HAILU ALEMU COLLEGE

DEPARTMENT OF BSC NURSING

Team Training Program at Finoteselam Town West Gojam

Zone, Amhara National Regional State, Ethiopia, from 06/04/10-
06/05/10 E.C

BY: FOURTH YEAR REGULAR BSC NURSING STUDENTS.

SUPERVISOR: - MR. MINELE TESFA (BSC, MSC)

Finoteselam, Ethiopia, December 2010 E.C

Participant Students
Acknowledgements

ii
First, we would like to thank HailuAlemu Collage Department of BSC and CBE committee, for Giving
This Chance.
Secondary, we would like to express our “special” deepest gratitude and thanks for our supervisor Mr.
Minale Tesfa for his unreserved encouragements and provision of constructive and necessary
comments and help of day to day activities without tiredness.

Our gratitude goes to HailuAlemu College, Finoteselam Hospital, in Individually Mulugata Andualem
from finotselam hospital and Zewuda Fenta for their assistance by giving all necessary information,
Economical supports and their involvement in different activities.

At last but not least, our heartfelt gratitude extends to shembekuma community and shembekuma
administration and to other concerned organizations for their unlimited and necessary support.

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Acronyms and Abbreviations

- AFI acute febrile illness

- AURI Acute Upper Respiratory Infections
- ANC Antenatal Care
- ANRS Amhara national regional state
- BSC Bachelor of Science
- CBE Community Based Education
- DMSS Diseases of Musculoskeletal System
- EPI Expanded Program of Immunization
- FP Family Planning
- GC Gorgonian Calendar
- HEW Health extension worker
- HSDP II Health Sector Development Programme II
- HSEP Health services extension program
- OPD Outpatient Department
- PHC Primary health care
- SWOT Strength Weakness Opposites Treat
- TTP Team Training Program

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Table of Contents
Acknowledgements.................................................................................................................................................IV
Acronyms and Abbreviations...................................................................................................................................V
List of tables...........................................................................................................................................................VII
Summary...............................................................................................................................................................VIII
1. INTRODUCTION................................................................................................................................................1
1.1 Community Based Education (CBE).............................................................................................................1
1.2 Back ground of the TTP.................................................................................................................................3
2. OBJECTIVES.......................................................................................................................................................5
2.1 General Objective:.........................................................................................................................................5
2.2 SpecificObjectives:........................................................................................................................................5
3. COMMUNITY DIAGNOSIS..............................................................................................................................6
3.1 Identified Problems ofthe Community Diagnosis inFinoteSelam Town Administration..............................6
3.2 PrioritizedProblems........................................................................................................................................7
3.2.1Action Plan................................................................................................................................................8
4. PUBLIC LATRINES..........................................................................................................................................11
4.1 Executive Summary of the Mini-Project:....................................................................................................11
4.2 Introduction..................................................................................................................................................12
4.3 Risksand Problems Associated With Absence of Latrine............................................................................12
4.4 Advantages of the mini-project....................................................................................................................12
5. PRIMARY HEALTH CARE (PHC) PROGRAM EVALUATION..................................................................13
5.1 The concept of Primary Health Care (PHC)................................................................................................13
5.2 Principles of Primary Health Care...............................................................................................................14
5.3 Elements/Components of Primary Health Care...........................................................................................14
5.4 Components of Health Service Extension Programmes..............................................................................15
5.5 Intersect oral collaboration..........................................................................................................................16
6. RESULTS OF OUTREACH ACTIVITIES.......................................................................................................16
6.1 Home Visiting..............................................................................................................................................16
6.2 In Environmental Health Service.................................................................................................................19
6.3 Private Health Institution..............................................................................................................................20
6.4 Pharmacy and Drug Stores...........................................................................................................................21
7. MINI PROJECTS...............................................................................................................................................21
8. STATIC ACTIVITY..........................................................................................................................................23
9. PROBLEMS FACED DURING OUR STAY AND SOLUTIONS TAKEN....................................................26
10. RECOMMENDATIONS................................................................................................................................27
11. REFERENCES................................................................................................................................................28

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List of tables

Table1: Number of health professionals of Finoteselam town administration in 2010 E.C

Table 2: prioritizing the identified problems

Table 3: SWOT Analysis or Environmental Scanning done to see the situation for the implementation
of the identified problems

Table 4: Action plan for the prioritized problem in Finoteselam town, West Gojjam Zone, Amhara,
Ethiopia 2010 E.C

Table 5: static activity plan in FSHC, FS town, West Gojjam zone, ANRS, Ethiopia, from May 12 to
June 10, 2010 E.C

Table 6: Static intervention action plan for Morning Discussion, Seminar presentation, Case
presentation in FSHC

Table 7: budget summary of the mini project for public latrine

Table 8: Our static activity plan weekly achievement according to the 2 rd annual plan of the health
center from 06/04-06/05/ 2010 E.C.

