Keneni Gutema Negeri

Background: Though Ethiopia has achieved remarkable progress in immunisation services, there is limited evidence on comprehensive national immunisation coverage. Therefore, this national study evaluated the performance of life-course immunisation services. Methods: This study was conducted in all Ethiopian regions and city administrations from March to July 2023. Two-stage stratified cluster sampling was used. About 13666 children aged 12-35 months, 5338 adolescent girls (15–18) and 13843 adults aged 12 years or more were included in the study. Child vaccination status was assessed through reviewing immunisation cards/health facility registration books/caregivers’ recall. A descriptive analysis was done with an adjusted sampling weight. Results: Three-fourths of children aged 12-23 months received the first dose of the pentavalent vaccine, and two-thirds received the third dose of the Pentavalent Vaccine. About two-thirds and half of the children received the first and second doses of the Measles vaccine, respectively. The dropout rates for Pentavalent was 14.1% and for Measles, was 19.9%. Full immunisation coverage was 43.9%, and zero-dose children accounted for 24.7%. About 85% of mothers received the first dose of the Tetanus-Diphtheria vaccine. Half of adolescent girls received their first vaccination, and a quarter of them received a second dose of the HPV vaccine. Conclusions: Although Ethiopia has made strides in child immunisation, coverage remains below national and global targets. Tetanus-diphtheria vaccine uptake was initially high but dropped significantly by the fourth and fifth doses. HPV vaccine coverage was suboptimal, with most not receiving the second or booster doses. Strengthening national efforts to address both demand and supply barriers is vital for increasing vaccine uptake.

Background: Ethiopia has expanded immunisation coverage significantly over the past two decades through strengthened primary healthcare services. However, the quality of immunisation services remains a concern, and their overall quality status has not been thoroughly investigated. This study assesses the immunisation service quality using technical aspects, such as pre-, intra-, and post-administration session quality, as well as perceived quality (client satisfaction), in Ethiopia. Methods: This study was part of the national immunisation program evaluation survey. Vaccinators’ practices were observed, and exit interviews were conducted with mothers and caregivers. The study was conducted in all regions and city administrations, except for the Tigray region. A total of 2,971 session observations and 2,955 exit interviews were included. A structured checklist assessed vaccinators’ competency, while satisfaction was measured using a Likert scale questionnaire. Results: The study revealed sub-optimal immunisation session quality and client dissatisfaction. Only 4% of vaccinators conducted a complete infant assessment, 11% used educational materials, and 7% delivered key immunisation messages. Nearly half of the sessions were handled by a single vaccinator. Incorrect vaccine administration was noted, with 9% and 11% missing the correct route and site for BCG, 8% and 9% for measles, and 7% administering incorrect doses of the Rota vaccine. Only 55% of mothers/caregivers reported satisfaction with the service. Conclusions: The study highlights poor communication regarding immunisation, vaccine administration, and post-administration safety practices, as well as caregivers’ dissatisfaction. Strengthening immunisation service quality through standardised guidelines, ongoing capacity-building, and accountability measures is essential to improve immunisation service uptake, quality, and health outcomes.

This study aimed to assess the Ethiopian immunization supply chain (iSC) using the WHO-UNICEF Effective Vaccine Management (EVM) assessment tool in 302 nationally representative facilities. Ethiopian Pharmaceutical Supply Service (EPSS) center, the Sub-national hubs, lower distribution centers, and service provision levels of the Ethiopian immunization supply chain participated in this assessment. The finding is presented in 9 facility operations (E1-E9) and 4 management criteria (M1-4) across levels. The overall composite score of Effective Vaccine Management (EVM) is 69%. EPSS center or Primary level (PR) scored 85 % and EPSS hubs or Sub-National (SN) levels scored 81% hitting the WHO-recommended target score. The lower distribution (LD) and service provision (SP) levels scored 65% and 61% respectively, both being lower than the recommended WHO target score which is 80%. Vaccine management was a criterion that surpassed the WHO target recommended score. Temperature management, storage and transportation, and iSC performance monitoring criteria were consistently lower than the WHO target. Ethiopia's immunization supply chain management system is still far from meeting the WHO targets, particularly at lower distribution and service provision levels. EPSS centers perform well in many criteria but struggle with temperature management, storage, and transportation capacity. Ministry and stakeholders must prioritize improving facility operations and management at lower distribution and service provision levels. There is a need to develop a continuous improvement plan based on EVM findings and implement and systematically monitor the improvement activities to ensure their success.

