RESUMO
Background: Ethiopia has been implementing Mobile Health and Nutrition Teams (MHNTs) to improve the accessibility of essential healthcare services for unreached populations with poor infrastructure to ensure health for all target by Universal health coverage (UHC). However, the current implementation status of this MNHT is not assessed. Objective: This study aimed to capture the current implementation status of the MHNT from the program managers, supporting partners and decision makers at each level of the health system structure in Afar and Somali regions. Methods: We conducted qualitative study with phenomenological study design. The data was collected from RHB MHNT coordinator, woreda health office MHNT coordinator, MHNT leader and representatives from implementing partners. The interview guides were developed using the CFIR framework. Results: Out of the 17 respondents, 13 responded all the standard service packages a MHNT is expected to deliver (76.5%). Overall, the KIIs mentioned that the MHNTs are effective in ensuring access and quality of health services. MHNT strategy has high demand and acceptability by the community and the service providers. The main barrier to program implementation is the gap in service integration within and across sectors. Inadequate staffing of the MHNT, gaps in ensuring proper professional mix, frequent turnover of contract health workers, and skill gaps hamper effective and sustainable implementation of the program. Conclusion: MHNT establishment, effectiveness, acceptability and sustainably in the implementing woredas of Afar and Somali Regions is very promising. The culture of MHNT documentation and reporting needs some improvement. Besides, community engagement and government ownership are good drivers for sustainability of MHNT. Standardizing and adding additional professionals with capacity building is crucial to ensuring service quality. Furthermore, community mobilization and woreda leadership commitment boosting will be needed for granting sustainability. Finally, national scale up of this alternative strategy is recommended through standardized implementation modality.
RESUMO
Background: Ethiopia's exposure to the El Niño drought (2015-2016) resulted in high malnutrition, internally displaced people, and epidemics of communicable diseases, all of which strained the health system. The drought was especially challenging for mothers and children. We aimed to identify salient factors that can improve health system resilience by exploring the successes and challenges experienced by a community-based health system during the drought response. Methods: We collected data via key informant interviews and focus group discussions to capture diverse perspectives across the health system (eg, international, national, district, facility, and community perspectives). Data were collected from communities in drought-affected regions of: 1) Somali, Sitti Zone, 2) Hawassa, Southern Nations, Nationalities, and Peoples' Region (SNNPR), and 3) Tigray, Eastern Zone. Data were analysed using a deductive-inductive approach using thematic content analysis applied to a conceptual framework. Results: A total of 94 participants were included (71 from the communities and 23 from other levels). Key themes included the importance of: 1) organized community groups linked to the health system, 2) an effective community health workforce within strong health systems, 3) adaptable human resource structures and service delivery models, 4) training and preparedness, and 5) strong government leadership with decentralized decision making. Conclusions: The results of this study provide insights from across the health system into the successes and challenges of building resilience in community-based health systems in Ethiopia during the drought. As climate change exacerbates extreme weather events, further research is needed to understand the determinants of building resilience from a variety of shocks in multiple contexts, especially focusing on harnessing the power of communities as reservoirs of resilience.