exam items in a bank
facilitates storage and retrieval of items when needed, provides a systematic approach

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for using item analysis data to improve existing items, provides models for constructing
quality items and improves item writing skills of faculty. Staff collected, reviewed and
revised the previous exam papers, resulting in improved and quality exam items for
future use.

Support External Examination of Medical Students – Debretabor University

The HRH Project has supported Debretabor University to develop and implement
innovative curricula for medicine and midwifery programs including faculty
development, establishment of a health science education development center and
skills learning lab, and donation of educational materials.
In the fourth quarter, the HRH Project provided technical support to the
University to prepare and conduct a comprehensive qualification exam for the first
batch of medical students who finished pre-clerkship, to decide progression to clerkship.
The Project trained exam developers to develop an exam blueprint, higher order
multiple choice questions, objective structured practical/clinical examination stations
and structured oral exam questions. The multiple choice questions were designed to
test ability to use medical knowledge instead of mere memorization of facts. The
objective structured practical/clinical examination was intended to assess practical and
clinical skills. The structured oral exam was designed to assess ability of students to
apply biomedical and public health principles in understanding and solving health
problems and integrate perspectives from different disciplines. The Project also
technically supported administration of structured oral exams by external examiners
drawn from several universities by providing training, mentoring and quality assurance.
The examination also created an opportunity for the young University to receive
feedback from older universities on strengths and areas for improvement. The
examination was the first of its kind in the country both in content, process and rigor
and the experience has already inspired other medical schools to design similar
qualification exams.

3.1.3. Strengthen Gender Offices and Clubs at Universities and Colleges

Girls and women in Ethiopia are a disadvantaged segment of the population, and have
much lower access to educational opportunities when compared to men. To address
this gender gap, the HRH Project has emphasized the support of female students at
Universities and colleges towards empowerment and gender equality.

Gender Orientation and Discussion Forums

Through the FOG mechanism, the HRH Project supported 12 universities and 9 RHSCs to
conduct gender orientations and discussion forums. The orientation sessions focused on
the roles and responsibilities of the gender unit/office and addressed strategies to
support female students and enable them to succeed academically. The orientation
sessions also focused on key gender issues such as gender-based violence, gender
equity, and female empowerment. A total of 1541 female students participated in the
gender orientation and discussion forum sessions, which were facilitated by gender
focal persons who participated in the Gender Training of Trainers (TOT) training

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organized by the HRH Project in the previous years. These activities are expected to
impact the academic and social success of the female students, and promote gender
equity and female empowerment.

Conduct Life Skill Trainings for Female Students

Through the FOG mechanism, the HRH Project supported 12 universities and 9 RHSCs to
conduct life skill trainings for 1315 female students. The training provided the female
students with information on academic/study skills, gender based violence, HIV/AIDS,
reproductive health issues, assertiveness, stress management and problem solving skill
with the aim of helping them to navigate the academic setting and successfully
complete their health training programs.

Support Gender Offices to implement Student Support and Retention Programs for
Female Students
Through the FOG mechanism, the HRH project supported gender offices to provide
financial assistance to 282 female students facing severe financial challenges. The
financial assistance included provision of hygiene and sanitary items, stationery, cooking
oil, etc. The financial support is intended to support the students by improving their
living conditions, increase their self-confidence and improve their academic
performance.
In addition, 89 best performing female students received awards (pocket money
and/or certificate of best performance at 8 HEIs in SNNPR, to further encourage and
incentivize them to perform well in their course work (see photo of recognition of
students at Mizan-Aman Health Science College).
Inputs have resulted in positive outcomes
for the students – as an example,
Banchiaymolu Damte, a first year
medicine student and award winner in
Arbaminch University, stated that
“previously, getting copies of learning
materials was a nightmare for me since
my family couldn’t afford to photocopy
the learning handouts. Now, I can get the
copies and study them thanks to the 100
birr stipend I get monthly from the
gender office. Because of that, I performed the best in this year and got the annual
reward for my academic performance”

3.1.4. Improve Teaching Facilities at Education Institutions and their Affiliated Clinical
Sites
Appropriate and relevant educational resources, infrastructure and clinical practice sites
are required to ensure that health worker training is optimal. Ensuring that faculty
members are updated and have the latest pedagogical skills is also important. The HRH
project has been providing HEIs with financial and technical resources to improve the

22 October, 2015 Page 64

teaching-learning environment. In this reporting period, the following support was
provided:

Mapped, Collected and Distributed National Health Service Guidelines to Health

teaching Institutions:
Many health training institutions do not have adequate numbers of standardized
learning materials and national health policies, protocols and guidelines for educational
purposes. To improve student learning of local health priorities such as HIV/AIDS, FP,
RMNCH, TB and malaria, the HRH Project distributed 26 updated health service
guidelines to 25 institutions nationally (13 in Amhara, 11 in SNNPR, 1 in Gambella).

These guidelines included:

 National malaria guideline
 Ethiopian Consolidated National Guidelines for HIV Prevention, Care and
Treatment
 Public Private Mix Directly Observed Treatment Short Course (PPM-DOTS)
Implementation Guidelines
 National guideline for family planning services in Ethiopia
 Bleeding after birth: helping mothers survive
 National strategy for infant and young child feeding
 National Expanded Program on Immunization Implementation Guideline
 National Cervical Cancer Prevention Guidelines
 Maternal Death Surveillance and Response (MDSR) Technical Guideline

Medical Equipment Maintenance

The HRH project provided medical equipment maintenance services to clinical sites and
skill labs in 3 HEIs in Oromia and 1 in SNNP. Medical equipment, skills lab equipment,
and models were repaired at each institution (40 at Shashamene RHSC, 42 at Negele
RHSC, 36 at Medewalabu University and 44 at Hawassa University) and clinical sites
(Shashemene, Hawassa referral, Negele Hospitals). The repaired equipment included
autoclaves (steam & dry oven), sphygmomanometers, delivery couches, oxygen
concentrators, weight scales, stethoscopes, examination lights and anesthesia
machines, which are now available for both teaching and service delivery, thus enabling
access to essential RMNCH, HIV/AIDS, TB, and Malaria services.
In addition, to ensure that essential equipment used for neonatal service provision
is appropriately utilized and maintained, the HRH project supported the FMOH to
conduct a 6-day skill training for 20 regional and hospital biomedical engineers and
technicians on maintenance of neonatal incubators and phototherapy machines.

Assessment of availability of medical equipment in public hospitals

The FMOH initiated a baseline assessment to collect information on the availability,
quality and status of medical equipment in public hospitals. Findings from the
assessment will guide decision making related to procurement, maintenance and
disposal of equipment in these facilities. The HRH Project provided technical support to

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the FMOH to conduct a medical equipment inventory at 3 hospitals (Dilchora Hospital in
Diredawa, Jijiga Hospital in Somali and Adama Hospital in Oromia). Functional and
strengthened infrastructure in hospitals will benefit both clinical services and education.

3.1.5. Faculty Development at HSEDCs

Building the skills of teachers and clinical preceptors in effective teaching/learning
methods and relevant clinical topics is important to ensure the quality of education. The
HRH Project has supported training institutions to build the capacity of their HSEDCs to
train faculty in various pedagogic skills such as effective teaching skills, simulation
training, clinical preceptorship, instruction design training, multimedia for learning,
quality assurance management and need-based technical updates. In this reporting
period, the Project continued its support for faculty development as highlighted below:

Table 11: Faculty Development Training Provided at HSEDCs

Type of Training Number Remarks
Trained
Multi-media for 23 Participants obtain skills required to design, develop
learning and deliver instructionally sound, competency-based
multimedia learning materials that can successfully
bridge learning between the classroom, skills lab and
clinical sites
Instructional 44 Participants obtain knowledge and skills to review,
Design (ID) appraise and standardize course materials – curricula,
syllabus, learning content strengthening and teaching
methods
Clinical 48 Conducted for skill lab assistants and teaching staff
Simulation from 12 universities and 10 RHSCs
Training
PMTCT Option B+ 15 Instructors and preceptors from Mettu Health Science
College
Effective 30 Six departments from Jimma University (medicine-7,
Teaching Skills pharmacy-7, Nursing and Midwifery-6, Medical lab
and parasitology-4, biomedical sciences-4 and
anesthesia-2). The university provided financial
resources for the training, and the HRH Project
provided technical support.

Conducted Supportive Supervision Training for St. Paul Hospital Millennium Medical
Colleges Staff:
A three-day facilitative supervision training was conducted for 21 case team leaders,
quality assurance (QA) officers and nurse coordinators from various units of the college,
who are involved in internal supervision, inspections and QA activities of the hospital

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and the college. The participants were provided with the knowledge and skills to plan
and prepare for supportive supervision, develop supervision tools, apply effective
communication, coaching, and mentorship skills, provide feedback for performance
improvement, and support performance assessments. The HRH Project provided
technical support for this activity upon request from the College and all financial costs
were covered by the College.