Table 9: Top 10 morbidity and mortality causes of adult outpatient department in 2010 E.C
Table 10: Top 10 morbidity and mortality causes of under five outpatient department in 2010E .C

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Summary
Introduction: Team Training Program is part of community based education which concerns about
community health problem & health related factor. Team training program is one component of CBE
that enable students to work as a member of a team in solving community health & health related
problems by applying the knowledge & skills of their professionals & integration these with the
knowledge & skills of other members.

Finoteselam town [formerly (before 1939 E.C)] called “Wojet” is one of the five town administrations
in West Gojjam zone, ANRS. It is found at a distance of 376 Km NW from Addis Ababa, the capital of
Ethiopia, and 176 Km SE from Bahir Dar, the capital of Amhara [Link] town is the capital
of west gojam.

Objective: The aim of this TTP is to assess & intervene health & health related problem provide health
care service for the community.

Method: The study was done by observation, interview, and referring other documents by check result
and intervention.

Result: In our catchment area community health problem were Lack of public latrine,improper latrine
utilization, low proportion of delivery at health institution and improper solid waste disposal.

Conclusion:In our catchment area had community health problem Shortage of Public Latrines,
improper latrine utilization, low proportion of delivery at health institution and improper solid waste
disposal and from health center profile at adult OPD the most abundant disease Pneumonia, AURTI ,
AFI, Intestinal Parasite, Helmetiasis, DMSS ,Trauma ,Dyspepsia, Diarrhea and Skin Infection and at under 5
OPD AURTI, AFI, Diarrhea, Helmetiasis, pneumonia, parasitic infection, acute bronchitis, Trachoma,
Skin infection and Trauma.

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 1. INTRODUCTION

1.1 Community Based Education (CBE)

CommunityBased Educationis a means of achieving educational relevance to communityneeds. It
consists of learning activities that uses the community extensively as a learningenvironment. Students,
teacher, members of the community and representatives of other sectors areactively and continuously
engaged in the CBE exercises. The recognition of the importance ofcommunity based training as
Community development problem-solving mechanism wasdocumented since 1940s (Trostle, 1986;
WHO, 1987).

CBE evolved from the field of community development that grew in the industrialization model of
the mid-1900. The best substitute for the word “development,” are terms that are more supportive
of process concepts such as advancement; betterment; capacity building; empowerment; and
nurturing, hence, community development is shortly defined as “the capacity of people to work
collectively in addressing their common interests (Maser, 1997).

Historically, universities were centers of academic excellence where keen people of the society
produce young philosophers, politicians and scientists through their teachings and generate new
ideas. They had the opportunity to attract the creams of society and boost their image. The
traditional universities saw the `general public as silent recipient of ideas. In most cases, these
universities confined themselves in more theoretical activities, which isolated them from the real
world that the society lived in.

The concept of formal education particularly tertiary education contributing towards social and
economic development is being challenged in Africa, most particularly in Ethiopia (Thompson,
1981; Devi, 2003; Amare&Temechegn, 2002). It has been argued that, higher education in Africa
didn’t go further than producing trained public servants needed to meet the requirement of
bureaucratic hierarchy (Meseret, (2005b). The competence and commitment of graduates to serve
the community and bring a meaningful change for economic development is also challenged.
These could be attributed to insufficiency of curricula for practical training in the community. In
this regard, Burgess 1986 argued that, the focus on teaching in higher education is lecture method
that has jeopardized the students’ capability required in community development. It was suggestedthat,
education has to concentrate on analysis, criticisms and the acquisition of knowledge on

1
formulation, provide solutions to problems, organizing and enhance constructive and creative
activity to ensure educational relevance.

The creation of a new balance between education, research and service in the university educational
system and the introduction of educational strategy that addresses the real development problems of
the society through collaborative effort has been the order of the day in the late 1960s and 1970s.
This teaching model has also inspired a reform in the traditional education system that redirects
education to serve the society and respond to the real needs and problems of societies. Many
international seminars and workshops were organized to promote the new strategy of education and
transform the universities from their isolated status of pure academics to active participation in
social development. The teaching, research and service were oriented to solve realistic problems of
the society around them. In view of the above, some universities started to experiment their training
to make more relevant to the needs of the people. These universities are known as ‘innovative
schools’ and the educational philosophy they adopted were ‘Community –Oriented Education’ and
’Problem Based Learning’. Community oriented/based education, as a learning activity, involves
the students, teachers, the community, and all other stakeholders in the community and follows a
problem solving approach that starts with the identification of community problems, setting of
objectives, set plan of action, implementation of plans and monitoring and evaluating of the
progresses.
The international trend in the early 70s has compelled Ethiopia to think and introduce CBE. Hence,
Addis Ababa university issued its manifesto that declares its commitment to enhance education to
serve the interest of the Ethiopian people through that integration of education, research and
services in 1975. On the other hand, the Global Movement of Health for All and Primary Health
Care were also accepted by the Ethiopian Government in the late 1970s. These national and
international trends on CBE motivated to pick and implement CBE in HailuAlemu College in 2009
E.C.
Team training program (TTP) is one of the community based education (CBE) programs in which
different departments of health science student’s work at training health centers (THC) in team during
their final years. The team members are expected to diagnose a community and intervene on promotive,
preventive, curative and rehabilitative health services for the catchment population of a health center.

