Enhancing Health through Self-Care: A New Initiative in Ethiopia
Self-care is defined as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability, with or without the support of a healthcare provider. The new guidelines, endorsed by the Ministry of Health, provide a comprehensive framework for implementing self-care interventions in Ethiopia. They emphasize the importance of integrating self-care into the existing health system rather than replacing direct healthcare provider interactions.
The scope of self-care encompasses a broad range of activities, including health promotion, disease prevention and control, self-medication, care for dependent persons, and seeking necessary hospital or specialist care. Key areas of focus include maternal health, family planning, adolescent and youth health, neonatal and child health, immunization services, and nutritional interventions. Each of these areas is addressed through tailored self-care practices designed to empower individuals and communities.
The rationale for promoting self-care is clear: health systems worldwide are strained by the increasing demand for responses to public health emergencies, affecting access to essential health services. By 2030, a global shortage of 18 million health workers is anticipated, and currently, 400 million people lack access to the most basic health services. In Ethiopia, self-care is seen as a critical strategy to mitigate these challenges and ensure that health services reach all segments of the population, particularly in humanitarian and crisis-affected settings.
To implement these self-care interventions, the guidelines outline several key considerations, including gender dimensions, health system tier structures, capacity building for healthcare providers, and ensuring access to necessary medical supplies and products. Social and behavior change communication (SBCC) is highlighted as an essential component of promoting self-care practices within communities.
Specific self-care interventions are detailed for various health domains. For example, in maternal health, non-pharmacological methods for labor pain management, postnatal care practices such as early ambulation and wound care, and measures to address common physiological symptoms during pregnancy are included. Family planning interventions promote the use of over-the-counter contraceptives, self-administration of injectable contraceptives, and pregnancy self-testing. Adolescent and youth health interventions focus on providing SRH information through digital technologies and community awareness programs.
The guidelines also address neonatal and child health, emphasizing the promotion of positive mental health for mothers and caregivers, education on managing common childhood illnesses, and interventions to prevent neonatal and childhood emergencies. Immunization services are enhanced through education on vaccine-preventable diseases and self-detection of adverse events following immunization. Nutritional interventions include education on healthy eating, prevention and treatment of maternal malnutrition, and breastfeeding support.
Implementation of the self-care guidelines involves a multi-faceted approach, leveraging health education, digital technologies, community conversations, and continuous supply of necessary commodities. Monitoring and evaluation will be conducted at regional and national levels, with specific indicators for each self-care intervention to assess their impact and effectiveness.
ESOG, in collaboration with the Ministry of Health and other stakeholders, will play a pivotal role in promoting and supporting these self-care initiatives. By empowering individuals and communities with the knowledge and tools to manage their health, we aim to reduce the burden on the healthcare system and improve health outcomes across Ethiopia. This initiative represents a significant step towards achieving universal health coverage and enhancing the well-being of all Ethiopians.
The Ethiopian Society of Obstetricians and Gynecologists (ESOG) is delighted to report the successful commencement of the Clinical Skills Improvement Training under the FIGO LDI:REACH Project—Removing Barriers to Effective Access and Coverage of Maternal Health.
On July 3, 2024 a significant training session was conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC), focusing on enhancing the knowledge and skills of healthcare providers in managing postpartum hemorrhage (PPH) using EMOTIVE, the WHO's first response bundle care, including the administration of tranexamic acid (TXA).
The training also covered the administration of antenatal corticosteroids (ACS) to prevent lung immaturity and its consequences in premature babies, aiming to reduce maternal and neonatal morbidity and mortality.
Other sessions are also continuing at other locations. On July 5 and 6, 2024 the training is held at Marie Stopes Ethiopia Gotera MCH Center (MSI). Following these, additional sessions will be conducted at Adare General Hospital in Hawassa and Welkite University Specialized Hospital in Welkite in the coming weeks.
These sessions are designed to provide practical, hands-on experience to doctors, midwife nurses, clinical nurses, and other healthcare providers from FIGO LDI:REACH sites and their respective catchment health facilities. This initiative is a crucial step in the FIGO LDI:REACH Project’s mission to enhance maternal health care and outcomes across Ethiopia by equipping healthcare providers with the latest skills and knowledge.
Drawing upon the principles outlined in the Leadership Development Initiative under the FIGO LDI:REACH program, supported and overseen by the International Federation of Gynecology and Obstetrics (FIGO), the training is aimed to equip participants with the necessary skills and knowledge to drive positive change in maternal and neonatal healthcare delivery.
The Ethiopian Society of Obstetricians and Gynecologists (ESOG) participated in the launch of the new and revised Maternal Health Policy Documents. The event, organized by the Ministry of Health (MoH), was held at the Hyatt Regency in Addis Ababa on June 27, 2024. This significant milestone marks a major step forward in enhancing maternal health services across the nation.