3.1.8. Strengthen the Student Selection Process

Quality in higher education is a multidimensional concept, which includes all the related
inputs and functions of a university system. An important element is the quality of
students admitted, hence the need for sound student selection criteria. In Ethiopia,
there are many challenges with the student selection and admission procedures at
health science programs, including a lack of consideration of students’ interests and
abilities, and inadequate counseling during the admission and course selection process.
In response to these challenges, the HRH project conducted a desk review on
best practices and global evidence related to student selection and admission. A draft
concept paper was developed for discussion at a stakeholder meeting planned for the
next project year. It is expected that these discussions will result in recommendations
for the FMOE and FMOH on effective student selection and admission criteria and
policy.
The concept note stipulates that students should be selected and admitted for
health professional training when they:
 Make informed self-selection through the provision of timely vocational guidance;
 Attain the necessary academic achievements as indicated by performance at school
and /or undergraduate studies;
 Have cognitive ability as measured by psychometric testing;
 Have desirable personal attributes like compassion, motivation and integrity as
measured by psychometric testing
 Have Interpersonal skills as measured by interview.

3.2.10 Improve partnership with the Private Sector

There are more than 75 private colleges in Ethiopia contributing significantly to produce
trained human resources. Ensuring quality of education at private health science
colleges is therefore critical. In year I & II, the HRH Project provided technical support to
private health science colleges in Tigray, Amhara, Oromia, SNNP and Addis Ababa to
strengthen quality of education.
In this reporting period, the HRH Project supported the training of 33 faculty from
16 private health science colleges in Addis Ababa with the goal of developing effective
teaching, student assessment and quality assurance management skills of their staff. In
addition, they were oriented to essential teaching materials such as the Effective
Teaching Skills (ETS) reference manual, terms of reference for establishing health
science development centers, and national accreditation and quality improvement
standards. Financial costs for this training were covered by the private colleges, which

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indicate that they are committed to ensuring the academic quality of their health
training programs.

3.1.12. Support the FMOH to Provide Pre-Licensure Examinations for new graduates
from Medicine, Health Officer, Midwifery and Anesthesia education programs
With support from the HRH Project, the FMOH established a National Board Exam (NBE)
to protect the public through independent verification of a graduate’s ability for safe
and effective practice. The following support was provided in this reporting period:

Support the FMOH to Develop a National Guideline for Licensure Examination

A licensing exam is an important regulatory mechanism to protect the public from
unskilled and unsafe practitioners, and improve
Valid and reliable assessment of
the quality of education through feedback. In
competence gives the public
the previous year, the HRH Project supported
confidence that only qualified
the FMOH to draft a policy document, organize
and competent health
stakeholder consultation meetings and hire a
professionals receive a license to
seconded staff to initiate licensing exams for
practice.
university graduates. In the first quarter, the
HRH Project supported the FMOH to conduct a three day workshop to develop the
national licensure examination implementation guide. The guideline was developed
based on international best practices, national experience with national examinations,
and stakeholders’ inputs.

Conduct Advocacy on National Licensure Examination

In the first quarter, the HRH Project supported the FMOH to organize an advocacy
workshop on the national licensure examination for 7 private colleges and leadership at
the FMOH, in an effort to increase awareness of and prepare for the conduct of the
examinations. Following this workshop, FMOH leadership agreed to allocate an
additional budget to administer and manage the exam given the huge number of
candidates expected to take the exam.
In the second quarter, a consensus building workshop was held with deans and
academic leaders of health science colleges from both public and private higher
education institutions) to discuss the introduction of the licensure exam. It was
unanimously agreed that the exam shall be introduced through standardization of the
Qualifying exam where exams will be developed and stored in a centralized Item Bank
at the FMOH (National Board Exam, NBE) and assessors will be selected, trained and
assigned by the NBE in collaboration with training institutions. The accepted/agreed
upon exam formats selected were MCQ and OSCE. The agreement reached at this
meeting was critical for implementation of the licensing exam.

Licensure Examination Question Development Training

In the second quarter, a 5-day National Licensure Examination Question Development
training for Anesthesia and Midwifery was conducted for 33 Midwifery and 17
Anesthesia subject matter experts. Building on the results of task analysis studies

22 October, 2015 Page 68

conducted in year two, the training enabled development of exam blueprints
(specifications) for both Anesthesia and Midwifery. The training focused on writing
quality Multiple Choice Questions (MCQ) items, and designing an Objective Structured
Clinical Examination (OSCE) for student performance assessment, resulting in
participants developing questions which will be part of an “exam pool” for both cadres.
In the fourth quarter, an additional 36 item developers from Medical and Health
Officer training programs were trained, and they subsequently developed 1000 MCQs
and 25 OSCE items in line with the blue prints developed for the programs. This activity
expands the pool of questions available for medicine and health officer licensure
examinations. Financial cost for this training was covered by the FMOH, which shows
the commitment of the government for this initiative.

Reviewed, standardized and banked quality questions for licensure examinations:

As part of the ongoing effort by the FMOH to develop defensible, valid and reliable
assessment tools, the HRH Project supported the review, standardization and banking of
approximately 4500 examination questions for medicine, health officer, midwifery and
anesthesia programs. These included multiple choice questions and objective structured
clinical exam station scenarios. The questions are ready to be used for the examination
of graduates from these cadres.

Assembled examination forms based on the blueprint

The HRH Project supported the FMOH to assemble exam forms based on the Blueprint
for Anesthesia (180 MCQs; 3:30Hrs), Midwifery (180 MCQs; 3:30Hrs) and Health officers
(200MCQs; 4:00Hrs). This task improves validity and reliability of licensure examination
by ensuring broad and representative sampling of contents.

Identified an open source item banking software (Moodle):

The HRH Project supported the FMOH technically to identify an open source item
banking software (Moodle) and supported negotiation to obtain commercially available
exam development software. The availability of item banking software will help to
ensure security and efficiency in the preparation, storage, and administration of
licensure examinations.

Draft Assessor’s Guideline for OSCE administration developed:

Performance assessment is prone to rater error/bias. The HRH Project provided
technical support to the FMOH to develop a guideline for administration of OSCEs. The
draft has been completed and will be further reviewed, strengthened and finalized.
Upon completion, it will standardize the OSCE procedures used during the licensure
examinations and improve reliability and fairness of results.

Support Administration of the Examinations for four cadres (Medicine, Anesthesia,

Midwifery and Health Officer):
The HRH Project provided technical support to the NBE to assemble and administer
licensure exams for 4756 graduates from public and private higher education

22 October, 2015 Page 69

institutions (790 Medicine, 850 Midwifery, 116 anesthesia and 3000 Health officer
graduates). Before the exam, technical assistance was provided to review and refine the
exam questions.

Support the FMOH to provide computer-based testing in collaboration with the

FMOE’s Data Center
The FMOE has established a Data Center to facilitate educational and research
networking and sharing among Ethiopian higher education institutions. The HRH Project
initiated and provided technical support to the FMOH to collaborate with the FMOE to
host the licensing exam for medical schools at the FMOE’s Data Center for computer-
based testing. The HRH Project assisted with installation, configuration and
customization of Moodle, a learning management system for online test administration
and item banking at the Data Center and coordinated the preparation of computer labs
at training institutions for computer-based testing. A computer-based test was
successfully administered in Bahir Dar University and Jimma University. Repeated power
failure and some technical difficulties forced a shift to a paper-based test at University
of Gondar. The other two universities (Addis Ababa University and Hawassa University)
had a paper-based examination due to not having adequate preparation.

Conduct Standard Setting and Validation Workshops

The HRH Project provided technical support to the FMOH to conduct two standard
setting and answer key validation workshops for Anesthesia, Midwifery and Health
officers. The objective of these workshops was to determine a pass score (cut-off point)
for the exams. After determining a cut-off score, discussions were held to evaluate the
fairness of the cut-off score. The exam papers were then scored, and a preliminary item
analysis of the exam items (determination of the reliability, difficulty level and
discrimination ability of items) conducted.

Support the FMOH to score exams using Optical Mark Recognition (OMR) open source
software
The first round exam scoring was done manually, and it took a lot of time to identify
examinee data for statistical analysis. Recognizing this will become increasingly
laborious and error prone as we test more students, the HRH Project supported FMOH
to adopt a pencil-shaded answer sheet format which can be easily scanned and data
transformed to score electronically. Each examinee’s answer sheet was scanned with
the Optical Mark Recognition (OMR) open source software, thus facilitating quick
scoring and item analysis (3638 of the exams will be scanned).

