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My summer internship

During my summer internship, I was privileged and grateful to get the opportunity to join the team of experts that are developing Implementation Science (IS) an Implementation program for Family Planning at the WHO Collaborating Center for Research Evidence for Sexual and Reproductive Health at the University of North Carolina, Chapel Hill. The program will spearhead the use of the evolving field of IS and implementation-related disciplines (including design thinking, operations management, behavioral change and organizational change management, and implementation and improvement science) to systematically generate solutions for the implementation of family planning strategies and practices.  This will enable policy makers to identify high impact strategies and determine the level of investment required to promote the implementation of such practices. It will also assist funders to establish the accountability framework based on demonstrated sustained performance of these strategies. It is believed that IS will support providers in discharging valued and quality services to clients; and finally it will empower implementation agencies to strengthen their abilities to continually improve program performance and provide the scientific underpinning for the design and implementation of best implementation practices in family planning services.

After I had a very important and interesting discussion with my research team members, the Ethiopian Health Extension Program (EHEP) was selected as a case study for my summer internship. There are a number of justifications for this. Firstly, before I came to the US, I worked as a Consultant to the Federal Ministry of Health and other organizations in the design, development, and evaluation of maternal health programs. In addition, I was also involved in the development of training curricula for maternal and child health care services in general, and family planning information and services for EHEP in particular. Secondly, the EHEP has been identified by the global health community as a high impact practice to increase access to modern contraceptive methods. This was highlighted in April 14, 2014, at a USAID webinar in Washington DC, held by leading authorities under the title: “Ethiopia’s Investments in Family Planning – Lessons for U.S. Policy.”

It has to be noted here that Ethiopia’s health sector challenges are multi-faceted. As a resource poor country, Ethiopia has poor reproductive health indicators, which include, maternal and child health and family planning, among others. Maternal mortality remains one of the highest in the world, due partly to the fact that only less than 10 percent of pregnant women deliver with the help of skilled attendants. The other 90 percent and more mothers are dependent upon traditional birth attendants and relatives. Among women and married adolescents, the unmet need for family planning remains very high-33 percent. Moreover, harmful traditional practices such as child marriage, abduction and female genital mutilation/cutting (FGM/C) put adolescent girls at risk of developing negative reproductive health outcomes while pregnant and during childbirth.  In 2004, the government of Ethiopia launched an ambitious but innovative community based health care delivery program, which was referred above as EHEP to bring basic primary and preventive health care services to all, including to communities that reside in hard-to-reach rural areas. Ten years of EHEP implementation resulted in rising awareness about the importance of delaying child marriages, and the availability of family planning information and services. The other achievement of EHEP could be attributed to the sharp reduction of under-5 child mortality, which enabled Ethiopia to meet Millennium Development Goal 4.

The summer internship is expected to provide a prototype for the program using EHEP as a best practice for family planning in order to provide an implementation roadmap; develop basic assessment and management tools to support its implementation; and develop advanced analytical tools to support decision-making, forecast, and resource allocation for EHEP. Working on this program in the summer will help me gain the IS expertise that is needed to implement, sustain, and scale-up the EHEP.  Furthermore, I will also be able to reverse engineer the implementation systems for EHEP to include processes, organizations, equipment, facilities, technology, etc. to achieve required outcomes. I will also be in a position to develop assessment tools for readiness to adopt, adapt, and incorporate EHEP in the health system. Finally, I would also be able to develop, test, and utilize tools to monitor the performance of HEP, sustainability, and scalability.

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