Developing an innovative primary health care system for pastoralist community

Pastoralists in Ethiopia constitute about 15% of the over 86 million people. Although pastoralists are socio-economically important segment of the population, they are subjected to harsh environment and extreme poverty with poor infrastructure and social services. As a result pastoralists have poor health status with high infant, child and maternal deaths. Cognizant of the challenges and socioeconomic importance, there have been continental and national efforts to improve the livelihoods of pastoral people. Ethiopia introduced a community-based Health Extension Program (HEP) in the pastoral areas to address the poor health status and achieve equitable health outcomes. The HEP model, which was originally designed and piloted in 2004 for adaption to the context of the agrarian sedentary population, was introduced into pastoral areas with minor adjustments on human resource taking into account the cultural context, language and scarcity of high-school graduates.
Although there has been a significant improvement in the performance of the health system in the country, the impact has been less successful in the pastoral areas demonstrating that the adaptation of the HEP model to pastoral areas was not based on adequate consideration to the local context. We propose to follow the following steps to develop an appropriate public health interventions for pastoral settings: 1) description of the local context including existing health systems; 2) selection of potential interventions; 3) testing interventions (feasibility, acceptability and efficacy); 4) formulation of appropriate public health intervention; 5) implementation at a scale; and 6) monitoring effectiveness and adequacy.
The purpose of this 'development grants' proposal is to address the first two steps, which will be used to develop a well-informed research project (moving forward through the steps) for submission to the 'full-scale research project grants'. We aim to describe the morbidity patterns, characterize the context and identify health determinants, and address the question as to what are the most appropriate interventions for pastoral areas. We will describe the wider context and barriers to service delivery to inform the design of strategies that ensure acceptability and service utilization addressing the question as to how to most effectively delivery health interventions building on existing structures. We will also explore existing venues that are potentially adaptable for service delivery in the pastoralist setting and address the question as to how to most effectively delivery health interventions using existing social events and services.
The study will be conducted in Borona zone, Oromia region. It will involve documentation and analysis of contextual factors and existing health services. The research will employ basic epidemiological study based on health facility records and registers, and community level surveys. Behavioral and social processes that put the pastoralist community at high risk will be described through qualitative study. Process evaluation will be conducted through case-study approach to thoroughly examine the underlying context at various levels of implementation and stakeholders using key informant interviews and Community Focus Group Discussions. The designing process of potential health interventions will involve community participation, adoption of innovative and adaptive approaches, and consider cultural sensitivity.
The study will contribute to achieving equitable health outcomes and the MDGs in Ethiopia and beyond, and to ensure the widest use of the research findings, we aim to establish a collaborative partnership involving policymakers and relevant stakeholders. Results of the research will be communicated through presentations in national and international conferences, publications, the Internet, and mass media.

Technical Summary

To address the high child and maternal mortality rates, Ethiopia introduced a community-based Health Extension Program (HEP) in the pastoral areas. Despite this initiative the impact has been less successful demonstrating that the adaptation of the HEP model did not consider the pastoral context. We aim to describe the pastoral context in terms of the morbidity patterns, identifying risk factors and health determinants, and address the question as to what are the most appropriate intervention packages for pastoral areas. We also aim to describe the wider context and barriers to service delivery and explore existing venues that are potentially adaptable for service delivery in the pastoralist setting addressing the question as to how to most effectively delivery health interventions building on existing structures and social events. We also aim to use this information to identify possible interventions for the pastoral context. The ultimate objective of this 'development grants' project is to provide information for the development of a well-informed research project for submission to the 'full-scale research project grants' with the aim of testing potential interventions and formulating appropriate public health intervention.
The study will be conducted in Borona zone, Oromia region. It will involve documentation and analysis of contextual factors and existing health services using basic epidemiological study and case-study approach based on key informant interviews and Community Focus Group Discussions. The potential health interventions will be designed through community participation, and adoption of innovative and adaptive and culturally sensitivity approaches. The study will contribute to achieving equitable health outcomes and the MDGs in Ethiopia and beyond. A collaborative partnership involving policymakers and relevant stakeholders will be established to ensure the widest use of the research findings.