3.1.14. Support to Technical and Vocational Education and Training

Support Technical and Vocational Education and Training (TVET) and Certificate of
Competence (COC):
Annually, regional health science colleges and private health science colleges produce a
significant number of health professional graduates who join the world of health care

22 October, 2015 Page 70

services. The competencies of these new graduates are verified by standardized
Certification of Competence (COC) assessments before they are allowed to practice.
However, there are reported challenges in the quality of these COC assessments.
Improving the COC assessments will improve the quality of the health training
and protect the public from incompetent providers. In the first quarter, the HRH Project
organized two successive 5-day capacity building trainings on conducting and managing
competency based assessments. 76 COC assessors from Tigray and Amhara Regions
attended the training, which built their capacity to conduct state-of-the-art
occupational competency assessments in their regions.
In the second quarter, the HRH project provided financial and technical support to
Amhara, Tigray, SNNP, Somali, Oromia, Harari and Dire Dawa regional COC centers to
train a total of 90 new assessors to more effectively conduct and administer COC
assessments.
In the third quarter, two trainings were completed for Tigray and Oromia COC
assessors to enable them conduct assessments of biomedical technician, nursing,
medical laboratory, pharmacy, health information technicians (HIT), health extension
workers and midwifery programs in their regions.
 Tigray: the HRH Project provided technical and financial support to train 39 new
COC assessors on assessment methodology.
 Oromia: Financial and technical support was provided to the RHB and Oromia
COC center to conduct a 5 day assessors training for 40 COC assessors.

Develop and finalize accreditation and quality improvement standards for 5 cadres
In the fourth quarter, the HRH Project provided technical support to develop and
finalize quality and improvement standards for the following cadres (from Level II to
Level IV) – Midwifery, Nursing, Anesthesia, Pharmacy, and Medical Laboratory training.
The standards will be used to guide quality assurance for these training programs.

Disseminate Educational Quality Assurance Findings

The HRH project presented key program findings and lessons learned related to quality
of health worker education at several conferences. Successful Quality Assurance (QA)
practices, tools and new developments in health professionals’ education were
promoted and distributed at these conferences, and the visibility of Ethiopia’s efforts to
improve the quality of health worker education was increased. The following
presentations were made:

Presentation Title Event

Strengthened QA Mechanisms to Address Increased 2015 biennial International
Complexities of Higher Education Landscape in Ethiopia: Network of Quality
A strategic Partnership of a USAID Funded Project and Assurance Agencies in Higher
HERQA – paper presentation Education (INQAAHE)
Developing National accreditation and quality Conference in Chicago, USA
improvement standards for health profession education
in Ethiopia: lever for quality assurance – poster

22 October, 2015 Page 71

 presentation
National accreditation and quality improvement 4th Ethiopian Public Health
standards for public health officer, medicine and Officer Association (EPHO)
nursing degree programs conference, the 51st
Ethiopian Medical
Association (EMA) annual
conference, and the
Ethiopian Nursing
Association (ENA) annual
conference
 Status of Health Professionals Training Quality at National workshop on
Private College in Ethiopia – a research finding; Quality of Pharmacy
 National Strategies for Revitalizing Health Training education, organized by the
Quality; Ethiopian Pharmaceutical
 Findings of Internal Quality Assurance Functions at Association (EPA), HERQA
Ten Public Pharmacy Schools in Ethiopia; and and Jhpiego
 National Accreditation and Quality Improvement
Standards for Pharmacy Degree Program
Presentation on current implementation activities, HERQA and the Education
resulting in interest from the FMOE and other Strategic Center (ESC)’s 5th
stakeholders in extending activities related to quality annual international higher
improvement to other non-health educational education quality
programs. conference, with attendance
of over 500 participants from
universities, FMOH, and
other stakeholders
Ensuring Quality of Nursing Education: Adoption of 25th International Council of
Global Nursing Education Standards in Ethiopia Nursing (ICN) conference in
Seoul, Korea
 A keynote lecture on “Education Development 3rd Eastern Africa Health
Centers as Levers for Excellence of Health Profession Education
professionals’ Trainings in Ethiopia”. Association (EAHPEA) annual
 An oral presentation on “Developing Innovative conference held in Kigali,
Medical Curricula in Ethiopia” Rwanda
 An oral presentation on “Improving Midwifery
Education in Ethiopia”
Effective collaboration towards improved accreditation Network: Towards Unity for
practices for health training programs in Ethiopia Health Conference” in
Johannesburg, South Africa

Participation in these conferences and meetings provided an excellent opportunity to

share HRH success stories and increase visibility of the Project as well as learn from and
network with others.

22 October, 2015 Page 72

IR 3.2 Improved Quality of In-service Training (IST) of Health Workers
In-service training and continuing professional
When capacity to develop and
development (CPD) aligned with national health
provide need-based in-service
priorities and professional needs is crucial not only
training is strengthened, the
for updating and maintaining competence of health
knowledge, skills and
workers, but are also important as motivational
performance of health workers
tools to improve performance and retention of
in the provision of HIV, TB,
health workers.
malaria, maternal and child
To date, in response to the FMOH priority
health and family
to institutionalize and standardize in-service
planning/reproductive health
training, the HRH Project provided support to
will improve.
develop an IST framework and guideline, establish
35 IST sites, and initiate capacity building
interventions for IST sites. The Project has continued its comprehensive support to the
IST sites, regional health bureaus and FMOH. The following are the key
accomplishments in this reporting period:

3.2.1 Build the capacity of 35 training centers to provide IST

Procure and distribute IST materials and Furniture

In the first quarter, the HRH Project finalized procurement and distributed furniture and
training materials to 24 in-service training (IST) centers. The centers are now adequately
equipped to provide standardized training in line with the national guidelines. It is
expected that future trainings will be conducted at these sites, improving the training
quality, reducing the costs associated with hotel-based trainings, and ensuring
standardization among government partner trainings, which will ultimately lead to
improved skills of health providers to provide comprehensive HIV/AIDS, RMNCH, TB
and malaria care to the community.
In the fourth quarter, additional items (LCD projectors, Printers, flipchart stands and
fans) were distributed.

Develop a generic financial manual, and generic Standard Operating Procedures to

guide implementation of In Service Training
The HRH Project developed generic IST standards of practice and a generic financial
manual and distributed them to the 35 IST Centers. The manuals, which provide
guidance on planning, organizing and monitoring of trainings, will help the centers to
manage the financial aspects of trainings and to deliver quality priority trainings
addressing gaps in health worker knowledge and skills. This in turn will improve the
quality of RMNCH, HIV/AIDS, malaria, and TB health services.

Create a database for in-service training centers

The HRH project provided technical support for the review of a national in-service
training database which will be hosted at the FMOH data center. Once the database is

22 October, 2015 Page 73

fully functional and available to IST centers in the country, data to guide evidence based
decisions will be available regarding the design, implementation and evaluation of in-
service training activities. This will result in the delivery of need based and quality in-
service trainings especially in the areas of HIV/AIDS, TB, malaria, maternal and child
health services.

3.2.2 Build the capacity of RHBs to coordinate regional IST standardization and
institutionalization

Advocacy for Implementation of the IST guidelines

In the second quarter, the HRH project conducted a meeting with the FMOH, RHBs and
other stakeholders, to advocate for
RHBs acknowledged that use of these implementation of the national IST
centers would help them save costs on guidelines and criteria. Discussions focused
health worker training, and enable on the importance of conducting trainings
them to training an even larger number at the selected 35 sites. During the
of workers, resulting in improved meeting, the FMOH officially
access to and quality of HIV/AIDS, TB, communicated its directives related to
malaria, maternal and child health institutionalization of IST to RHB leaders,
services. and urged them to use the 35 selected sites
for all short-term trainings in the respective regions. As a result of this meeting, RHBs
have now begun to conduct trainings in these centers. Examples are below:
 The Amhara RHB has signed a Terms Of Reference (TOR) with 6 IST centers in the
region so that the centers will conduct 70% of the in-service trainings on
HIV/AIDS, TB, MNH, malaria, FP and other priority health conditions in the
coming years. The Regional Health Bureau has allocated over 6 million birr to
the centers.
 The Tigray regional health bureau has also signed a TOR with IST centers at
Mekelle and Axum Universities so that the centers will conduct HIV/AIDS related
trainings for 2,600 health workers in the region in the coming years.
 Upon request from the SNNP RHB, the Hawassa University IST center has
conducted 16 in-service training courses in the area of HIV/AIDS, maternal &
child health and TB from December 2014 to February 2015. The RHB has also
signed an agreement with the university for approximately 20 million birr, for
the provision of relevant IST trainings.

