Primary Health System Efficacy

HEPCAPS Projects

Project Overview

From 2011 to 2015

HEPCAPS 1 & 2

Prior to the Fenot project, Professor Berman led the HEPCAPS projects in Ethiopia, in collaboration with John Snow Research & Training (JSI) and the YaleGlobal Health Leadership Institute (GHLI), with funding from the Bill &Melinda Gates Foundation.

At its initiation in 2012, a key objective of the HEPCAPS 1 project was to assist the Government of Ethiopia to strategize about how to address the challenges system management and sustainability, having successfully established a large nationwide primary health care system since the late 1990s. A number of key areas of focus were detailed in a “visioning”exercise. The latter part of HEPCAPS 1 and then HEPCAPS 2 strengthened evidence for policy development in relation to these key areas. As well, the project aimed at accelerating the achievements made in maternal, newborn and child priority health outcomes, and disease prevention and control efforts.

Specifically, HEPCAPS supported the Government of Ethiopia to:

  • Act as a mechanism to promote coordination of efforts to improve primary care and alignment with the Ministry of Health primary health care vision.
  • Define and strengthen selected capacities at national and sub-national levels to implement, evaluate, and enhance elements of the existing primary care system as Ethiopia develops and to tailor elements to fit local circumstances, giving priority to agrarian settings.
  • Design, demonstrate, and evaluate innovative strategies to improve primary care performance and adapt to changing conditions for a sustainable future primary care system.

HEPCAPS I & II

Achievements.

Strategic Visioning and Policy Development in Primary Health Care

  1. Conducted a comprehensive situation analysis of the Ethiopian primary health care system through an extensive literature review and stakeholder interviews.
  2. Supported the development of Ethiopia’s “Vision for Achieving Universal Health Coverage through PHC,” a foundational input to the 2015 Growth and Transformation Plan and a model for strategic visioning widely recognized in Ethiopia.
  3. Organized a global expert consultation on primary health care system development in 2012, bringing together international experts and Ethiopian stakeholders to explore strategies and best practices.

Health Financing and Resource Optimization

  1. Developed a Health Finance Projection Model to estimate Ethiopia’s future health care resources, comparing projected resources to anticipated costs for primary health care and exploring various financing scenarios.
  2. Conducted a review of public-private partnerships (PPP) using local case studies and global practices to inform policy and develop a PPP implementation guideline for the MOH.
  3. Increased evidence-informed policy capacity by supporting the MOH in creating national policy and planning documents that enhance the use of evidence for decision-making and policy analysis.

Strengthening Health Workforce and Community Engagement

  1. Conducted a study on Health Extension Workers (HEWs) to quantify their time usage and understand their relationships with other health system entities, including the Health Development Army and health centers.
  2. Supported the development and piloting of formal training and Level I certification for volunteer community health workers, creating a career progression pathway to improve community service delivery and transition volunteers into health extension worker roles.
  3. Increased HEWs’ capacity to deliver clinical services by advancing the training model from “Level 3” to “Level 4,” adding clinical service packages and implementing them in collaboration with the MOH and regional health bureaus.

Primary Health Care System Reforms and Innovations

  1. Implemented Primary Health Care Unit Reforms in the agrarian regions of Amhara, Tigray, Oromia, and SNNP in collaboration with regional health bureaus.
  2. Supported Urban Primary Health Care Reforms in Addis Ababa’s Bole and Gulele Woredas, introducing family health teams, prioritizing care through census data, and providing health kits to community health workers.
  3. Facilitated community engagement by supporting the development of health worker training programs and exploring innovative approaches to strengthen interactions between communities and health teams.