Ethiopia’s Political Will to Increase Access to Pneumonia Oxygen Treatment

Ethiopia’s Political Will to Increase Access to Pneumonia Oxygen Treatment

Credit: UNICEF Ethiopia

Credit: UNICEF Ethiopia

August 25, 2016

By Salma Warshanna-Sparklin, Advocacy and Communications Specialist, International Vaccine Access Center (IVAC)

Faced with 200,000 children dying annually in Ethiopia, Habtamu Seyoum Tolla and his team at Clinton Health Access Initiative (CHAI) are helping the government form new policy around treatment for pneumonia—the leading cause of child mortality in his country.

“When a kid comes into the health facility gasping from pneumonia, the mother crying in front of me, it’s really heartbreaking,” says Tolla, a physician specializing in tropical and infectious diseases. It’s a common sight in Ethiopia, he adds, a country ranked 6th for total pneumonia and diarrhea deaths in children under 5 in the Pneumonia and Diarrhea Progress Report 2015, based on data from the World Health Organization (WHO).

In an effort to curb child mortality, the Federal Ministry of Health (FMOH) developed a National Newborn and Child Survival Strategy in 2015 to be implemented over the next five years. The goal: to prevent over 415,000 deaths of children under 5 and over 210,00 neonates by 2020. One component of the five-year strategy, which CHAI is helping FMOH implement, is advocating for new policy on oxygen scale-up and management, a vital treatment in combatting pneumonia-related issues.

The most important part of the strategy, Tolla say, is that “there is strong FMOH leadership and commitment to make this happen.”

Pneumonia can affect the movement of oxygen from the lungs into the bloodstream. To measure the amount of oxygen in a patient’s blood, health care workers can use the pulse oximetry test. A probe can be placed against a patient’s finger, and the device uses light to measure blood oxygen levels. When a child is experiencing abnormally low oxygen levels, or hypoxemia, a health worker can provide oxygen therapy to help prevent organ failure and death.

The ability to detect and treat hypoxemia in neonates and children under 5 is critical to reducing mortality rates, explains Tolla, but there are significant limitations in Ethiopia. Among health centers, a mere 2% have fully functional oxygen delivery devices—like nasal cannulas or face masks—and 0% have functional pulse oximeters, according to a baseline survey by CHAI/FMOH. Hospitals fare better but still have room to improve, with 64% possessing fully functional oxygen delivery devices and less than half (45%) having pulse oximeters available in their inpatient pediatric wards.

Furthermore, the baseline data showed that only 14% of hospitals have standard operating procedures on oxygen use or health care workers trained in oxygen therapy. Even if they do have oxygen available, only 41% of hospitals have biomedical engineers and technicians who can maintain oxygen equipment.

This dramatic dearth in available resources and trained personnel is what Tolla hopes to change. His team has been turning those findings into a strategy to formulate a national roadmap for oxygen and pulse oximetry scale-up—the first of its kind in the country.

“We have a chance to set up policies and guidelines that have broad impact—not on one or two facilities, but nationwide,” he says. Among the ambitious targets is comprehensive implementation of pulse oximetry and oxygen access and management in more than 3,500 health centers and more than 800 hospitals in Ethiopia, by the end of 2020.

The team was able to support the FMOH in revising guidelines to incorporate amoxicillin dispersible tablets as a preferred treatment for pneumonia, and now also include the use of pulse oximetry at primary care points where they didn’t exist before. Plus, for the 1,600-plus sites that the project is supporting over the next three years, they are providing supply chain training and sensitization related to pneumonia, and diarrhea commodities supply system training, based on updated guidelines. “We are laying the groundwork,” Tolla says, “to begin implementation in 2017.”

“The political commitment is here,” he stresses, “and we need to garner support from global stakeholders.” Given the geographic size of the country and the limitations in health infrastructure, a massive oxygen and pulse oximeter scale-up will require immense resources for training human resources, establishing systems for distribution, financing technology procurement, and more.

Hypoxemia is the major fatal complication of pneumonia, making this a strategic investment for the country. The WHO emphasizes the need for increased awareness, pulse oximetry use, and access to oxygen therapy in its recent 2016 report, “Oxygen Therapy for Children,” citing how this intervention has been shown to cut pneumonia death rates by one third in a rural, low-income settings.

To global stakeholders, Tolla’s request is simple: “Come support Ethiopia’s ministry, we have the political will.” That’s arguably one of the most valuable—and difficult—resources to garner.