Consultative Workshop – Partnerships between RHBs and IST Centers

In collaboration with the FMOH and ICAP Ethiopia, the HRH project organized a national
consultative workshop in the second quarter to design mechanisms for improving
partnerships between RHBs and IST centers. Representatives from all RHBs and 35 IST
centers participated in the workshop.
In SNNPR, following the workshop, the region developed a joint annual IST plan and
established an IST steering committee.

22 October, 2015 Page 74

Provided Training Skills Training for Mekelle University
The Mekelle University IST Center was provided with support to conduct a training skills
course for 55 Mekelle University trainers. The trainers are expected to provide
HIV/AIDS, PMTCT and other programmatic trainings, and the Center has agreed with the
Tigray RHB to deliver TB, HIV/AIDS and maternal health related trainings to health
workers in the region.

PMTCT Training of Trainers at the Haramaya University IST Center

With the technical support of the HRH project, a prevention of mother to child
transmission of HIV (PMTCT) training of trainers (TOT) course was conducted for 23
potential trainers from the Haramaya University IST center. This training increased the
pool of PMTCT trainers available to cascade the trainings in West Oromia and Harari
region, which will in turn improve the quality of PMTCT services available to mothers
and newborns.

Support a Training of Trainers (TOT) for the ALERT Training Center

The HRH Project supported the ALERT Training Center to organize a 6-day in-service
training skills course TOT for 29 candidate trainers from various IST centers. The
objective of the course was to develop candidate trainers skills in IST planning, and
implementing, managing, and monitoring competencies. The trainers developed a
training cascading plan for TB, HIV/AIDS, maternal health and training skills courses to
be conducted in their respective training centers.

Provide Technical Support for HIV/AIDS TOT Training

The HRH Project provided technical support to the St. Paul Millennium Medical College
and the Menelik II Hospital IST centers in Addis Ababa to organize Anti-retroviral
treatment (ART) and PMTCT TOTs for 27 and 34 potential trainers, respectively, in
collaboration with ICAP Ethiopia. This will increase the IST centers’ pool of trainers who
can deliver standardized ART and PMTCT courses.
In addition, the HRH project supported the conduct of an ART TOT by the
Haramaya University IST center, for 22 potential trainers of the university. These
trainers will be available to provide training to health professionals in West Oromia and
Harar, which in turn will improve the quality of chronic care for HIV/AIDS patients in
West Oromia and Harari Region.

3.2.3 Support the FMOH to Standardize IST Packages

The HRH Project supported the review of the following training packages as per the
course standardization checklist. The course standardization checklist, developed by the
FMOH with the support of the HRH Project, has criteria to assess the quality of content,
teaching and assessment methods and tools in training packages. During the review
process, the FMOH provided comments to be incorporated by the respective course
developers before approval of the materials.

22 October, 2015 Page 75

 1. Prevention of mother to child 10. Health Management Information
transmission of HIV (PMTCT). System (HMIS).
2. Severe acute malnutrition. 11. Cervical Cancer Prevention.
3. Programmatic management of 12. Midwifery Mentoring and
drug resistant tuberculosis (TB). Coaching courses.
4. Advanced leprosy management. 13. Infection prevention for support
5. Integrated TB, TB/HIV & Leprosy staff.
management. 14. Integrated emergency medicine
6. Self-study module of blended TB training.
management. 15. Immunization training
7. Life support in Obstetrics 16. Clinical mentoring
8. Sexually transmitted illnesses 17. Human Resources Information
9. Integrated emergency training System

In addition, the Cervical Cancer Prevention, Immunization in Practice and Inactivated

Polio Vaccine Introduction in-service training packages were reviewed as per the in-
service training course standardization checklist and comments were provided to be
incorporated by the respective course developers. Accordingly, the comments were
incorporated and the three courses have been approved by the Ministry. These
standardized training materials will improve the quality of training provided, and
ultimately improve service delivery.

3.2.4. Support FMOH and FMHACA to develop and Implement a CPD Accreditation
System
In order to continue to provide safe and quality healthcare services, health professionals
must keep themselves current by undertaking continuing professional development
activities. In the last two years, the HRH Project has supported the FMOH to develop a
regulatory framework and implementation guideline for a needs-based and accredited
CPD system. In this reporting period, support to develop national capacity for a planned
and managed CPD system continued.

Support the Food, Medicine and Health Care Administration and Control Authority
(FMHACA) to appoint Accreditors and Providers for CPD
Under the leadership of FMHACA, a CPD accreditation committee has been established,
including representatives from professional associations, training institutions and
development partners. The committee meets regularly to identify CPD providers and
accreditors. A CPD provider is an institution capable of providing need based courses
which are approved by selected CPD accreditors. In the first quarter, the HRH Project
provided technical support to identify 35 In-service training centers, and 30 professional
associations and 7 federal hospitals as potential CPD providers.
In the third quarter, The HRH project continued to participate in the national

22 October, 2015 Page 76

CPD committee and supported the review of applications from 68 potential CPD
providers and eleven Pre-Accreditors. As a result, forty CPD providers and ten Pre-
Accreditors were chosen for providing CPD services. A License certificate will be
provided to each as soon as FMHACA completes the internal processes for licensure.

Develop Standards of Practice (SOPs) for CPD accreditors and Providers

The HRH project supported the development of Standards of Practice (SOPs),
application forms and proposal templates for the accreditation of CPD providers and
accreditors. These tools were used to guide the process of identifying 10 CPD course
accreditors whose role will be to accredit providers and courses. As part of the
continuing education and in service training, the CPD providers are being encouraged to
focus on key priority areas such as family planning/reproductive health, maternal and
child health, HIV, malaria and tuberculosis.

Developed Checklist for CPD Accreditation of Courses

The HRH Project supported FMHACA to develop a checklist to assess the quality of
online courses for the purpose of accrediting international continuing professional
development (CPD) providers. This will help CPD providers and FMHACA to consider
credit points accumulated by health professionals from international CPD providers, and
will allow Ethiopian health professionals to participate in quality international CPD
courses on priority health problems.
In the second quarter, the HRH project provided technical and financial support to
the national CPD committee to conduct onsite accreditation assessments for CPD
providers using the checklist. A total of 57 CPD providers and 9 CPD course accreditors
were assessed and accredited. Many of them are national health professional
associations and private companies. This will facilitate the availability of quality, need
based and relevant professional development courses, thus contributing to improved
delivery of HIV/AIDS, malaria, TB and maternal & reproductive health services.
Similarly, the checklist was used to assess and recognize 81 international CPD
providers for health workers using the assessment checklist. This will facilitate the
process of including international CPD learning opportunities obtained by health
professional as part of their overall CPD requirements.

National Workshop to Orient CPD Providers and Accreditors

In the fourth quarter, the HRH Project provided technical assistance to FMHACA to
organize a national workshop to orient Continuing Professional Development (CPD)
Providers and Accreditors, including 87 participants from professional associations, and
representatives from health science colleges, government in-service training
institutions, and private training institutions.
During the workshop, CPD course requirements and Standard Operating
Procedures for designing CPD courses were discussed with the CPD providers. This will
strengthen efforts to establish a CPD system in the country to continually improve the
competence of health professionals in delivery of quality health services including
Reproductive, maternal & child health and HIV/AIDS, tuberculosis and malaria.

22 October, 2015 Page 77

Provide Technical Support to Strengthen CPD
The HRH Project staff participated in a 4-day experience sharing workshop on health
professionals regulation conducted at FMHACA in collaboration with the College of
physicians and surgeons of Alberta, Canada. Lessons learned were shared with the CPD
Committee members and higher officials at FMHACA with the purpose of improving
health professionals’ regulation.

Conduct Advocacy Workshop on CPD

The HRH Project staff gave a presentation on CPD and IST at a workshop organized by
the FMOH in collaboration with the Cure Hospital. At the end of the workshop, which
focused on rehabilitation, an agreement was reached to develop standardized IST
materials on physical rehabilitation and conduct periodic update trainings for
professionals working in rehabilitation.

Provide Capacity-building Support and Mentorship for FMHACA Staff

The HRH Project provided mentorship support to the Customer Services Directorate at
FMHACA to improve the team’s performance in registration, licensing and re-licensing
of health professionals. The Project also identified gaps in interpreting the national
Continuing Professional development (CPD) guideline and invited two staff from
FMHACA to attend instructional design training. This will increase the ability of the staff
to actively engage in the CPD course review and accreditation process.

Support FMHACA to develop Health Regulatory Sector Transformation Plan

Using preliminary findings from the Health Professional Regulation Study conducted by
the HRH Project, technical support was provided to FMHACA to inform the planning
process for the agency’s five-year health regulatory sector transformation plan. The
findings also helped to revise the targets for a regulatory indicator, ‘percentage of
health professionals re-licensed’.

