Bonga, Ethiopia

Source: OCHA/ReliefWeb

Bonga is a small city and the administrative center of Kafa Zone (and its 1 million people) in southwestern Ethiopia. According to the WHO, Ethiopia has fewer human resources for health services than average for Africa,and Bonga is no exception. It is plagued with subacute diseases like tuberculosis and malnutrition, and witnesses many deaths to preventable diseases such as pneumonia, diarrhea, and problems in childbirth. To combat these problems, Kafa Zone has almost no doctors, and relies heavily on less-trained midwives and health officers. The Peace Care model enabled Northwestern University to partner with the Bonga community to help it better address its health care needs.

Goals

  1. Cultivate grass roots global health solutions by creating enduring links between communities of need and entities of resource
  2. Perform a community-directed medical training intervention and collect data using a community-based participatory research framework
  3. Further inform and develop the Peace Care model that was first tested in Senegal
  4. Develop and retain the local health care workforce, enhance quality of care and improve health outcomes and service delivery.
  5. Foster global health education

Peace Care Ethiopia Project Plan

Peace Care Ethiopia was a second pilot project for the organization Peace Care in collaboration with the Bonga community, Northwestern University, and Peace Corps Ethiopia.   The partners’ roles, the timeline, and the planned phases for the initial intervention are described below.  

Community partners in Bonga were actively engaged as members of the collaborative and research team throughout the research process.  A local Community Advisory Board guided consideration of all components of the project.  Northwestern University managed this project from the perspective of university contribution.  In doing so, NU actively engaged all investigators, key personnel, and collaborators on a regular basis while placing the community’s needs in the forefront. Peace Corps offered support in the field through information gathering, relaying of information, community organizing, conference planning and organization, data gathering, translation, reinforcement and oversight of implemented systems components, and cultural orientation and guidance. Peace Care acted as a consulting body for expert guidance concerning health interventions in low resource settings.

Partners:

Northwestern University Peace Corps Ethiopia Peace Care

Jeffrey Panzer, MD

Carolyn Baer, MPH

Juliet Sorenson, JD

Katy Wright, MPH

Dan Baker, Acting Country Director

Michael Waidmann, PCV

Chuck Adams, PCV

Laura Harrington, PCV

Raymael Blackwell, PCV leader

Andrew Dykens, MD, MPH

Laura Sadowski, MD, MPH

 

 

Phase 1 Partnership Formation 3-6 months August 2011 – February 2012
Phase 2 Assessment 3-5 months March 2012 – April 2012
Phase 3 Project Development 3-4 months May – September 2012
Phase 4 Project Implementation 1 month October 2012
Phase 5 Evaluation 6-9 months October 2012 – March 2013
Phase 6 Dissemination ongoing Began March 2013

 

Phase 1: Partnership Formation

  • representatives from the Northwestern team made an initial site visit (September 2011).   During this visit, the NU team met with Peace Corps, Bonga hospital staff and community leaders, and the minister of health of Ethiopia.
  • an initial Institutional Review Board (IRB) process at Northwestern was initiated.

Phase 2: Assessment

  • A general community health assessment was conducted using focus groups and key informant interviews. Data was evaluated and discussed by the community advisory panel, Peace Care, and Northwestern, and the primary issues were identified.
  • The primary issue identified was maternal health.

Phase 3: Intervention Development

  • A literature review and synthesis of the evidence was conducted to identify the health intervention. All partners adapted the designed intervention to the local milieu.   The intervention was directed at the level of health care practitioners based at health centers or district hospitals.
  • The community advisory panel and PCVs provided guidance concerning cultural norms, realities on the ground, logistical concerns, and priority areas.
  • Specific outcomes data were defined for future collection
  • The ALSO©  (Advanced Life Savings in Obstetrics) course was chosen as the training intervention.   It is a short-term (2-3 day) course in emergency obstetrics that uses the train-the-trainers model, and has been validated in multiple countries including other developing countries.

Phase 4: Project Implementation

  • Health Service Capacity Building:  the university team conducted train-the-trainer courses by a well-developed curriculum.  The newly-certified trainers then trained others with support from the visiting team.
  • Sustainability Component: Local trainers and health officials developed guidelines and infrastructure.  Trainings continued after departure of the university team.
  • Global Health Education:  U.S. trainees learned about global health disparities, community based research, and low income country clinical practice.

Phase 5: Evaluation

  • Process Evaluation: Each phase was critically evaluated by all stakeholders involved through focus groups and key informant interviews.
  • Outcomes Evaluation: We collected baseline data and developed interventions that were well incorporated into the established health system, so that we reliably and precisely measured our impact.

Phase 6: Dissemination

  • The investigative team disseminated project outcomes to other communities within Ethiopia and to other countries to replicate best practices for development of health service infrastructure.