Thus,HailuAlemu Collage Department of BSC nursing assigned 4 th year BSC nursing students `
assigned as a health team in Finoteselam site. The team had 1 leader, 1 reporter and 1 logistic and
19member.

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 1.2 Back ground of the TTP

Finoteselam town [formerly (before 1939 E.C)] called “Wojet” is one of the five town administrations
inWest Gojjam zone, ANRS. It is found at a distance of 376 Km NW from Addis Ababa, the capital of
Ethiopia, and 176 Km SE from Bahir Dar, the capital of Amhara region.

Lying between 10041’ N latitude and 37016’ E longitude. The town has an altitude of 1860m above sea-
level. It covers a total surface area of 4,247.9 Hectors and most of this is plane area. The average annual
temperature and rainfall is 240c and 1,250mm respectively.

It is bordered with seven Kebeles of Jabitehinanworeda, [Link]&Fetegem-Yesheret in the North,

Hodansh-gatagon and Fetegem-yesheret in the North East, Arbaitu-Ensisa and Abasem-Zeguay in the
South-West, Woga-tebeta in the West, Mebesh and Woga-tebeta in the North West. Consisting
sixKebles (two rural, four urban), from this shembkumakebela was the target site for this TTP.

ShembkumaKebela is found in W/gojame zone finoteselam town. The total population of the area is
3805 and 205 housholds. Population projection is also becoming one of farming site in the woreda. The
kebela has one governmental health post and one governmental agricultural site and one primery
school.

Finoteselam town administration has been established to be the main town of west Gojjam zone since
2004 E.C.

Currently, FinoteSelam town administration has a total population of 42,063 (21,287 males & 20,776
females) of which 1,123 were under 1year age, 3,813 are under five children, 9336 were women in
reproductive age and 129 were pregnant women.

All the people are Amharic language speaker and 94.89% religion followers are Orthodox Christian,
4.24% are Muslim and 0.87% is Protestant.

The town has 20Health institutions, i.e. 1 governmental district hospital, 1 health center, 5 health posts,
6 private clinics, 7 drug stores. There are a total of 260 health workers.

Table 1: Number of health professionals of FinoteSelam town administration in 2010 E.C

S.N Type of Professional Number

1. Surgeon 1
2. Other Specialists 6
3. General medical practitioner 18
4. Health officer 8

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 5. Nurses 135
6. Midwives (all type) 20
7. Laboratory technician 24
8. Pharmacy technicians 30
9. Anesthetist 2
10. Environmental health technicians 1
11. Radiographer 5
12. HEW 10

In education, there were about 19educational institutions, i.e. 5 private KGs, 6 elementary schools (1
private and 5 governmental), 2 secondary schools, 1 preparatory and 5 colleges.

There are only three communal solid waste disposal sites and five public latrines in the town. The
coverage of pure water supply is 66% (86% in the urban and 26.4 in the rural Kebeles) (2).

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2. OBJECTIVES

2.1 General Objective:

 To diagnose the community health & health related problems and solve identified problems
at Finoteselam town administration, west Gojjam zone, ANRS,

2.2 Specific Objectives:

 To identify community health & health related problems.

 To provide promotive health service through working in team.

 To provide preventivehealth service through working in team.

 To provide basic curative and rehabilitative health service through working in team.

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 3. COMMUNITY DIAGNOSIS

In this community diagnosis, to identifypriorities and determine courses of actions both qualitative and
quantitative data were collected in the first two days.

Qualitatively, primary data was collected through observation in possible areas (public water sources,
public latrine, and environmental sanitation at schools, colleges, and prison, health center and e.t.c) and
face to face interviews of relevant bodies.

Quantitatively, secondary data was collected through document review (HC records and reports,
prison clinic records and reports, schools and colleges’ records and reports, town health office records
and reports),and from our CBTP results.

After the collected data was analyzed manually, the following problems were identified and prioritized
as shown in table 2.

3.1 Identified Problems of the Community Diagnosis in FinoteSelam Town

Administration

1. Improper latrine utilization at schools & public latrine

2. Improper solid waste disposal system
3. Low condom distribution
4. Inadequate clean Water Supply
5. Low proportion of delivery at health institution
6. Low vaccination coverage of under one year
7. Lack of public latrine

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 Table2: prioritizing the identified problems.

Prioritizing criteria’s
Problems Magni Sever Feas Community Gov’ta Tot Ran
tude ity ibly concern l al k
[Link]

concer
n
1 Improper latrine 4 4 4 3 5 24 2
utilization
2 Improper solid waste 4 3 2 3 5 17 4
disposal
3 Low vaccination coverage 3 2 4 2 2 15 5
of under one year
4 Lack of public latrine 5 5 5 5 5 25 1
5 Inadequate clean Water 3 2 1 4 3 13 6
Supply
6 Low proportion of 3 3 5 2 5 18 3
delivery at health
institution
7 Low condom distribution 3 3 4 1 2 12 7

3.2 Prioritized Problems

1. Lack of public latrine

2. Improper latrine utilization
3. Low proportion of delivery at health institution
4. Improper solid waste disposal

To address these problems properly, first we have categorized these health problems under the four
major components ofHSEP. Remember that these are: Disease Prevention and Control, Family
Health Service,Hygiene and Environmental Sanitation, and Health Education and
Communication. Improper solid waste disposal, Lack of public latrine, improper latrine utilization,
underHygiene and Environmental Sanitation, Low proportion of delivery at health institution under
Family Health Service. Health Education and Communication covers all the four components and
was part of the work dealing with all these health problems.