Provided technical support to FMHACA and Federal MOH to conduct an external

evaluation of Tikur Anbessa Specialized Hospital (TASH) and College of Health
Sciences, Addis Ababa University, Ethiopia
Upon request from FMOH, an HRH Project staff was assigned to lead a team who
conducted a comprehensive patient care quality assessment in Tikur Anbessa
Specialized Hospital (TASH) involving interviews and focus group discussions with staff
and patients. The evaluation report has been submitted to the Office of the State
Minister of Health of Ethiopia.

3.2.5 Develop capacity of professional associations to provide CPD

Conduct Instructional design course for Professional Associations:

The HRH Project provided an Instructional Design Skills course to 22 potential IST course
developers from 11 professional associations in collaboration with the Ethiopian

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Medical Association. At the end of the training participants developed CPD courses in
their respective health science fields. This will strengthen the capacity of professional
associations in developing need based CPD courses for health professionals. This in turn
will improve the quality of health care including TB, HIV/AIDS, malaria, maternal and
child health services.

Advocate for CPD at the Ethiopian Society of Internal Medicine Annual Conference
The HRH project supported the Ethiopian Society of Internal Medicine (ESIM) to
promote the national CPD directives, scope of practice and ethics activities during its
annual conference.

Provide Technical Support to the Ethiopian Public Health Officers Association to

Develop a Strategic Plan
The HRH Project supported the Ethiopian Public Health Officers Association to develop a
three-year Strategic Plan and a 6-month implementation plan during a workshop
organized by the Association. The HRH Project representatives ensured explicit inclusion
of the Association’s role in strengthening health officers’ education, in-service training
and continuing professional development (CPD) in the Strategic Plan.

Support the FMOH to distribute training materials to selected Professional

Associations
To strengthen the capacity of Professional Associations to deliver quality CPD courses,
training equipment/materials such as LCD projectors, printers and flipchart stands were
distributed to the Ethiopian Nursing Association, Ethiopian Medical laboratory
Association, Ethiopian Dentistry Professionals Association and the Ethiopian
Pharmaceutical Association.

Activities Conducted by Seconded Staff at the FMOH

Through the HRH supported staff who are seconded to the FMOH, the following support
was provided in this reporting period:

Support the FMOH to conduct a TOT Training on Mobile Health (mHealth)

In August 2012, the FMOH published the “m-Health Roadmap: Architecture and Design
Workshop Report”, which summarized functional requirements for a national mobile
health platform to support the Health Extension Program and MNCH services. The
FMOH has also developed an Interactive Voice Response (IVR) system to improve the
data exchange practices of HEWs from the community to higher levels.
The HRH project provided technical support to the FMOH for the conduct of a
TOT training on mHealth/IVR, and supported cascading the training to HEWs using the
mobile health platform in 9 regions.

Support the FMOH to Strengthen the use of Telemedicine

In Ethiopia, where 86% of the population resides in rural areas and has limited access to
specialized health care, investments in the use of eHealth to strengthen the health

22 October, 2015 Page 79

system are important. Advances in Information and Communications Technology (ICT)
have enabled telemedicine to be integrated into the routine care of patients, and
coupled with eLearning technologies, to facilitate the exchange of medical knowledge
through virtual seminars, lectures, conferences, and other online educational and
training materials. The HRH project provided technical support to the FMOH to establish
the use of telemedicine as follows:
 Provided technical support for the purchase and installation of telemedicine
equipment;
 Provided technical support for the conduct of onsite training on various health
conditions using telemedicine for 137 Health professionals.
 Supported the FMOH to develop rural/urban site identification for
teledermatology, and created linkages for additional 29 sites. In addition,
consultative sessions between the 2 hubs and 17 spoke sites for the
teledermatology were enabled.
 Supported the FMOH to develop a teleradiology consultation reimbursement
guideline document (the Ethiopian National Teleradiology Strategy
Implementation Plan (2015-2020);

Additional selected inputs include:

- The health system support directorate of the FMOH was supported to improve data
collection, interpretation, and utilization for decision making through developing
weekly and monthly reporting and feedback mechanisms;
- The FMOH’s health system special support directorate was supported to develop
integrated supportive supervision checklists, which will be used to strengthen health
extension program packages including maternal and child health, malaria,
HIV/AIDS, and TB.
- The FMOH was supported technically to conduct the third round of leadership,
management and governance training for 103 district health facilities of Somali
region. Competencies of managers were developed regarding human resources
planning, management, development and training. In addition, logistics, supply,
drugs, information system management skills were addressed.

Support the FMOH to develop a GAVI Health Systems Strengthening (HSS) Proposal
The HRH project provided technical support to the FMOH for the development of a GAVI
health system strengthening (HSS) project proposal. The proposal identified essential
inputs that can facilitate implementation of the FMOH’s soon-to-be-approved working
documents - a 20 year envisioning document, and a five year strategic plan (Health
Sector Transformation Plan (HSTP)). Out of the major areas of focus in the
transformation document, the GAVI HSS support is planned to support three main
objectives in strengthening the Health System;
 Improve Child Health service Delivery through community involvement
 Strengthening the capacity of the National Supply Chain System through
strengthening the Cold Chain and the supply chain, the network system and the

22 October, 2015 Page 80

 regulatory system.
 Strengthening the Monitoring and Evaluation System through strengthening the
HMIS and CHIS.

Result 4: Program Learning and Research Conducted

To be effective, HRH policies and programs must be based on evidence. The HRH Project
supports the FMOH and professional associations to conduct operational research and
document program learning on critical HRH issues using a capacity building approach. In
this reporting period, the following support was provided:

IR 4.1 Research and Evaluation Evidence on Critical Human Resource for Health Issues
Generated

Conduct Data Collection : Study on Health Professionals’ Regulation and Practice in

Ethiopia
The HRH project supported the FMOH and FMHACA to conduct a study on the
regulation of health professionals practice in the country. The aim of this study is to
generate evidence on the existing health professionals’ regulation practice in the
country, which will guide the implementation of relevant guidelines and directives. The
research questions included:
- Identify current CPD practices and institutional capacity of key stakeholders to
provide and regulate continuing professional development in the country;
- Examine current practices in regulation of scopes of practice of health professionals
at different levels of the health care system;
- Assess the existing practices in managing fitness to practice (ethics and competence
review) concerns; and to
- Investigate how registration, licensure and re-licensure are being practiced at
different levels of the country;
Data was collected in March 2015 in 102 randomly selected health facilities, 11 RHBs,
FMHACA, FMOH, 26 health professional associations and 35 in-service training sites. A
total of 554 health professionals were interviewed in selected health facilities to obtain
information on adherence to their scope of practice and how they stay up-to-date.
Findings from the study are expected to serve as inputs to improve the existing
professionals regulatory, licensure and CPD policies.

Technical Reports and Manuscripts – Research Studies

In this reporting period, the HRH Project drafted or finalized technical reports and
manuscripts using data from previously conducted research activities including:

Technical Reports:
 In Year Two, the HRH Project conducted a national study with the aim of
identifying factors related to the health workforce motivation, job satisfaction
and retention in Ethiopia. A technical report summarizing study findings was

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 finalized and submitted to USAID/FMOH.
 A draft technical report summarizing findings from the “Regulation of Health
Professionals Practice in Ethiopia” study has been drafted and will be finalized
and submitted to USAID, the FMOH and FMHACA at the beginning of the next
project year;
 Draft technical reports summarizing findings from the “Task Analysis Study for
Five Cadres – Medical Doctors, Health Officers, Nurses, Medical Laboratory
Professionals and Pharmacy Professionals” have been initiated and will be
shared to respective professional associations for their inputs;

Manuscripts:
 A manuscript titled “How well does pre-service education prepare midwives for
practice: competence assessment of midwifery students at the point of
graduation in Ethiopia” was published in the BMC Medical Education Journal
(open access – see link: http://www.biomedcentral.com/1472-6920/15/130)
 A manuscript titled “Preparing the health workforce in Ethiopia: a cross sectional
study of competence of anesthesia graduating students” has been accepted for
publication in the Education for Health Journal - the editors are finalizing the
publication.
 A manuscript titled “Factors Affecting Turnover Intention amount Nurses in
Ethiopia” has been submitted to the World Health and Population Journal.
 Task Analysis manuscripts for Midwifery, HEWs and Anesthetists are currently
being refined.