The guidelines launched on the event include National Intrapartum Care Guideline, National Guideline on Management of Hypertensive Disorders of Pregnancy, Integrated RMNCAYH-N Catchment Based Clinical Mentorship Guideline (Second edition), Integrated RMNCAYH-N Catchment Based Clinical Mentorship (Pocket Guide 1st Edition), National RMNCAYH-N Self Care Intervention Guide, Technical and Procedural Guideline for Abortion Care Services in Ethiopia, Confidential Enquiry into Maternal and Prenatal Mortality and Morbidity, Emergency Preparedness and Response Guide for Sexual and Reproductive Health in Emergency Situation, National Preconception Care Guideline, Basic Obstetrics Ultrasound Training for Ethiopian Obstetric Care Providers Participants and Facilitarors Guide.
The primary objectives of the workshop were threefold: to disseminate the newly developed and revised policy documents, to create a platform for discussing these critical policies, and to mobilize resources while strengthening the commitment towards their implementation. The target audience included high-ranking officials from the Ministry of Health, representatives from regional health bureaus, donors and development partners, National Blood and Tissue Bank, professional associations, and the Ethiopian Health Care Federation.
The workshop commenced with a welcoming address delivered by Dr. Alemayehu Hunduma, Maternal, Child and Adolescent Health Service Lead Executive Office Acting lead officer and Sr. Zemzem Mohammed, National Maternal Health Desk Lead. H.E. Dr. Dereje Duguma, the State Minister of Health, provided the opening remarks, urging all stakeholders to take the newly launched guidelines and documents seriously and to work diligently towards their successful implementation.
The full day event was packed with insightful presentations on key components of the new policy documents. Takele Yeshewas, MoH.JSI Seiner Technical Adviser, discussed PCC and CBCM, while Sr. Zemzem addressed topics related to SRH and CE. Following a tea break organized by the event team, Dr.Zerihun Bogale, MoH./EH Seiner Technical Adviser, presented on CAC and Self-care, highlighting crucial aspects of the policies designed to improve maternal health outcomes.
Participants were then engaged in a comprehensive discussion session, facilitated by the presenter and various participants, which allowed for an in-depth exploration of the new policies and their potential impact.
The workshop also featured a presentation by AAU-PMA on PMA, moderated by Addisalem. This session further reinforced the need for data-driven approaches and continuous monitoring to ensure the effectiveness of the new policies.
The collaborative efforts of ESOG in developing these guidelines were acknowledged, underscoring the Society's pivotal role in shaping the future of maternal health services in the country. This workshop not only marked the launch of vital policy documents but also reinforced the collective commitment to enhancing maternal health care across Ethiopia. As these policies are implemented, ESOG remains dedicated to supporting their success and improving health outcomes for mothers and children nationwide.
Injectable contraceptives, particularly those that are discreet and highly effective, have long been popular in Sub-Saharan Africa. Among these, the subcutaneous formulation of DMPA (DMPA-SC), known by the brand name Sayana Press, stands out. This method can be administered by community health workers (CHWs) and by clients themselves. Globally endorsed and proven safe and effective, DMPA-SC for self-injection has been added as a "strong recommendation" by the WHO. In Ethiopia, it has been approved by the Ethiopian Food and Drug Administration (EFDA) and is poised to revolutionize contraceptive options for women.
In Ethiopia, DMPA-SC is currently available through limited private health facilities as a provider-administered injection. Recognizing its potential, the MoH, with support from EPHI and FHI 360, conducted an implementation research study in 2021. This study, involving 400 women from six public health centers in Addis Ababa, assessed the safety, acceptability, and feasibility of DMPA-SC self-injection. The findings were promising: 95.3% of participants could safely self-inject during enrollment, and 83.1% continued to do so at follow-up. High satisfaction rates (84%) and willingness to recommend the method (85%) further underscored its potential impact.
The MoH envisions a phased-based introduction of DMPA-SC for self-injection across Ethiopia, aiming to integrate it into the broader FP method mix. The objectives include expanding FP options through public service delivery channels, piloting the method in diverse settings, ensuring consistent supply and commodity security, and integrating DMPA-SC into national FP programs for sustainable monitoring and scale-up.
The introduction plan is structured to ensure systematic integration into existing service delivery systems, including training, supervision, and monitoring. The phased approach begins with major cities and urban settings, followed by semi-urban contexts, and finally, pilot studies in agrarian and pastoralist regions. This structured rollout is designed to address specific needs and contexts of different regions in Ethiopia.
Advocacy efforts will align with national FP communication guidelines to create a supportive policy environment. Key objectives include increasing contraceptive options, engaging decision-makers for resource mobilization, and raising awareness through diverse media channels. By fostering an environment that supports DMPA-SC self-injection, the initiative aims to empower women and enhance self-care practices.
Service delivery will target pre-identified facilities with high FP service demand. Comprehensive counseling on contraceptive options will be provided, and both new and current DMPA-IM users will be informed about DMPA-SC and SI options. Training will adopt a cascade approach, starting with master trainers and extending to FP service providers at various levels. The MoH will also integrate DMPA-SC training materials into pre- and in-service training curricula.