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 Table 3: SWOT Analysis or Environmental Scanning done to see the situation for the
implementation of the identified problems

Strength Weakness
- Have committed group members - Problem on attending the
- Good Communication among group workplace timely.
- All the group members are familiar to the
Internally

environment

Opportunity Threat
- Materials from Kebele - financial problem
- Place for latrine contraction - shortage of time
Externally

- Contribution of Birr from the community

- Governmental policy
- Good Cooperation among Keble workers
- Resources supply from Keble

To do intervention on the above selected & prioritized problems an activity plan is adopted below

3.2.1 Action Plan

Table 4: Action plan for the prioritized problem in FinoteSelam town, West Gojam Zone,
Amhara, Ethiopia 2010E.C

Problems Objective Target Activities strategies Responsible Time

population body
Lack of increase community Dig out Initiate the Group 15/04/10-
public latrine number of the public communit member, 06/05/10
public latrine and y by home HEWs and
latrine health to home concerned
education and body
meeting
and act as
role model

8
Improper To increase community Health Home to Group 1504/10-
the education home visit, member, 06/05/10
latrine
awareness at public town
utilization of the area municipality
community and ,HEWS
about the
use of
latrine

Low Increase Pregnant Health Home to Group 15/04/10-

proportion of institutional mothers education home visit members 06/05/10
delivery at delivery HEWS
health
institution

Improper To increase community Health Home to Group 15/04/10-

solid waste the education home visit, member, 06/05/10
disposal awareness at public town
of the area municipality
community and ,HEWS
about the
use of
proper solid
waste
disposal

Table 5: Static activity plan in FSHC, FS town, West Gojjam zone, ANRS, Ethiopia, from
December 06/04/10-06/05/10E.C

S/ OPD ACTIVTY MONTH OUR W1 W2 W3 W4 TAT

N LY MONTH AL
PLAN of LY P A P A P A P A
FSHC PLAN
1 ADULT Dx, Rx, & counseling 2029 2100 52 52 52 52
OPD 5 5 5 5
2 UNDER Dx, Rx, & counseling 310 350 87 87 87 87
FIVE
OPD
3 DREASI cleaning 730 800 20 20 20 20
NG AND -dressing 0 0 0 0
INJECTI -injection
ON -suturing
ROOM
4 DELIVE Attending labor & 100 130 32 32 32 32
RY delivery
5 ANC Counseli 1ST 117 150 37 37 37 37
ng 2ND

9
 accordin 3RD
gly 4TH 117 150 37 37 37 37
6 FP Providin PIILS 704 750 18 18 18 18
g FP DEPO 7 7 7 7
service IMPLAN
informat OL
ion SINOPLA
NT
JADLE
IUCD
COMDO
M
7 EPI Giving BCG 117 117 29 29 29 29
vaccine OPV0 108 108 27 27 27 27
OPV1 108 108 27 27 27 27
PENTA1 108 108 27 27 27 27
PCV1 108 108 27 27 27 27
ROTA1 108 108 27 27 27 27
OPV2 108 108 27 27 27 27
PENTA2 108 108 27 27 27 27
ROTA 2 108 108 27 27 27 27
PCV2 108 108 27 27 27 27
OPV3 108 108 27 27 27 27
PENTA3 108 108 27 27 27 27
PCV3 108 108 27 27 27 27
MESAL 108 108 27 27 27 27
V-A 108 108 27 27 27 27

N.B: This Stastical activity plan is planed based on 2ndquarter annual plan of FSHC.

Table 6: Static intervention action plan for Seminar presentation, Case presentation and
Morning health education in FSHC Administration West Gojjam Zone, Amhara Regional State,
Ethiopia December 06/04/10-06/05/10 E.c

W1 W2 W3 W4

N
Achieve

Achieve

Achieve
achieve

O
Plan

Plan
plan

plan

1 Seminar presentation No 5 3 5 3 5 2 5 5

2 Case presentation No 5 4 5 3 5 3 5 5
3 Morning healtheducation Every day 40 50 50 60 40 50 50 70

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 4. PUBLIC LATRINES

4.1 Executive Summary of the Mini-Project:

 Name of the project: public latrine(1)

 Owner of the project: shembkuma kebeles, finoteselam town administration community.
 Proposers of the project: Hailu Alemu Collage Department of BSC nursing, finoteselam site
team training program members.
 Required space: 2 meter width & 8 meter depth area.
 Site: around shebekuma(church of shembkumamikaiel).
 The time that the project will start to give service: after 06/05/10 E.c.

 Budget: If public latrine constructed by daily laborers, a minimum of 9570 Birr would be required.

Table 7: budget summary of the mini project for public latrine.