Scope of Work Developed: HRH Midterm Evaluation

The HRH project drafted a scope of work for the midterm evaluation in the first quarter.
The purpose of the midterm evaluation is to assess the HRH project implementation
process and document the extent of results achieved against the process, output and
intermediary outcome level indicators presented in the project performance monitoring
plan and implementation plan. The midterm evaluation will cover public training
institutions, private health science colleges, the FMOH, RHBs, ZHDs, sample woreda
health offices, HERQA, FMHACA, TVET agencies (Federal, Oromia, Tigray and Amhara
regions) and 6 implementing partners (Jhpiego, MSH, OU, EMwA, EAA and project
mercy).
In the second quarter, the scope of work was revised based on inputs from USAID
and submitted for approval.

Rapid Assessment: Contributions of the HRH Project towards Priority Health Issues
The HRH Project conducted a rapid assessment to collect data on the Project’s
contribution towards HIV/AIDS, TB, Malaria, and RMNCH services, as well as priority
health worker demand and supply. The assessment was conducted in all regions except
Gambela, and included inputs from 25 health officers, 11 medical doctors, 35 midwives,
41 nurses, 12 Anesthetists and 19 HEWs from 59 health facilities.
Large numbers of people are being served by health professionals whose

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education was supported by the HRH project since 2012. For example, HRH supported
graduates from different cadres reached 3,184,526 people with voluntary HIV
counseling and testing (VHCT) services, of whom 1,196,860 were pregnant mothers.
They also provided ARV services to 82,054 HIV exposed infants (see attached report).

Present Study Findings at the Dutch Working Party on Safe Motherhood and
International Child Health
The HRH Project presented findings from the Student Competency Assessment Study
conducted in Year two at the Dutch Working Party on Safe Motherhood and
International Child Health meeting held from November 26 – 30, 2014. The title of the
presentation was “How well does pre-service education prepare midwives for the world
of work: competence assessment of midwives at the level of graduation”. The meeting
was an opportunity to highlight the health systems strengthening activities being
conducted in Ethiopia.

Present project findings at the Ethiopian Public Health Association Conference

The HRH project made the following presentations at the 16 th Ethiopian Public Health
Association (EPHA) annual conference held in the second quarter.
- Educational Standards to Improve Health Professional Training
- Developing Master of Public Health Programs in Human Resources for Health
Management and Health Economics in Ethiopia
This was an opportunity to share key findings with the participants, and increase
visibility of the project activities.

4.2 Build Local Capacity in M&E and Research focusing on HRH

In an effort to build local capacity for the conduct of high quality research on relevant
HRH related issues, the HRH project has been working with the Amhara, Tigray and
Oromia RHBs, as well as selected professional associations, to implement the following
research activities:

Support Amhara and Tigray RHBs to conduct a study on assessing the competency of
midwives in the health facilities of the regions
In response to a request from the
It is expected that findings from this
Amhara and Tigray regional health
study will be used to develop
bureaus, the HRH project provided
recommendations for strengthening
mentorship and guidance for the conduct
both the in-service and pre-service
of a study to assess the competency of
training for midwives in these regions,
midwives working in the regions. The
ultimately increasing access to quality
aim of this study was to assess
maternal and child health services for
performance of midwives in the provision
women and children.
of care during labor, childbirth and the
immediate postpartum period. The study also aimed to identify current gaps in the work
environment that influence performance during provision of labor and delivery services.
Data were collected in February 2015 in 56 randomly health facilities (19

22 October, 2015 Page 83

hospitals and 37 health centers) in Amhara and 59 randomly selected health facilities
(13 hospitals and 46 health centers) in Tigray. A total of 150 midwives in Amhara and
144 midwives in Tigray were observed by proficient assessors.
An abstract highlighting findings from data collected in Amhara was submitted for
oral presentation at the Amhara RHB Annual Research Conference. An abstract was also
submitted for presentation at the upcoming Ethiopian Midwifery Association annual
general assembly meeting planned for October 2015.
Technical reports documenting findings from the two regions will be finalized in
the next project year.

Support Health Professional Associations to conduct a Task Analysis Study for Five
Selected Cadres
The HRH project supported the FMOH and 5 health professional associations to conduct
a task analysis study for five cadres (medical doctors, health officers, nurses, medical
laboratory professionals and pharmacy professionals). The purpose of the study was to
assess the needs and gaps in the education, practice and competencies of these cadres.
In the first quarter, data collection tools were finalized and ethical clearance was
received from the Johns Hopkins University IRB. Data was collected in February 2015, in
more than 65 hospitals and 93 health centers across all regions. A total of 192 medical
doctors, 213 health officers, 223 nurses, 228 medical laboratory professionals and 235
pharmacy professionals were interviewed. Preliminary results for medical doctors and
health officers were produced, and used to inform blueprints for licensure examination
development for these cadres. The findings from the study will be used as inputs for
licensure, curriculum revision and design of in-service training courses.

Draft Study Protocol Developed: Competence Assessment of Level IV Health

Extension Workers in Oromia
The HRH project is supporting the Oromia RHB to develop a study protocol to assess the
competence of Level IV HEWs in the region. The aim of this study is to assess selected
HEW competencies focusing on HIV, maternal, child and newborn health. These findings
will be used to inform programmatic efforts to strengthen the pre-service education and
integrated refresher training of HEWs, which will in turn improve the quality of
healthcare services in the region. A total of 120 Level IV HEWs and 18 HEWs supervisors
will be assessed. The protocol will be submitted to the Johns Hopkins University (JHU)
IRB for ethical review and approval.

Support the Federal Ministry of Education and Federal Ministry of Health to Establish
a Student Tracking System
In the second quarter, the HRH project provided financial and technical support to the
FMOE to initiate the process of establishing a student tracking system at Universities.
Specific inputs included supporting the higher education directorate of the FMOH to
conduct a needs assessment and collect information on the prerequisites required for
developing the student tracking database. This included a desk review and onsite
assessments at 4 HEIs. The draft document outlining the requirements for the student

22 October, 2015 Page 84

tracking database is in the process of review and will be finalized in the next project
year.

Support the FMOH to Develop an In-Service Training Database

In response to a request from the FMOH to develop a standardized in-service training
database, the HRH project participated in four consecutive meetings with the FMOH,
CDC, ICAP and Tulane to discuss and recommend database options for tracking in-
service training (IST) participants in the first quarter. The HRH project provided technical
support in identifying IST data elements for discussion. The team proposed to customize
the existing HRIS database to include the IST data elements. The HRH project will
contribute for the development of standard operating procedure after the
customization of training database by Tulane.

Conduct Annual Data Quality Assurance Assessments using Routine Data Quality
Assessment (RDQA) tool
The HRH Project conducted a Data Quality Assessment (DQA) in 18 training institutions
(4 universities and 14 regional health science colleges) supported by the Project. The
purpose of the DQA was to verify reported data, review the existing system for routine
data recording and reporting in the targeted training institutions, and to utilize findings
to provide recommendations to training institutions for improvement and maintenance
of quality data.
The DQA verified the reported data on two selected standard indicators:
1. Number of new Health Care Workers (HCW) who graduated from a pre-service
training institution or program as a result of USG-supported strengthening
efforts. In this category; graduates of midwifery, anesthesia and emergency
medical technician programs are assessed.
2. Number of community health and para-social workers who successfully
completed a pre-service training program” In this category; community health
workers i.e health extension workers who trained at level III and level IV
program were assessed.

The assessment also reviewed data management systems and processes to assess
proper flow of information as well as documentation in registrar offices of selected
education institutions. Findings from the DQA include:
 The number of health care worker graduates reported and recounted figures
were 1,586 and 1,445 respectively which is an 8.89% margin of error. The data
quality rating is within the acceptable range (5%-10%).
 For HEW graduates, reported and recounted figures were 2,754 and 2,758
respectively with a 0.15% margin of error. This margin of error is less than 5%
showing adequate reporting quality.
 All the institutions have computers and related materials for recording and
keeping student information but they lack an adequate system and trained
personnel to record and report quality data. Registrar office personnel need
support to build their capacity on computer use and close follow up so that the

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 M&E system can provide reliable, valid and timely data.
Document effectiveness of HRH project at pre-service education institutions:
To document progress in improving the quality of education as a direct result of inputs
from the HRH Project, data was collected at all HRH project supported Universities,
Colleges and stakeholders such as regional COC agencies. A semi-structured tool was
developed to guide the data collection, and it included questions on:
• HSEDC establishment and institutionalization,
• Faculty development,
• Improving the quality of curricula,
• Building the capacity of simulation centers,
• Availability of educational and ICT resources (books and computers),
• Improving clinical education,
• Improving gender activities,
• Strengthening in-service training centers, and
• Improving the capacity of FMOH, FMHACA, RHBs and HERQA
A report summarizing findings from the data collection will be finalized in the next
project year. The findings will help to consolidate efforts in the coming two years.