Background: There is insufficient evidence on the current condition of vaccine cold chain equipment (CCE) in Ethiopia. This study is aimed to assess the status of the CCE of the Ethiopian immunization supply chain (iSC) system. Methods: A cross-sectional study was conducted at 302 iSC sites across nine regions in Ethiopia using the World Health Organization (WHO) Expanded Program of Immunization (EPI) review guide and the EVM2.0 tool. Data were collected through direct observation and face-to-face interviews with the EVM Assessor mobile app, assessing vaccine storage capacity, including CCE type, brand, and model, at one EPSS center and 15 hubs. Results: All EPSS hubs use passive storage devices and have refrigeration and/or freezer units. A total of 408 refrigerators and/or freezers were found at lower distribution (LD) and service provision (SP) levels, including 335 regular refrigerators and 73 combined units (refrigerators and freezers). During the survey, 157 of these refrigerators had a functioning 30-day-temperature-record (30DTR) system. The average storage capacity for vaccines positive (2--80) was 1434 liters in 286 facilities. The average storage capacity of vaccine negatives (-25--150) was 538 liters in 286 facilities. The EPSS center and 13 hubs have conducted preventive maintenance and repaired refrigerators in the past year. Most institutions (82.95%) at the LD and SP levels lack a documented preventive maintenance schedule. Only 20% of institutions maintain records of preventive maintenance. Conclusion: Improving cold chain management through better temperature monitoring, increased refrigeration, and enhanced transportation is essential to ensure vaccine potency and reduce wastage.

This study assessed vaccine storage, stock management, and distribution practices in Ethiopia using the EVM 2.0 tool from March to July 2023. It involved 302 health facilities, one central EPSSA hub, and 15 EPSSA sub-national hubs. A mixed-method approach was used, with data collected via the EVM assessment tool and analyzed using STATA 16 and ATLAS.ti software. Findings showed that the EPSS center and four hubs maintained well-organized stock records, but variation existed in vaccine stock arrangement, security of records, and frequency of physical stock counts. Although all sub-central hubs submitted requests electronically, 74.15% of facilities did not. Three-fourths of institutions documented maximum stock levels. Less than 50% of institutions retained stock records for at least three years, except health centers. One-tenth of institutions faced storage emergencies in the past year, and 70.07% of health institutions stored records securely. Distribution and allocation records were updated monthly in 81% of institutions. Challenges included a lack of accurate denominators, poor infrastructure, inadequate storage equipment, and migration. Vehicle unavailability hindered distribution. Despite these issues, stock management knowledge was found to be encouraging at all levels. The government should focus on improving vaccine forecasting, implementing computerized systems, and addressing transportation infrastructure challenges.

The effectiveness of health-targeted aid in improving health outcomes in developing countries remains a subject of debate. This paper investigates the short-run impact of health aid on health status in low-income countries globally. A panel dataset was constructed from 34 low-income countries spanning 2000 to 2017, with Infant Mortality Rate (IMR) serving as the primary proxy for health status. To estimate the short-run effect, First Difference GMM and System GMM estimators were employed, with a preference for System GMM due to its robustness against weak instrument problems in dynamic panel data models. The model incorporated log transformations for Health Development Aid (HDA), GDP per capita, and cereal yield, while exponential transformations were applied to human capital and governance indices, alongside adolescent fertility rate and elderly dependency rate. The System GMM estimation revealed a statistically significant and beneficial short-run effect of health aid on health status. Specifically, a doubling of health aid is associated with a reduction of 2 infant deaths per 1,000 live births. Other significant findings include the positive impact of GDP per capita, human capital, and governance, and the negative impact of adolescent fertility rate and elderly dependency rate on infant mortality. The Sargan test confirmed the validity of the over-identifying restrictions (p=0.2279), and the Arellano-Bond test for AR(2) indicated no serial correlation in the idiosyncratic errors (p=0.158). The findings strongly suggest that health aid serves as a potent instrument for narrowing the health status gap between high and low-income countries, thereby contributing to the achievement of Universal Health Coverage. However, recipient countries should also prioritize fostering domestic factors that positively influence the health sector to reduce persistent reliance on external resources.