No Required material Unit Amount Unit price Total
price(birr)
1. Wood for wall Each 18 120 2160
2. Wood for cover of Each 3 120 360
latrine hole
3. Mager Each 12 70 840
4. Neel killogram 5 40 200
5. Iron sheet Sheet 14 165 2310
6. Ashewa Kuntal 3 200 600
7. cement Kuntal 2 250 500
8. stone ------- -------- 600 600
9. Daily labor number 10 100-150 1000-1500
10. Reserve 500
Sum total 9570 Birr

4.2 Introduction

Approximately, 1.3 billion people in developing countries lack access to adequate quantities of clean
water and nearly 3 billion people are without adequate means of disposing their faces. An estimate of
10,000 people suffer from water and sanitation related diseases and a range of debilitating illness

11
among this water and sanitation problems, diarrheal diseases account for nearly 30% burden of
childhood communicable diseases, with in estimated 2.2 million number of child death annually and
much larger number of children and adults suffering the illness.

Poor environmental sanitation results a large range of health problems which is explained below

4.3 Risksand Problems Associated With Absence of Latrine

If peoples have no latrine they will excrete around the environment which they live. This may lead
peoples for the following problems.
 It exposed for different communicable disease like typhoid, common cold, e.t.c
 Increase Breeding site for different vectors
 Increases Air pollution by dust, & bad odor
 Increase suitable environment for burden of vector borne disease
 Increase water pollution

4.4 Advantages of the mini-project

If properly sited, designed & operated, use of latrine properly, will have the following advantages:
 Vector breading will be prevented
 Air pollution by dust, & bad odor will be controlled
 Increase suitable environment for burden of vector borne disease will be reduced
 decrease water pollution
 Additionally, is low in cost, easy to operate & it will serve as a disposal site for all human
faces. By considering the above risks of absence of latrine and benefits of using latrine, we
proposed to construct public latrine at the area which is explained above

5. PRIMARY HEALTH CARE (PHC) PROGRAM EVALUATION

Primary health care evaluation is the judgment made on the value of the result achieved regarding to
PHC components.

Objectives:
To evaluate which specific PHC component is achieved

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 To promote intersectoral collaboration

Activities:
 Looking at documents, review reports and interviews

 Evaluating at health facility and community level.

 Interviewing households regarding the components of PHC, e.g. Maternal and child health

 Reviewing activities in different sectors, e.g. Educational sector in training health club
members and school health Promotion.

 Inform other responsible bodies on outcome of the implemented program.

5.1 The concept of Primary Health Care (PHC)

Primary health care is an essential health care made universally accessible to individuals and families in
the community by means acceptable to them, through their full participation and at a cost that the
community and the country can [Link] is one of the countries in the world which has adopted
PHC as a national strategy since 1976. This strategy focuses on fair access to health services by all
people throughout the country, with special emphasis on prevention and the control of common
diseases, self-reliance and community participation. Since this time, the concept of Health Posts has
been developed.
In late 1997, the Federal Ministry of Health in Ethiopia started to decentralize the health delivery
system from Regional to woreda and kebele level, while still maintaining the vertical health programme
approach. This approach has not brought the required health outcomes. A new initiative, Health
Service Extension Programme (HSEP), was therefore launched in 2003 together with the Health
Sector Development Programme II (HSDP II).

The Health Service Extension Programme, (HSEP) is an innovative, community-based programme that
was first introduced in Ethiopia in 2003 and it is an approach that brings healthcare down to the
household [Link] program was launched after realizing that the basic health services were not
reaching the majority of the [Link] objective of HSEP is to improve equitable access to mainly
preventive health services through community (kebele) based services. These services all have a strong
focus on health promotion and preventive health activities, as well as increased community health
involvement(4).

5.2 Principles of Primary Health Care

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1. Accessibility (equal distribution):. Healthcare services must be equally shared by all the people of
the community irrespective of their race, creed or economic status. This concept helps to shift the
accessibility of healthcare from the cities to the rural areas where the most needy and vulnerable
groups of the population live.
2. Community participation: this includes meaningful involvement of the community in planning,
implementing and maintaining their health services.
3. Health promotion: involves all the important issues of health education, nutrition, sanitation,
maternal and child health, and prevention and control of endemic diseases. Through health
promotion individuals and families build an understanding of the determinants of health and
develop skills to improve and maintain their health and wellbeing.
4. Appropriate technology: technology that is scientifically sound, adaptable to local needs, and
acceptable to those who apply it and for whom it is used.
5. Inter-sectorial collaboration: to be able to improve the health of local people the PHC programme
needs not only the health sector, but also the involvement of other sectors, like agriculture,
education and housing.