Proper storage and waste management practices are crucial for DMPA-SC. Clients will be trained to store units safely and dispose of used needles properly. The supply chain management plan aims for accurate stock monitoring and timely procurement, leveraging Ethiopia’s existing FP commodity distribution platform.
Targeted SBCC will play a vital role in raising awareness and addressing myths about DMPA-SC/SI. Mass and social media campaigns, community dialogues, and facility-level education will ensure informed choices and increased demand for FP services. Engaging men in FP discussions and ensuring provider readiness are also integral components of the SBCC strategy.
The Ethiopian Society of Obstetricians and Gynecologists (ESOG) will play a pivotal role in this endeavor. ESOG will engage in advocacy, training, and awareness campaigns to support the introduction and scale-up of DMPA-SC self-injection. By collaborating with policymakers, healthcare providers, and communities, ESOG aims to ensure that every woman in Ethiopia has access to safe, effective, and self-administered contraceptive options. Through these efforts, ESOG is committed to advancing women's health and empowerment across Ethiopia.
This transformative initiative represents a significant step towards improving contraceptive access and empowering women in Ethiopia, aligning with broader goals of gender equity and universal health coverage.
In January 2024, a delegation of Ethiopian health specialists, including representatives from the Ministry of Health, Population Services International (PSI) Ethiopia, and the Ethiopian Society of Obstetricians and Gynecologists (ESOG), visited Nigeria to learn about the implementation and scale-up of DMPA-SC self-injection (SI). The visit aimed to gather insights and best practices that could inform Ethiopia's own efforts to introduce and expand the use of DMPA-SC for self-injection, an initiative that has been in the exploratory phase since early 2020.
Depot medroxyprogesterone acetate subcutaneous (DMPA-SC) is a contraceptive injection administered under the skin. It is a lower-dose alternative to the traditional intramuscular (IM) DMPA injection, with 104 mg compared to 150 mg. DMPA-SC is delivered through a prefilled, ready-to-inject system, making it convenient for self-administration and community-based distribution. This method is not only safe and highly effective in preventing pregnancy but also has the potential to significantly improve contraceptive access and method choice for women, especially in underserved areas.
Nigeria's successful integration of DMPA-SC SI into their national family planning program offers valuable lessons for Ethiopia. Nigeria, like Ethiopia, faces challenges such as diverse populations, natural disasters, internal conflicts, and disease outbreaks. Despite these challenges, Nigeria has made significant progress in expanding contraceptive options and improving access to sexual and reproductive health care by adopting and implementing WHO’s Self-Care Guidelines.
During the visit, the Ethiopian delegation observed the practical application of DMPA-SC SI in various settings, including policy formulation, stakeholder engagement, training, and service delivery. The key takeaways from the visit include:
Nigeria’s success underscores the importance of a favorable policy environment and strong advocacy efforts. The development and endorsement of national self-care guidelines and task-shifting policies were critical to the scale-up of DMPA-SC SI. Engaging a wide range of stakeholders, including government agencies, NGOs, and professional associations, was essential for coordinated efforts and sustained progress.
Nigeria implemented standardized training curricula and low-cost training approaches, training over 29,000 providers across various states. Integrating DMPA-SC into national family planning training curricula ensured that providers were well-equipped to support self-injection. DMPA-SC was integrated into routine forecasting and quantification processes, and distributed to all state stores. Effective service delivery was supported by robust monitoring systems, including data collection and analysis through national health information systems.
Tailored social and behavior change communication materials were developed to increase awareness and acceptance of DMPA-SC. These efforts were crucial in driving demand and ensuring high continuation rates among users. Proper disposal of used DMPA-SC units was emphasized, with recommendations for puncture-proof containers and appropriate disposal methods to ensure safety and environmental protection.
Ethiopia is poised to benefit greatly from the insights gained during the learning visit to Nigeria. By adopting similar strategies, Ethiopia can enhance its family planning services, particularly through the introduction and scale-up of DMPA-SC SI. The Ethiopian Ministry of Health, in collaboration with partners like PSI and ESOG, is committed to creating a supportive policy environment, building provider capacity, engaging stakeholders, and developing effective monitoring and demand generation strategies.
The Ethiopian Society of Obstetricians and Gynecologists (ESOG) is committed to playing a pivotal role in the introduction and scale-up of DMPA-SC SI in Ethiopia. ESOG will focus on advocacy efforts to ensure a favorable policy environment, provide training and capacity-building support to healthcare providers, and contribute to the development of tailored educational materials. By leveraging its expertise and networks, ESOG aims to promote the adoption of self-care practices and improve access to contraceptive options for women across Ethiopia.
The learning visit to Nigeria provided invaluable insights that will guide Ethiopia in enhancing its family planning services through the introduction of DMPA-SC self-injection. With the collaborative efforts of the Ministry of Health, PSI, ESOG, and other stakeholders, Ethiopia is well-positioned to expand access to contraception, improve health outcomes, and empower women to take charge of their reproductive health.