Integrated Supportive Supervision - Oromia and SNNPR RHBs

In preparation for Integrated Supportive Supervision in Oromia region, the HRH project
provided technical support for review and revision of the existing ISS checklist. Revisions
included adding new HRH related indicators on HR structure and staffing, HR planning,
HR guideline and policy document availability, HR data management, HR development,
motivation and retention and information sharing and communication. The updated
checklist was then used to conduct ISS in the region in all zonal health departments, and
selected town health offices. Key findings include:
- Promising efforts in filling HR vacant positions at WoHOs observed;
- Most ZHDs and WoHOs routinely reviewed their HR plans, completed performance
appraisals according to the BSC and provided feedback to their staff;
- Trainings were provided on HRIS and software was installed at zonal health
departments and town health offices;
Similar support was provided to the SNNP region, where visits were made to 7 WoHOs.
Key findings included:
- The Human Resources Data & Statistics units visited have a weak HRIS system;
- Most of the WoHOs have now instituted an employee orientation program.

Joint Supportive Supervision - Training Institutions

The HRH project provided financial and technical support to the FMOH to conduct joint
supportive supervision in 13 training institutions in the first quarter and 7 training
institutions in the second quarter. The supervisory team included representatives from
the FMOH, the Federal Ministry of Education, and the HRH Project. The team visited
midwifery, anesthesia, health extension, health informatics and emergency medical
technician training programs, with the objective of:
- Assessing the implementation of the health professional training programs as per

22 October, 2015 Page 86

 national educational standards,
- Assessing the extent of effective coordination, collaboration and integration among
teaching facilities, RHBs and health facilities.
Selected key findings include:
- The institutions have established an internal quality assurance framework and are
conducting regular self-assessment on the progress of educational quality
improvement using the standardized HERQA tools;
- There continues to be a high turn-over of faculty, which contributes to teachers
having a limited role in assessing practical training.
- Some training institutions have created mechanisms to motivate and improve
performance of health facility preceptors through providing them with trainings on
clinical teaching skills, technical updates, and awarding scholarships for career
development through summer and extension education programs.
- Regional Health Science Colleges are receiving support from several partners
including the HRH project, AMREF, UNFPA, ICAP and Tulane, particularly for HEW,
health informatics and emergency medical technician training – these inputs should
be coordinated.
At the end of each visit, discussions were held with the university or college
management, the HSEDC focal person and department heads to provide feedback,
technical recommendations and develop action plans.

Conduct monitoring visits to Regional Health Bureaus

The HRH project conducted monitoring visits to all RHBs (except Addis Ababa and Afar)
during the reporting period. The aim of the visits was to mentor human resource
support core process owners and human resource management officers on project
documentation, branding and performance tracking. Key findings include:
- HRIS is not functional in most of the RHBs due to a lack of trained personnel and
computers. The RHBs have requested partners for support to increase the
functionality of the HRIS.
- Emerging regions (Somali, Benshangul Gumuz and Gambela) have challenges in
hiring qualified professionals in the HR department, which has resulted in poor
documentation of personnel files and a weak individual performance appraisal
system.
The team provided onsite feedback to address identified gaps.

Conduct regular follow-up at Midwifery, Anesthesia, HEW, Biomedical Technician, &

EMT training institutions to monitor project activities.
In the first quarter, the HRH project conducted regular follow up through phone calls
and onsite visits. A total of 26 training institutions (12 in Amhara, 4 in Oromia, 6 in
Tigray and 4 in SNNP), were monitored and provided with follow-up to support the
implementation of activities in the HSEDCs and gender offices.
In the second quarter, regular follow up via phone and onsite visits were
conducted at 38 training institutions to provide technical support and follow-up the
progress of HSEDCs, and educational quality improvement. Ongoing monitoring

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activities will contribute to building the capacity of institutions and faculty members to
provide quality education to health professional students, ultimately resulting in the
production of competent health workers who will provide safe MNCH, FP, TB, HIV/AIDS
and Malaria services.
Findings indicate that HSEDCs have begun to support performance of faculty and
preceptors through providing need-based technical updates, and awarding scholarships
for career development.

Conduct Supportive Supervision visits at 7 RHBs and 31 In-Service Training (IST) sites
In the second quarter, the HRH Project conducted supportive supervision visits at 7
RHBs and 31 in-service training centers to strengthen IST standardization and
institutionalization. Key findings include:
- Most IST centers have started organizing and conducting various courses on priority
health issues such as Basic Emergency Obstetrics and Newborn Care (BEmONC),
long acting family planning methods, TB, malaria, and HIV/AIDs.
- Non-governmental partners and governmental institutions have started using these
IST centers for trainings.
- Centers have begun using the standardized IST courses, national IST directives,
manuals and project management documents.

In addition, the HRH project supported the Amhara RHB to conduct supportive
supervision at six In-Service Training sites with the objective of advocating for and
strengthening the status of IST centers in the region. Key findings include:
- All sites have the national IST guideline and manual and almost all have assigned a
focal person (either the academic vice dean or HSEDC focal person) to lead the
process;
- All the sites visited are using the IST center for both internal and external trainings;
- Five of the sites have established a well-furnished training center which can
accommodate more than 30 participants for various trainings;

Technical support provided to Oromia RHB to conduct Hospital Supervision and

Evaluation:
The HRH Project provided technical support to the Oromia RHB for supportive
supervision and evaluation of three hospitals: Abomsa, Robe-dida’a and Bishoftu. The
supervision and evaluation was conducted using a comprehensive checklist containing
elements related to the Ethiopian Hospitals Reform Implementation Guide (EHRIG),
referral systems, Maternity issues and Clean and safe Hospitals. The results showed that
there were gaps in the implementation of HRM functions – there was no comprehensive
HR plan, incomplete HR policy documents, no strong performance appraisal system and
employee files were not complete with all necessary documents. Appropriate corrective
measures were forwarded from the supervising team.

Collect Annual HRM performance data from RHBs, ZHDs, and WoHOs
Using a standardized data collection tool, annual HRM data collection was conducted at

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10 RHBs (except Harar as the RHB focal person was unavailable), 26 ZHDs, 49 WoHOs
and 5 Hospitals. The objective of the data collection was to assess the implementation
status of human resource management practices, and identify major gaps and
challenges in HRM implementation. Key findings from all the regions are summarized
below:
Improvements were observed in implementation of HRM practices, including
availability and utilization of comprehensive regional HRDM policy documents,
availability of updated employee job descriptions in 95% of organizations visited, and
staff requirement plans available in 88% of organizations visited; provision of housing
for health professionals to improve retention and motivation (Gambela); allocation of
non-salary budgets to support HRM activities (Oromia); and improvements in the
educational profiles of HRM staff (E.g., SNNPR, where 77% of existing HR staff have a
bachelor’s degree in an area related to HR management). In Tigray, the RHB has a CPD
plan for critical cadres such as HEWs – in the last EFY 2007 (2014/2015), the bureau
trained 333 level III and level IV HEWs.
Gaps identified included turn-over of HR staff, weak HR data collection and
utilization, staff absenteeism (Somali), and a lack of budget allocation for non-salary
HRM support in some regions.
Overall, from the data collected, there are currently 155, 305 health workers (9626
Midwives, 545 Anesthetists, 36,319 HEWs, 477 EMTs and 122 biomedical technicians) in
the regions, except for Harari whose data was not available at the time of data
collection. Over 1,584 health workers formally resigned in the reporting period.

Collect Annual HRH performance data collection from training institutions

The HRH Project collected data from 54 higher education institutions that have been
receiving support from the project (28 Universities, 25 HSCs and one private college).
The data collection tool used captured relevant information such as: the type and
number of students enrolled in each year, number of graduates in the academic year,
dropout rates, number of students who took the COC exam and passed in the year,
availability of skill labs and preceptors, and functionality of gender offices established in
the institutions.
In the September 2014-July 2015 academic year, a total of 6,435 students
graduated from 20 universities and 21 health science colleges (see table below).
Compared to the last two years of project implementation newly enrolled students in
Anesthesia, HEW level III, HEW level IV and other essential cadres such as emergency
medical technicians and biomedical technicians have significantly increased.

Table 1: Number of Graduates by Cadre, FY 14

Institution Midwifery Anesthesia HEW Level III HEW level IV EMT
type (upgrading)
University 1124 146 - - -
RHSC 985 48 1778 2302 52
Total 2109 194 1778 2302 52

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Fig. 1: HRH Project supported institutions – total number of graduates per cadre,
planned 5 year targets versus 3-year achievements.