5.3 Elements/Components of Primary Health Care

PHC includes:

1. Health Education
2. Provision of essential drugs
3. Immunization
4. MCH/FP
5. Treatment of common Diseases and injuries
6. Adequate supply of safe water and basic sanitation
7. Communicable Disease control
8. Food supply and proper nutrition
9. Oral Health
10. Mental Health
11. Useoftraditionalmedicine
12. HIV/AIDS control
13. ARI control
14. prevention & controls of locally endemic disease

14
 15. EPI
16. provision essential technology for health
17. Reproductive health needs
18. prevention & controls non of communicable disease &
19. Occupational health
20. Healthpromotion

5.4 Components of Health Service Extension Programmes

Health Service Extension Programme has been designed to provide a number of health packages which
are categorized under four main topics:

1. Disease Prevention and Control፡ Under this component the most dominant communicable diseases
are addressed.
a. TB, HIV/AIDS and other STI prevention and control.
b. Malaria prevention and control.
c. First aid and emergency measures.

2. Family Health Service፡ Maternal and child health.

a. Family planning. c. Adolescent reproductive health.

b. Immunization. d. Nutrition.
3. Hygiene and Environmental Sanitation: Excreta disposal.
a. Solid and liquid waste disposal. d. Healthy home environment.
b. Water supply and safety measures. e. Control of insects and rodents.
c. Food hygiene and safety measures. f. Personal hygien

1. Health Education and Communication፡

This is part of all the packages.

5.5 Intersect oral collaboration

To improve the health of a community, PHC Program needs not only the health sector, but also the
involvement of other sectors like agriculture, education, water, finance, must work together.

15
Being part of Ethiopia Finote-selam town administration can serve as a site for Primary Health Care
(PHC) program Evaluations. Finote-selam health service office has been working in collaboration
with:

 Educational sector in training health club members and school health Promotion.
 Water Resource office to ensure availability of adequate and clean water supply.
 Agricultural sector on nutrition, prevention and control of communicable diseases.
 Finance office on improving resource allocation to the health sector..
 Youth and Sports office in adolescent health services & reproductive health.
 Private sectors and NGOS on the expansion of health infrastructure& provision of health
services

6. RESULTS OF OUTREACH ACTIVITIES

After community diagnosis and problem prioritization, interventions were done according to the
prioritized problems.
Health education was provided for two primary schools about the use of environmental hygiene, proper
latrine utilization and for recent epidemic communicable disease in this area, malaria (definition, cause,
prevention and control methods).

6.1 Home Visiting

Home visit was conducted and the general health status of 300 households was assessed based on the
check list adopted by The Collage.
Among 300 visited households, poor general cleanness in 5.3%, poor solid waste disposal in 7.1% ,
poor latrine utilization in 8.1% , poor personal hygiene in 0.3%, poor vaccination of woman in 6.9% ,
poor ANC in 4.6%, satisfactory feeding of children <2 years in 6.7% households were observed but
there were no sick person at each visit. Anyhow health education was provided for these households
accordingly like on:
 ANC
 FP
 Personal hygiene
 AFI
 Breast feeding
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 Check list for home visiting
Scoring:
1. General cleanness:
0 =poor (Animal live in the same house floor & wall not clean, poor
arrangement of thematerials in the house
1 = satisfactory (Clean floor, Animals not clean, poor house, wall not
clean, poor arrangementof the materials in the house)
2 =Good (clean Floor, animals do not live in the same house, wall clean.
poor arrangement of materials in the house)
3 = Very Good (clean floor, animals do not live in the same house, wall
clean. Good arrangement of materials in the house.
2. Solid waste disposal: 0 = poor (no pit for solid waste disposal or do not burn wastes)
1 =satisfactory (no pit but they burn wastes)
3. Latrine: 0 =poor (no latrine)
1 = satisfactory (latrine present but not clean)
2 = good (Latrine present and clean)
4. Personal hygiene : 0 = poor (all family members is unhygienic but not other family
members
2 =good (at least 50 % of the family members hygienic)
3 = very Good(all family members hygienic)
5. Vaccination of < 1 year infant: 0 = Poor (who is not vaccinated at all
1 = Satisfactory (there is < 1 year infant who started
vaccination but defaulted)
2 = Good (there is < 1 year infant who is fully vaccinated or
on vaccination)
3 = There is no infant in the house
6. Vaccination of women: 0= Poor (women never vaccinated)
1=satisfactory (Women vaccinated before but vaccination is not
completed)
2= Good (Women fully vaccinated or on vaccination)
7. Antenatal care : 0 = Poor (the mother is pregnant but not attending ANC)
1= Good (mother is pregnant and is attending)
2= No Pregnant women
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8. Feeding of children <2 years: 0 = (mother not breast feeding the child)
1 = Satisfactory (the child is < 6 months and the mother is
breast feeding the Infant in addition to other foodsor there is
a child whose age is > 6 months who is getting breast milk
only)
2 = Good (the child is <6 months & he/she is exclusively on
breast feeding or the child is > 6 months and is getting
complementary feeding in addition to the breastmilk)
3 = No child < 2 years
9. Family Planning : 0 = Poor (mother not using family planning methods)
1 = Satisfactory (mother using natural family planning methods)
2 = Good (mother using modern family planning methods or she has an infant
< 6 months old who is Exclusive on breast feeding)
3 = there is no women of reproductive age in the house
10. Presence of insects/rodents in the house
0 = poor (insects and rodents present)
1 = Good (insects and rodents absent)
11. Presence of sick person in the house and action taken
0 = (there is sick person in the house but didn’t get any help)
1= Satisfactory (there is sick person in the house and he/she visited traditional healers)
2 = Good (there is sick person in the house and he/she was seen in the health institutions
3 = there is no sick person in the house

Additionally, we promoted community health insurance in each house hold.

