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Gufue ZH, Haftu HK, Alemayehu Y, Tsegay EW, Mengesha MB, Dessalegn B. Damage to the public health system caused by war-related looting or vandalism in the Tigray region of Northern Ethiopia. Front Public Health 2024; 12:1271028. [PMID: 38645448 PMCID: PMC11026641 DOI: 10.3389/fpubh.2024.1271028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Background The war that started on November 4, 2020, in the Tigray region of Northern Ethiopia severely affected the health sector. However, there is no available evidence to suggest the economic damage caused to the public health system because of war-related looting or vandalism. This study was aimed at estimating the cost of war-related looting or vandalism in Tigray's public health system in Northern Ethiopia in 2021. Methods A provider perspective, a mixed costing method, a retrospective cross-sectional approach, a 50% inflation rate, and a 50 Ethiopian birr equivalent to one United States dollar ($) for the money value were used. The data were analyzed using Microsoft Excel, taking into consideration the Sendai framework indicators. Results The total economic cost of the war-related looting or vandalism in monetary terms was more than $3.78 billion, and the damage to the economic value in monetary terms was more than $2.31 billion. Meanwhile, the direct economic loss to the health system in monetary terms was more than $511 million. According to this assessment, 514 (80.6%) health posts, 153 (73.6%) health centers, 16 (80%) primary hospitals, 10 (83.3%) general hospitals, and 2 (100%) specialized hospitals were damaged and/or vandalized either fully or partially due to the war. Conclusion This war seriously affected the public health sector in the Tigray region. The Federal Government of Ethiopia, the Ministry of Health of Ethiopia, the Tigrayan Government, the Tigray Regional Health Bureau, and the international community must make efforts to find resources for the revitalization of the damaged, plundered, and vandalized healthcare system.
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Affiliation(s)
- Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | | | | | - Etsay Weldekidan Tsegay
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Meresa Berwo Mengesha
- Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Berhe Dessalegn
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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Bessler AL, Hoet AE, Nigatu S, Swisher S, Fentie T, Admassu B, Molla A, Brown M, Berrian AM. Advancing One Health through veterinary education: a mixed methods needs assessment for implementing a WOAH-harmonized national veterinary medicine curriculum in Ethiopia. Front Vet Sci 2024; 11:1357855. [PMID: 38601911 PMCID: PMC11005791 DOI: 10.3389/fvets.2024.1357855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction International organizations now actively promote and implement One Health collaborative approaches to prevent, detect, and control diseases in humans and animals, recognizing the critical importance of the veterinary and agricultural sectors. Moreover, Veterinary Services are chronically under-resourced, especially in low- and middle-income countries. Given the importance of National Veterinary Services to food security, nutrition, poverty alleviation, and global health security, strengthening veterinary capacity is a priority for the international community. The World Organisation for Animal Health (WOAH) outlines a set of minimum competencies veterinarians need to support National Veterinary Services effectively. To improve the quality of veterinary education, Ethiopia has developed a new 2020 national curriculum that is harmonized with the WOAH competencies. Methods A mixed methods needs assessment was conducted to identify barriers and challenges that Ethiopian veterinary medicine programs have faced in implementing the new WOAH-harmonized national curriculum. Representatives from active veterinary programs granting a Doctor of Veterinary Medicine (DVM) degree were invited to share their experiences via an online survey and follow-up focus group discussion. Results Fourteen veterinary programs, representing 93% of eligible programs nationwide, participated in the needs assessment. Quantitative analysis indicated that the most difficult topics associated with the new curriculum included Organization of Veterinary Services (Competency 3.1), Inspection and Certification Procedures (3.2), and practical applications of the regulatory framework for disease prevention and control (multiple competencies). Challenges associated with specific instructional methodologies, particularly the facilitation of off-site (private and public sector) student training, were also perceived as barriers to implementation. Focus group discussions elucidated reasons for these challenges and included limitations in faculty expertise, resource constraints (e.g., supplies, infrastructure), and access to off-site facilities for hands-on teaching. Conclusion The results of this needs assessment will be used to identify and prioritize solutions to implementation challenges, helping Ethiopian veterinary medicine programs move the new WOAH-harmonized curriculum from theory to practice. As veterinarians are integral partners in advancing One Health, strengthening the capacity of Veterinary Services can ultimately safeguard animal and human health, grow economies, and improve lives.
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Affiliation(s)
- Andrea L. Bessler
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Armando E. Hoet
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Shimelis Nigatu
- College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, Ethiopia
| | - Samantha Swisher
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Tsegaw Fentie
- College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, Ethiopia
| | - Bemrew Admassu
- College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, Ethiopia
| | - Adugna Molla
- College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, Ethiopia
| | - Manon Brown
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Amanda M. Berrian
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
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Aregay A, O’Connor M, Stow J, Ayers N, Lee S. Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study. Palliat Care Soc Pract 2023; 17:26323524231198542. [PMID: 37706166 PMCID: PMC10496462 DOI: 10.1177/26323524231198542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Background Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country's healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. Objective This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Design Face-to-face interviews were conducted in a rural region of Ethiopia. Methods Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Results Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals' awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Conclusions Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.