The universal health coverage (UHC) efforts in low- and middle-income countries such as Ethiopia encounter significant challenges in the implementation of community-based health insurance (CBHI) programs. This study investigated barriers and enablers influencing CBHI enrollment in Sidama National Regional State. Using purposive sampling, 48 participants were recruited, including four focus groups (12 participants each) and 20 key informant interviews. Participants comprised CBHI members (n = 5), non-members (n = 5), community leaders (n = 4), policymakers (n = 3), and healthcare providers (n = 3). Data collection occurred over three weeks in May 2024, with thematic analysis employed following phenomenological principles. Ethical considerations such as informed consent, confidentiality, and data protection were strictly observed. Findings indicate that awareness of CBHI has improved across Sidama; however, persistent misconceptions remain, including beliefs that CBHI is exclusively for the poor or is synonymous with preparing for illness. Several structural barriers were identified, notably ambiguous governance frameworks, a lack of accountability, and inadequate human resources. Issues in service delivery further undermine program effectiveness, characterized by discrimination against CBHI members, frequent shortages of essential medications and laboratory services, and delays in payment processes. Financial management challenges, lack of transparency, and the absence of grievance mechanisms were also found to erode community trust in the CBHI system. Despite these challenges, CBHI is recognized as valuable for reducing healthcare costs and enhancing access, particularly among women and low-income households, empowering women’s autonomy in health decisions. Community-based health insurance (CBHI) in the Sidama Region has improved awareness and access to healthcare. However, sustainability is challenged by misconceptions, governance challenges, and service delivery issues, which undermine trust and reduce enrollment and retention. Addressing governance, transparency, equity, and community involvement is crucial to strengthening CBHI and ensuring equitable healthcare access.

Strengthening data quality in the routine health information system is vital for the performance of health service outcomes. However, implementation of the routine interventions to improve data quality in the existing health system has been found inadequate two in Ethiopia. This study was aimed to examine the effect of Augmented Capacity Development Interventions (ACDI) on the performance of data quality in the routine health information system. A arm, parallel group, cluster-randomized control trial was implemented from July 1, 2023 to February 29, 2024. Baseline data were collected from April 1–30, 2023, and end-line data from April 1–30, 2024. The cluster design was employed as it allows for minimizing information contamination. The study included 72 health institution clusters and 304 health workers (154 intervention and 150 control arms). The implemented interventions include training, supportive supervision, mentorship, and recognition. General Linear Mixed Model was applied for analysis. The mean score for data quality perception improved from 2.32 at baseline to 3.13 at end-line (95% CI: 3.05, 3.21; P < .001). The data quality practice has significantly improved after the implementation of the ACDI packages (β = .17; 95% CI: 0.05, 0.30; P = .007), ease of data management (β = .14; 95% CI: 0.07, 0.22; P < .001), information use (β = .15; 95% CI: 0.08, 0.23; P < .001), and the combined effects of encouragement and training (β = .44; 95% CI: 0.23, 0.65; P < .001) were significant predictors of the change in the data quality. The ACDI packages implemented in this study effectively influenced data quality improvement. Key predictors of data quality practices included an encouraging system, ease of data management, written guidelines, supportive supervision, and training. Therefore, the interventions are recommended to be adapted and scaled up. Trial registration ID: PACTR202212472091194.

A strong Health Information System (HIS) is a foundation for evidence-based decision making in health care management. However, there is a dearth of literature with respect to health information use practice, particularly in public health facilities of Sidama Zone, Southern Ethiopia. A cross-sectional, facility-based quantitative study was conducted from February 1 to February 29, 2018. Quantitative data was collected using a structured questionnaire and checklists from a sample of 48 health facilities and 213 health workers, and analyzed using binary logistic regression. To complement the quantitative findings, qualitative data was collected using key informant interviews. The level of information use based on standard observation checklists was 58%. Health information system’s specific supportive supervision (Adjusted Odd Ratio, AOR, 3.070; 95% Confidence Interval, CI, 1.206, 7.816), staff’s perception of data use practice (AOR=3.732, 95%CI 1.383, 10.068), and staff’s experience of root cause analysis (AOR=3.782, 95%CI 1.456, 9.819) were significant factors associated with the information use. Health information use among public health facilities was low. Strengthening supportive supervision, awareness creation on the use of available data, and improving the skill of root cause analysis of the problem is recommended.