Ethiopia

Program Description

Overview

Context

Activities

Results

Lessons Learned

ethiopia-wonsho-21
Dates: November 2014 – Present
Status: Open
Partners:

  • Sidama Coffee Famers Cooperative Union
  • Fero Farmers Cooperative
  • Bokaso Cooperative
  • SNNP Regional Health Bureau
  • Pink Ribbon Red Ribbon
  • Sidama Zone Health Department
  • Wonsho District Health Office
  • Ethiopian Federal Ministry of Health

Objective

To integrate high quality cervical cancer screening and preventive therapy services at health facilities in the Southern Nation, Nationalities and People’s Region (SNNPR) of Ethiopia; to offer screening and preventive therapy services for women ages 30-49 through campaigns, mobile services, and work sites throughout Ethiopia.

Results – At A Glance

Key Performance Indicators Total (PY2015)
Women treated for positive screening result 481
Women Screened 3,159
VIA + 473
% Women Treated/ VIA + 95%

Program Year (PY): October – September


 

Output Indicators (cumulative) Total PY2015
Providers trained in screening and treatment 12
Community health promoters trained 91
Clinics equipped with cryotherapy 2

Context

Ethiopia is located in East Africa, the region with the highest morbidity and mortality from cervical cancer in the world. [i]   An estimated 12,965 Ethiopian women are newly diagnosed and roughly 7,089 women die each year from cervical cancer.ii   Most of these women’s lives can be saved by increasing access to cost-effective interventions to detect and treat pre-cancer and early stage cancer. Cervical cancer prevention (CECAP) services are currently available at 25 regional hospitals, established through the Pathfinder cervical cancer prevention program. The Ethiopian Federal Ministry of Health is preparing to scale up CECAP efforts by training providers and equipping over 100 primary hospitals and 900 health centers nationwide.

In Ethiopia, 15 million smallholder farmers and workers rely on coffee for their livelihoods.[ii] The birthplace of coffee, Ethiopia exports more coffee than any other country in Africa, generating 70 percent of Ethiopia’s foreign exchange earnings.ii Coffee cooperatives are composed of individual coffee farmers, most of whom cultivate small parcels of land. In Ethiopia, cooperatives typically work through a cooperative union, an association of cooperatives that functions as an intermediary between the primary co-op and the buyers. In Ethiopia, most cooperatives belong to one of four large unions: Oromia Coffee Farmers Cooperative Union, Sidama Coffee Famers Cooperative Union, Yirgacheffe Coffee Farmers Cooperative Union, or Kafa Forest Coffee Farmers Cooperative Union. ii SCFCU is an association of 46 primary cooperatives composed of over 80,000 small-scale coffee farmers, and is the second largest coffee producing cooperative in Ethiopia.

In 2014, Grounds for Health, together with Sidama Coffee Farmer’s Cooperative Union (SCFCU) as the primary co-operative, Fero Farmers Cooperative as the base co-operative, the Sidama Zone Health Department and Wonsho District Health Office, initiated a cervical cancer prevention program in the Sidama Zone of the Southern Nation and Nationalities Region (SNNPR) of Ethiopia. The program aims to reach women between the ages of 30-49 with screening and treatment services and establish two treatment facilities in the district. Expansion beyond Wonsho District to other districts and zones of SNNPR are being initiated in 2015 through alliance with Pink Ribbon Red Ribbon and the Ethiopia Federal Ministry of Health.

Grounds for Health and Pink Ribbon Red Ribbon propose expanding cervical cancer screening and preventive therapy services to 19 districts in Sidama zone as well as other zones in Western SNNPR. This partnership would build on Grounds for Health’s newly established program in Sidama with additional funding from GlaxoSmithKline, Grounds for Health’s East vs. West Coffee Roasters Challenge, and the President’s Emergency Plan for AIDS Relief  (PEPFAR), which will match funding raised through the Roaster’s Challenge to cover the expansion of the program to Western SNNPR.

Reference

[i] Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr. Accessed on Sept 8, 2014.
[ii] USAID, COMPETE East Africa Trade Hub. Ethiopia Coffee Industry Value Chain Analysis: Profiling the actors, their interactions, costs, constraints and opportunities. Chemonics International Inc. June 18 2010.

In October 2014, the cervical cancer prevention program was launched. Program activities include:

  • Training health extension workers, members of the health development army, and cooperative and community leaders to increase awareness of the importance of cervical cancer prevention and to recruit women in the target group;
  • Training local nurses and midwives in VIA and cryotherapy and providing supportive supervision after training to ensure continued quality of care;
  • Conducting Screen and Treat campaigns with local nurses and midwives for women in coffee growing communities;
  • Donating cryotherapy equipment, speculums and other essential materials for cervical cancer prevention to local clinics and providing technical assistance in its use.

Grounds for Health trained health extension workers in outreach and education and healthcare providers in screening and treatment, while simultaneously conducting a community campaign to screen and treat women in Wonsho District. The clinical training focused on visual inspection with acetic acid (VIA) to detect early signs of cervical cancer and treat them with cryotherapy (freezing) before they develop into cancer. This activity was followed by a four day screen and treat campaign at the Gejaba Health Center in which 318 women were screened and 35 treated. Women that needed additional treatment were supported with the assistance of the local health authorities and the coffee cooperative.

Following the initial screening and treatment campaign, trained providers continue to provide services for women in Wonsho District. Two health centers, Gejaba and Bokasso, were equipped with cryotherapy machined and continue to provide treatment to women with precancerous lesions. Women requiring further treatment are referred to Yirgalem Hospital and Awassa Referral hospital for additional treatment services.

In the current program year (2015), Grounds for Health will continue to conduct monitoring and supportive supervision for trained providers during the demonstration project in Wonsho district, while simultaneously expanding the program via collaborations with PRRR and the SNNP Regional Health Bureau.

Grounds for Health aims to provide 3,560 rural women with screening services and 274 with preventative treatment for precancerous lesions during the first year of program implementation. In addition, the program will provide training and support to 30 health professionals from 4-5 districts to carry out ongoing services, and equip 3 health centers with equipment for preventative treatment.

Annual Screening and Treatment Performance 

Key Performance Indicators Total (PY2015)
Women treated for positive screening result 481
Women Screened 3,159
VIA + 473
% Women Treated/ VIA + 95%

Program Year (PY): October – September


Coverage of Cervical Cancer Prevention Services

Output Indicators (cumulative) Total PY2015
Providers trained in screening and treatment 12
Community health promoters trained 91
Clinics equipped with cryotherapy 2

Accurate population data is pivotal in assessing coverage needs.

Program design must take into account accurate population data in selecting screening and treatment sites and locate services in central locations. Fixed treatment centers (equipped with cryotherapy) should have a continuous flow of patients to allow for skill retention.

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