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Affiliation(s)
- Atsede Aregay
- Health and Nursing Sciences, University of Agder, Høvågveien 140, Kristiansand, 4604, Norway
- School of Nursing, Mekelle University, Tigray, Ethiopia
| | - Margaret O’Connor
- Nursing and Midwifery, Monash University, Melbourne City Mission Palliative Care, Melbourne, Australia
| | - Jill Stow
- St Vincent’s Private Hospital, Melbourne, Australia
| | - Nicola Ayers
- Nurse Lecturer, School of Nursing, BPP University, London, UK
| | - Susan Lee
- Nursing and Midwifery, Monash University, Melbourne, Australia
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Gebrehiwet TG, Abebe HT, Woldemichael A, Gebresilassie K, Tsadik M, Asgedom AA, Fisseha G, Berhane K, Gebreyesus A, Alemayoh Y, Gebresilassie M, Godefay H, Gesesew HA, Tesfaye S, Siraj ES, Aregawi MW, Mulugeta A. War and Health Care Services Utilization for Chronic Diseases in Rural and Semiurban Areas of Tigray, Ethiopia. JAMA Netw Open 2023; 6:e2331745. [PMID: 37651138 PMCID: PMC10472195 DOI: 10.1001/jamanetworkopen.2023.31745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023] Open
Abstract
Importance The war in Tigray, Ethiopia, has disrupted the health care system of the region. However, its association with health care services disruption for chronic diseases has not been well documented. Objective To assess the association of the war with the utilization of health care services for patients with chronic diseases. Design, Setting, and Participants Of 135 primary health care facilities, a registry-based cross-sectional study was conducted on 44 rural and semiurban facilities of Tigray. Data on health services utilization were extracted for patients with tuberculosis, HIV, diabetes, hypertension, and psychiatric disorders in the prewar period (September 1, to October 31, 2020) and during the first phase of the war period (November 4, 2020, to June 30, 2021). Main Outcomes and Measures Records on the number of follow-up, laboratory tests, and patients undergoing treatment of the aforementioned chronic diseases were counted during the prewar and war periods. Results Of 4645 records of patients with chronic diseases undergoing treatment during the prewar period, 998 records (21%) indicated having treatment during the war period. Compared with the prewar period, 59 of 180 individuals (33%; 95% CI, 26%-40%) had tuberculosis, 522 of 2211 (24%; 95% CI, 22%-26%) had HIV, 228 of 1195 (19%; 95% CI, 17%-21%) had hypertension, 123 of 632 (20%; 95% CI, 16%-22%) had psychiatric disorders, and 66 of 427 (15%; 95% CI, 12%-18%) had type 2 diabetes records, which revealed continued treatment during the war period. Of 174 records of patients with type 1 diabetes in the prewar period, at 2 to 3 months into the war, the numbers dropped to 10 with 94% decline compared with prewar observations. Conclusions and Relevance This study found that the war in Tigray has resulted in critical health care service disruption and high loss to follow-up for patients with chronic disease, likely leading to increased morbidity and mortality. Local, national, and global policymakers must understand the extent and impact of the service disruption and urge their efforts toward restoration of those services.
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Affiliation(s)
| | - Haftom Temesgen Abebe
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Abraha Woldemichael
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kibrom Gebresilassie
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mache Tsadik
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Akeza Awealom Asgedom
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Girmatsion Fisseha
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Aregawi Gebreyesus
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Measho Gebresilassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hagos Godefay
- Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, United Kingdom
| | - Elias S. Siraj
- Division of Endocrinology & Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk
| | - Maru W. Aregawi
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Gesesew H, Kebede H, Berhe K, Fauk N, Ward P. Perilous medicine in Tigray: a systematic review. Confl Health 2023; 17:26. [PMID: 37254199 DOI: 10.1186/s13031-023-00524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The war in Tigray, North Ethiopia which started in November 2020, has destroyed decades of the region's healthcare success. There is some emerging published evidence on attacks on health care in the region, and we synthesized the available evidence on 'perilous medicine' in Tigray to understand the data source, subjects and content covered, and what gaps exist. METHODS We employed a systematic review and performed a systematic search of MEDLINE, PubMed, CINHAL, Web of Science and Scopus. We included English written documents published from 4 November 2020 to 18-19 October 2022 and updated the search on 23 January 2023. HG and NF independently performed title, abstract and full-text screening. We used Joanna Briggs Institute (JBI) tools to appraise and extract data, and applied content synthesis to analyze. The PROSPERO registration number is CRD42022364964. RESULTS Our systematic review search yielded 8,039 documents, and we finally found 41 documents on conflict and health in Tigray. The areas were: (1) attacks on infrastructure, health or aid workers, patients, ambulances or aid trucks identified in 29 documents-the documents reported targeted attacks on health infrastructure and personnel; (2) interruption of health or social services in 31 documents-the documents reported medical and humanitarian siege; (3) outcomes and direct or indirect impacts in 33 documents-the documents reported increased magnitude of illnesses, and catastrophic humanitarian crises including the use of food, medicine and rape as tools of war; and (4) responses, rebuilding strategies, and recommendations in 21 documents-the documents reported improvisation of services, and calling to seize fire, accountability and allow humanitarian. CONCLUSIONS Despite promising studies on conflict and health in Tigray, the documents lack quality of designs and data sources, and depth and diversity of subjects and contents covered; calling further primary studies on a prioritized future research agenda.
