The USAID/UHEP aims to strengthen the capacity of Urban Health Professionals to identify the most at-risk populations (MARPs) in their catchment areas and to provide them with health services to improve their overall health outcomes, including HIV prevention, care and support services. USAID/UHEP also works to expand the capacity of Urban Health Professionals to assess social and individual factors that may contribute to creating and increasing vulnerability and risk for health problems (including but not limited to HIV/AIDS) for vulnerable populations, as well as their ability to access services.
As frontline workers with close links to households and communities, these Urban Health Professionals have a unique opportunity to deliver integrated, tailored and targeted services. With its focus on strengthening the capacity of the Urban Health Professionals to provide HIV prevention, care and support services to MARPs, USAID/UHEP will not only ensure that MARPs have access to important public health information and services, but will also contribute to the overall strategic goals of the USG PEPFAR program in Ethiopia and specifically its emphasis on MARPs.
USAID/UHEP supports implementation activities in five regions and two city administrations, covering 19 towns/cities, as follows:
- Tigray Region (Mekele, Adigrat, Axum and Shire);
- Amhara Region (Bahir Dar, Gonder, D/Markos and Dessie);
- Oromia Region (Adama, Jimma, Shashamene and Nekemte);
- SNNPR Region (Hossana, Hawassa, Arba Minch and Wolaita Sodo);
- Harari Region (Harar Town);
- Dire Dawa City Administration (Dire Dawa); and,
- Addis Ababa City Administration (at two sub cities).
USAID/UHEP builds on the experiences, achievements and lessons learned from JSI’s Gates Foundation-funded project, The Last Ten Kilometers: What it Takes to Improve Health Outcomes in Rural Ethiopia (L10K). L10K works with the public sector and Civil Society Organizations/Non-governmental Organizations in four regions to strengthen the link between households, communities and the HEP, and improve maternal and neonatal health outcomes. Further, in 2009 USAID provided resources to L10K to launch the L10K Urban Health Project (L10K/ UHP). Both of these programs helped pave the way for the successful roll-out of the USAID/UHEP.
The Government of Ethiopia (GoE) recognizes the fact that public health interventions in urban settings are less than optimal and has been working to develop an Urban Health Extension Program (GoE/UHEP) building on the success of the Rural Health Extension Program. The goal of the GoE/UHEP is to improve access and equity to basic health services and address major health problems and other issues in urban areas such as HIV, food security, and poor sanitation, among many other health and non-health issues. Central to the design of the GoE/UHEP is the need to improve access and equity of public health information and services to the urban population through the training and deploying of a cadre of Urban Health Extension (UHE) Professionals, and at the same time expand physical health infrastructure.
The organizing principle of the GoE/UHEP is the provision of "household-centered" promotive, preventive and limited curative services with strong referral linkages to public sector health facilities. UHE Professionals are placed in health centers, so as to bridge households, communities and these lower level health facilities. Each health center serves 40,000 people; therefore, one UHE Professional is assigned to 500 households, with 16 of these workers are placed in each health center. UHE Professionals also have a cadre of Supervisors with whom they work closely.
The key services expected to be delivered by the UHE Professional include the following:
- Family health;
- Reproductive health;
- HIV prevention, care and support, including the prevention of mother-to-child transmission (PMTCT);
- Food and nutrition;
- Hygiene and environmental health;
- Disease prevention and control;
- Mental health; and,
- Violence and injury prevention.
The major HIV-related tasks of UHE Professional include the following:
- Organize, utilize and manage demographic/health data of the Kebele;
- Provide education on PMTCT;
- Provide education on sexual and reproductive health to adolescents;
- Promote healthy sexual lifestyles (abstinence, faithfulness, condom usage);
- Promote voluntary counseling and testing (VCT);
- Provide home-based counseling and testing (HBCT) through provider-initiated counseling and testing (PICT);
- Educate on sexually transmitted infections (STIs) and refer those that need STI services;
- Educate and promote the provision of care and support to the chronically ill;
- Promote early TB detection and health seeking behavior (including linking PLHIV to tuberculosis (TB) services and TB clients to HIV Counseling and Testing (HCT));
- Identify defaulters and encourage them to continue their treatment including adherence to ART and TB regimes;
- Refer identified patients for better management, receive feedback and ensure follow up for further action; and,
- Facilitate community mobilization.