In prison, we conducted prison health service inspection, cooking, feeding & living/sleeping rooms’
inspection and other problems like
 Improper latrine utilization
 Improper solid waste disposal
 Poor personal hygiene
And we planned to do intervention with the prisoners and give necessary health educations.

6.2 In Environmental Health Service

In environmental health service

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  We inspected and supervised 2 hotels and 8 restaurants and cafeterias two times in the first and
second weeks. During supervision we used standard checklist from the town sanitarian officer.
 These are some criteria’s according to the checklist: These are
 waitress uniform (they wear or not, color of uniform, is there any additional or not)
 weather the health of the waitress checked or not within 6 month
 trade license
 Three dish system for washing materials
 solid and liquid waste disposal system
 attractiveness and cleanness of the house
 cleanness of latrine
 how they dispose the broken glasses
 cleanness and handling of feeding materials
 cleanness of hand washing instrument and presence of soap
 presence of chimney on the roof of kitchen and its cleanness
 Appropriate place of the cooked food
 Condom distribution and demonstration to those who work at reception.
 hair covering of kitchen workers
 presence of enough light and air ventilation in the kitchen and others

AT 1st visit
During our first visit any hotel did not fulfill all of the above criteria’s. Some hotels and
cafeterias were good but most of them had problems.
Most had problem in liquid and solid waste disposal system, kitchen workers did not cover their
hair, waitress did not wear uniform, latrines were not clean and even we got the cooked foods
which were not covered.
 During inspection we gave feedback related with health aspects to correct their problems
accordingly.
2nd visit
 During our second visit, we got a great change in most hotels and cafeterias. In 2 hotels and 7
cafeterias and restaurants, we got good liquid and solid waste disposal system, latrines were
cleaned, kitchen workers covered their hair, and the cooked foods were covered appropriately.
Even if they corrected some problems still there were problems and we tried to give comment to the
owner of the hotel.

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6.3 Private Health Institution

 In the private health institutions, we supervised and inspected 3 medium clinics based on the
following criteria’s.
 presence and cleanness of latrine
 solid and liquid waste disposal system
 presence of lab room, injection room, appropriate placing of medication
 presence of examination bed and light
 number of workers and OPD
 Presence of license
 disposal of needle and syringe
 functionality of apparatus
In the visit
 all clinics have latrine
 All of them have solid and liquid waste disposal system
 all of them post license

6.4 Pharmacy and Drug Stores

 There are 2 pharmacies and 6 stores in finoteselam town. We supervised and inspected.
In the visit
 The license was posted in all pharmacies.
 The drugs put on according to their class.
 We did not get expired drugs.
 They burn the expired drugs in burial site.
 We didn’t get illegal drugs.

7. MINI PROJECTS

We had mini project in our intervention program. These were 1public latrine.

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21
The total budgets were10500 birr needed to do the project with full participation of the communities.
Our proposal had got acceptance & approved by the town service office, HEW & shembekuma kebela
community leaders. Together with the HEW &shembekuma kebela community leaders we selected the site.
Then by mobilizing the community, we prepare public latrine that can give service for shembkuma mikaiel
community. By mobilizing the community will promote health & create a chance to disseminate health
information. In addition to the community full participation Hailu Alemu College, finoteselam hospital
and some individuals help us by funding row materials like iron sheet, cements, stone Sand and others
like money.

8. STATIC ACTIVITY

The static group was working on promotive, preventive, curative and rehabilitative health services that
were offered to the needy/clients at F/selam health center, according to the action plan designed by
them.

In every day, there was a seminar on a selected case diagnosed treated in the health center. The static
group members were assigned in different rooms, i.e. in adult OPD, injection and dressing, ANC,
delivery, family planning, EPI and under five children to improve the quality of services in the health

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center. As shown below in table, our static activity was planed weekly according to the second quarter
annual plan of the health center.

As shown below in table 8: our static activity plan weekly achievement according to the 2 rd annual plan
of the health center from 06/04-06/05/ 2010 E.C.