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Affiliation(s)
- Hailay Gesesew
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Hafte Kebede
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Kenfe Berhe
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Nelsensius Fauk
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Paul Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
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Kebede MA, Beyene A, Kedir N, Abegaz B, Friebel R. Organizational peer support to enable rehabilitating surgical services in Northern Ethiopia. Confl Health 2023; 17:19. [PMID: 37061733 PMCID: PMC10105431 DOI: 10.1186/s13031-023-00515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/24/2023] [Indexed: 04/17/2023] Open
Abstract
The ongoing violent conflict in Northern Ethiopia has caused displacement, death, and destruction. Health services infrastructure became one of the primary victims of the war, leaving millions unable to access essential surgical health services at a time when demand for surgical interventions is on the rise. Rehabilitating surgical services was identified as a priority by the federal government, regional health bureaus, and humanitarian organizations, forming an integral part in rebuilding communities after war. Under the auspices of the Federal Ministry of Health of Ethiopia, a hospital twinning program between providers in non-conflict and conflict affected areas was first introduced in December 2021, now including 13 active partnerships. The program builds on a previous best practice gained from the Ethiopian Hospital Alliance for Quality to strengthen local health care providers in regaining capabilities to serve local populations. Field experience of two hospital twinning projects have shown significant scope of organizational peer support at times of crisis, successfully enabling conflict-afflicted hospitals to regain the capacity necessary to re-introduce surgical services. While overcoming challenges such as lack of basic supplies including electricity and blood may be required to further increase the scope of this program in Northern Ethiopia, relative success highlights important lessons for similar approaches in areas affected by conflict, or natural disasters.
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Affiliation(s)
- Meskerem Aleka Kebede
- Global Surgery Policy Unit, London School of Economics and Political Science, London, UK.
| | - Andualem Beyene
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Rocco Friebel
- Global Surgery Policy Unit, London School of Economics and Political Science, London, UK
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Kumar WM, Gebregziabher BA, Mengesha RE, Wise PH. Humanitarian aid must be allowed to enter the besieged Tigray region of Ethiopia. Nat Med 2022; 28:1734-1735. [PMID: 35982308 DOI: 10.1038/s41591-022-01921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wasan M Kumar
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Reiye E Mengesha
- Department of Surgery, Ayder Comprehensive Specialized Hospital and College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Tesema AG, Peiris D, Abimbola S, Ajisegiri WS, Narasimhan P, Mulugeta A, Joshi R. Community health extension workers' training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001160. [PMID: 36962619 PMCID: PMC10021836 DOI: 10.1371/journal.pgph.0001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers' (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia's health extension program (HEP), using an in-depth qualitative study conducted in 2019.The study covered two regions-the Tigray and the South Nations, Nationalities and Peoples Region (SNNPR)-and involved the Federal Ministry of Health. We conducted twenty-seven key informant interviews with federal and regional policymakers, district health officials, health centre representatives and HEWs.Participants highlighted substantial implementation challenges with training and supervision practices delivered via the HEP. Training for NCDs lacked breadth and depth. IT was described as inconsistently delivered with variable availability within and between regions;and when available, the quality was low with scant content specific to NCDs. HEP supervision was inconsistent and, rather than being supportive, mainly focused on finding faults in HEW work practices. Supervisors themselves had skill gaps in critical areas overall, and specifically concerning NCDs. HEWs' performance appraisal encompassed too many indicators, leading to excessive complexity, which was burdensome to HEWs. This, negatively impacted HEW motivation and compromised service delivery. HEW involvement in non-HEP activities (such as promoting other government programs) often competed with their core mandates, thus affecting HEP service delivery.Efforts to address training and supervision constraints in Ethiopia's HEP should focus on improving the quality of NCD training for HEWs and supervisors, shifting from authoritative to supportive supervision, simplifying performance appraisal and reducing competing attention from other programs.
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Affiliation(s)
- Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, Mekelle University, Mek'ele, Ethiopia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Whenayon S Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | | | | | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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