1. Tariq Azim Hailemaraim Kassahun Tsedeke Wodebo
Making a Difference:
Health Extension Workers (HEWs) Bring Innovation to Improve the Community Health Information System (CHIS) in Ethiopia
Tariq Azim
Hailemaraim Kassahun
Tsedeke Wodebo

2. Family Folder – the Backbone of CHIS in Ethiopia
Center piece of CHIS
Every household near a health post issued a family folder
Designed to assist the Health Extension Workers (HEWs) deliver an integrated primary health care package

3. The Evolution of the Tickler File System at Health Posts in Ethiopia
HEWs registered and followed-up with:
pregnant women
children who need immunization
family planning clients
HEWs faced difficulties in identifying these clients from the records

4. HEWs’ innovative ideas:
The Evolution of the Tickler File System at Health Posts in Ethiopia ctd.
HEWs’ innovative ideas:
Some HEWs introduced cloth pockets to hang on the wall
They arranged small paper chits with house numbers of clients requiring follow-up services
Other HEWs used paper packets with service tags to hang on the wall
They placed the house numbers of clients who required follow-up inside the packets

5. Lessons from the field and expert discussions
The Evolution of the Tickler File System at Health Posts in Ethiopia ctd.
Lessons from the field and expert discussions
Introduction of tickler file boxes
Included twelve monthly slots to organize client cards by month of next follow-up

6. Tickler File System
Ensures continuity of care, helping HEWs to track clients needing follow-up services
Pregnant women in need of antenatal, delivery and post natal care
Children < 2 years of age in need of newborn care, immunizations and good monitoring and nutrition
Orphans and vulnerable children
People living with HIV/AIDS

7. District Administration Mobilizing Volunteers
HEW Training
District Administration
Mobilizing Volunteers

8. HH Numbering
Record Keeping
FF Filing system

9. Did the Tickler File System Make a Difference?
Implementing the system requires investment:
Training
Wooden boxes
Supportive supervision and mentoring
Questions asked by managers and policy makers
We studied the evidences around us:
Electronic HMIS reports from health posts
Supervisory visit reports
Relevant publications

10. …. Relevant Publications
Quarterly Bulletins from the Federal Ministry of Health
USAID’s Top Ten Case Studies
Fact Sheets from the MEASURE Evaluation website
Case-study: Understanding how a family centered information system strengthened the community health program in SNNPR, Ethiopia

11. Findings - Community leader CHIS helped build HEWs’ confidence
“Previously we didn’t know who would come and when for family planning services because of the workload, but now we know, and this has helped to build the community's trust in me.”
- HEW
“(We) feel more attached to the health post, because the HEW now maintains our records.”
- Community leader

12. Findings ctd. Improved performance of pregnancy care services
Proportion of women who were receiving antenatal and postnatal services from health posts was well maintained (e.g. ANC1= 59%; ANC4=56%, PNC 75% in Duna woreda)
In Kaccha Bira, overall performance of health posts is low
Many mothers sought services at a hospital in this woreda

13. Duna Woreda, Hadiya Zone, SNNPR, Ethiopia

14. Conclusion
Paper-based CHIS played an important role in improving health services through better information use at the service delivery site
Overall, it provided a more accurate reflection of the situation
Digitized CHIS could be more useful