S/ OPD ACTIVTY MONT OUR W1 W2 W3 W4 TAT

N HLY MONT AL
PLAN HLY P A P A P A P A
of PLAN
FSHC
1 ADUL Dx, Rx, & 2029 2100 5 4 5 4 5 3 5 3 1680
T counseling 2 8 2 4 2 9 2 7
OPD 5 0 5 0 5 0 5 0
2 UNDE Dx, Rx, & 310 350 8 7 8 8 8 5 8 6 280
R counseling 7 6 7 2 7 9 7 3
FIVE
OPD
3 DREAS cleaning 730 800 2 1 2 1 2 1 2 1 680
ING -dressing 0 7 0 9 0 5 0 7
AND -injection 0 0 0 0 0 0 0 0
INJECT -suturing
ION
ROOM
4 DELIV Attending labor & 100 130 32 11 32 10 32 12 32 8 41
ERY delivery
5 ANC Counse 1ST 117 150 37 30 37 41 37 31 37 3 137
ling 5
accordi 2ND
ngly 3RD
4TH 117 150 37 22 37 26 37 31 37 2 103
4
6 FP Providi PIILS 704 750 18 13 18 14 18 12 18 1 570
ng FP DEPO 7 0 7 0 7 0 7 8
service IMPLA 0
inform NOL
ation SINOPL
ANT
JADLE
IUCD
COMD
OM
7 EPI Giving BCG 117 117 29 20 29 18 29 24 29 2 85
vaccine 3
OPV0 108 108 27 11 27 10 27 12 27 8 41
OPV1 108 108 27 20 27 18 27 24 27 2 85
3
PENTA 108 108 27 20 27 18 27 24 27 2 85
1 3
PCV1 108 108 27 20 27 20 27 24 27 2 87
3
ROTA1 108 108 27 20 27 18 27 24 27 2 85
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 3
OPV2 108 108 27 19 27 18 27 25 27 2 83
1
PENTA 108 108 27 20 27 18 27 24 27 2 85
2 3
ROTA 2 108 108 27 22 27 18 27 24 27 2 87
3
PCV2 108 108 27 20 27 18 27 24 27 2 85
3
OPV3 108 108 27 18 27 18 27 24 27 2 83
3
PENTA 108 108 27 20 27 18 27 24 27 2 85
3 3
PCV3 108 108 27 20 27 21 27 24 27 2 88
3
MESAL 108 108 27 20 27 18 27 24 27 2 85
3
V-A 108 108 27 20 27 18 27 24 27 2 85
3

N.B: Our stastical activity plan is planed based on 2nd quarter annual plan of FSHC.
Table 9: Top 10 morbidity and mortality causes of adult outpatient department in 2010 E.C

S/N Diseases
1 Pneumonia
2 AURTI
3 AFI
4 Intestinal Parasite
5 Helmetiasis
6 DMSS
7 Trauma
8 Dyspepsia
9 Diarrhea
10 Skin Infection
Source; FinoteSelam town health center 2rd quarter report, 2010 E.C
Table 10: Top 10 morbidity and mortality causes of under five outpatient department in
2010E .C

S/N Diseases
1 AURTI

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 2 AFI
3 Diarrhea
4 Helmetiasis
5 Pneumonia
6 Parasitic infection
7 Acute bronchitis
8 Trachoma
9 Skin infection
10 Trauma

Source; FinoteSelam town health center 2rd quarter report, 2010 E.C

 Top five diseases of adult OPD at F/selam HC which are selected by team member from 06/04-
06/05/ 2010 E.C
1. Acute febrile illnesses 4. DMSS
2. AURTI 5. Diarrheal diseases
3. UTI
Top five diseases of under-fiveOPD at F/selam HC which are selected by team member from 06/04-
06/05/ 2010E.C E.C
1. Diarrheal diseases(DD)
2. URTI
3. AFI
4. Pneumonia
5. Parasitic infection

9. PROBLEMS FACED DURING OUR STAY AND SOLUTIONS TAKEN

Problems

- Lack of reference and other materials

- Unwillingness of the respondents during data collection
- Some institutional administers were not cooperate
- Some administrative instructions had not well organized data
And Others

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Solutions taken

 Use of un published handouts

 Collect the data from those who are volunteers
 Asking other for support
 Visit households repeatedly

10. RECOMMENDATIONS

Our constructive recommendations were focused on assessing the health and health related problems of
the community for different concerned bodies such as;

 Some communicable diseases like malaria, typhoid, typhus etc are community problems in this
town. So we would like to recommend the town administration health office to increase the
distribution of bed nets, drainage of stagnant water, increase the accessibility of clean water
supply, create awareness about environmental sanitation and personal hygiene through intersect
oral collaboration and community mobilization.

 In this town, Lack of public latrine, improper latrine utilization, Low proportion of delivery at
health institution and improper solid waste disposal. Hence; we would like to recommend the
health sector, municipality, community and other stakeholders to work hard on the problem.

 We would like to recommend the sanitarian office to inspect and supervise regularly like;
hotels, restaurants and cafeteria, accordingly the standard check list.

 We would also like to recommend the school staffs and concerned bodies in order to create
awareness and knowledge towards the students the impact of poor environmental condition.

 Finally our constructive comment is to the administrator of the prison to do actively on health
promotion, and prevention activities with another concerned body.

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 [Link]

1. “Guidline and Procedure for Community Based Education” approved by jimma

universty Senate on its deliberation of March, 2013.
2. “Guidline and Procedure for Community Based Education” college of medicine
and health science, bahirdar university December 2016.
3. “Team Training Progeramme” approved by Hailu Alemu College, 4nd year public
health student May 2008 E.C.
4. Central statistical authority (CSA) &ICF international: Ethiopian demographic &
health survey 2011 (EDHS 2011), Addis Ababa, Ethiopia & Calverton Mary Land,
USA, 2012
5. Fnoteselam Town Administration Office Report 2015

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