Figure 2: HRH Project supported institutions – total number of students enrolled by

year, 2013 - 2015

Four training institutions; Jima University, Adama University, Wolayita Sodo University
and Menilik HSC have started Nursing Specialty Programs in Neonatal Nursing,
Emergency Nursing and OR Nursing. A total of 155 students were enrolled in the last
academic year. The post graduate programs in HRM and Health Economics are currently
being implemented at the Addis Continental Institute of Public Health (ACIPH), Jimma
and Gondar Universities with a total of 76 students enrolled in the year. A detailed
report of the annual data collection is attached in the Annexes.

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7. Challenges and Constraints and plans to overcome them during the
reporting period

Quarterly challenges and Constraints for each program area

Major Challenges during the Quarter
 Shortage of instructors and skills development lab equipment for newly opened
nursing specialty trainings (ICU, OR, and Neonatal Nursing);
 The HSEDC is not integrated into the organogram of some health science
colleges, which minimizes their ability to make decisions and effectively work
according to their mandate.
 In Gambella, the Project was unable to conduct HRM Training follow up and
mentorship at the Zonal Health Department, Woreda health office and facilities
level due to security problems in some parts of the region.
 In SNNPR, a recent change has been made that requires students to have
evidence showing that they have passed Level-II, Level-III, & Level IV COC
training. This new requirement came into effect after the Project Mercy College
had enrolled the 1st group of 17 midwifery students. Since this was not the
requirement at the time of their enrollment, many of these students don’t not
meet this new standard.
Plans to overcome challenges and constraints in each of your program areas
 The HRH project will advocate with the FMOH and relevant institutions for the
hiring of experienced instructors, and will build the capacity of existing ones;
 The issue of integration of HSEDC in the organogram of Health Science Colleges’
structure was discussed during the HRH forum, resulting in an agreement that
the appropriate revisions will be considered during the upcoming government
planning period.
 Ongoing monitoring of the security situation will continue, and local staff trained
to conduct supportive supervision.
 Project Mercy has made arrangements to allow the currently enrolled students
to continue under the standards in which they enrolled into the program. The
next group of students will have to meet the new standards. This means that it is
likely to be challenging to find enough students to meet enrollment targets.
However, efforts will be made to recruit both from the SNNP region, as well as in
other regions.

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8. Data Quality issues during the reporting period

Specific concerns you have with the quality of the data for program areas reported in this report
During data collection for the research studies, there were some missing responses and
unavailability of eligible study participants.
What you are doing on a routine basis to ensure that your data is high quality for each program area

 Deployed supervisors from the HRH project to ensure data quality

 Supervisors supported data collectors to check missing variables.
 Unavailable study participants were replaced from other selected health facilities
How you planned to address those concerns / improve the quality of your data for each program area
 Deployment of trained and experienced supervisors and data collectors
 Feasibility assessments should be required to minimize unavailable study
participants

9. Major Activities Planned in the Next Reporting Period

Result Area One: Improved Human Resources for Health Management

HRH4-001 Provide technical and financial support to the FMOH and RHBs to
implement HRM Capacity Assessment Plans through semi-annual
supportive supervision visits (to Regional Health Bureaus (RHBs), Zonal
Health Departments (ZHDs) and selected districts)
HRH4-015 Provide technical & financial support to RHBs to conduct Balanced Score
Card (BSC) Training for ZHDs & WHOs
HRH4-037 Conduct quarterly post-HRM In-service training follow up for HRM
training participants (100 in Q1)
Result Area Two: Increased Availability of Midwives, Anesthetists,
Health Extension Workers, and other Essential Health Workers
HRH4-054 Print, laminate and distribute anesthesia practice standards and
protocols
HRH4-060 Review and revise the generic Bachelor of Science (BsC) anesthesia
curriculum to address core professional competencies
HRH4-061 Using the nationally endorsed anesthesia education standards, provide
mentorship and coaching to Anesthesia Teaching Institutions,
supporting them to use the standards to improve quality of education
HRH4-092 Conduct mentorship training for senior midwives from health facilities
which also serve as clinical practicum sites
HRH4-094 Conduct a 4-day Instructional Design (ID) skills training and curriculum
revision for curriculum reviewers
HRH4-096 Mentor and support midwifery schools to assess and improve the
quality of education using national midwifery education standards
HRH4-101 Provide technical and financial support for the annual EMwA General
Assembly (Annual Conference)

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 HRH4-110 Support the Oromia RHB to train 300 midwives in the region
(upgrading), by providing tuition fee support
HRH4-111 Support the FMOH/TVET to provide a 6 day Effective Teaching Skills and
curriculum orientation training for newly hired HEW instructors
HRH4-119 Contribute to the FMOH 2-day Annual Forum for Regional Health
Science Colleges. During the forum, performance of anesthesia,
midwifery, HEW, biomedical technician, EMT, and nursing specialty
training will be reviewed.
HRH4-130 Provide financial and technical support to the FMOH to review and
finalize the Level IV biomedical technician modules developed in the
previous project year.
HRH4-159 Conduct a 3-day ID training and 5-day curriculum development
workshop for Psychiatric and Ophthalmic Nursing
HRH4-162 Provide mentoring and coaching to improve the quality of nursing
specialty education
HRH4-389 Provide tuition fee support for students enrolled in the programs
Result Area Three: Improved Quality of Training of Health Workers
HRH4-183 Provide semi-annual mentoring and coaching visits to HSEDCs to
promote a culture of program specific self-review using education
standards
HRH4-245 Customize open source software to be used by COC Centers for online
assessments
HRH4-226 Support HERQA to strengthen its data center by procuring a server, and
other essential networking material
HRH4-251 Procure a server to support item banking and online testing
HRH4-275 Provide technical support for the assessment of potential IST centers
HRH4-341 Support the Federal FMHACA to develop a ‘model Health Professionals
Regulation (HPR) practices’ project concept targeting 15 model public
health institutions from eleven regions
HRH4-343 Provide technical assistance to FMHACA, eleven RHBs and model health
institutions to develop a 'modeling HPR practices' project monitoring
and reporting tool
HRH4-360 Provide technical and financial support to FMHACA to assist eleven
RHBs and region-level FMHACA bodies to establish/strengthen regional
ethics committees
Result Area Four: Monitoring and Evaluation, Program Learning and
Research
HRH4-302 Conduct a high level dissemination workshop to present key findings
from HRH supported studies to key stakeholders (FMOH, RHBS,
Universities, Colleges, etc)
HRH4-312 Support Amhara and Tigray Region to conduct a manuscript writing
workshop using data from the Competency Assessment of Midwives
Study

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 HRH4-316 Conduct Joint Supportive Supervision (JSS) in collaboration with the
FMOH, RHBs and TVET at selected training institutions and in-service
training centers, and collect outcome monitoring data (HEW,
Anesthesia, Midwifery and other Essential Cadres)
HRH4-317 Provide ongoing program monitoring visits or follow-up over the phone
at training institutions, RHBs, ZHDs, and IST centers
HRH4-296 Support Professional Associations to conduct manuscript writing
workshops to draft manuscripts using data from a Task Analysis Study
for 5 cadres (Medical doctors, Health Officers, Nurses, Pharmacists, and
Medical Laboratory Scientists).

10. Environmental compliance

Describe any issues related to environmental compliance (if there are any)

Not applicable in this quarter

11. Financial accomplishment

(… in USD)

Life of Project Obligated Expenditure Remaining Remarks

budget to date (Accrual and actual balance
disbursement)
(a) (b) to date (d) = (b) – (c)
(c)
$55,000,000 $30,676,953 $28,901,618.62 $1,775,334.38

12. Issues requiring the attention of USAID Management

Identify and state issues that USAID needs to look at and address for each program area
N/A

13. Data Sharing with Host Government:

Have you shared this report with the host government?

Yes
No

If yes, to which governmental office/s?

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The report from the past quarter was shared with the Federal Ministry of Health and RHBs; This report will
be shared with the relevant governmental offices, according to government reporting timelines set for non-
governmental organizations.

If No, why not?

[Please put your response here]

Have you made data reconciliation with respective regional sectoral office/s?

Yes X
No

If yes, to which regional sectoral office/s? Were there any issues that came out from the reconciliation?
How these issues were handled/ will be handled?

HRH intervention training institutions

If no reconciliation was made, what are the reasons for it?

[Please put your response here]

14. Appendices

(Include any relevant documents, data etc as appendices)

1. Amhara National Regional State Health Bureau – Regional Human Resources for Health (HRH)
Annual Profile/Report
2. Federal Democratic Republic of Ethiopia Ministry of Health – Human Resource for Health
Strategic Plan (2009 – 2025)
3. Rapid Assessment Report
4. Annual Data Collection Report

22 October, 2015 Page 95