ROADMAP FOR INTEGRATING SMART START IN ETHIOPIA IS PAVING THE WAY FOR ENHANCED HEALTH SYSTEMS.
Author: Fana Abay, Marketing and Communications Director, PSI Ethiopia; Yonatan Tamiru, Communication and PR Specialist, PSI Ethiopia
In 2020, the Roadmap for Integrating Smart Start in Ethiopia (RISE) program launched a bold 5-year initiative to reduce teenage pregnancy rates and improve the health of married girls aged 15–19 through the innovative Smart Start program. Supported by the Children’s Investment Fund Foundation and the Bill & Melinda Gates Foundation, this health system-strengthening intervention involves critical partners, the Ethiopian Federal Ministry of Health (FMOH) and Population Services International Ethiopia.
Born from the A360 project, Smart Start revolutionizes contraceptive counseling by linking targeted financial and health information seamlessly. RISE is expanding its reach to six regions in Ethiopia, strongly emphasizing integration into the existing government structure. This strategic approach leverages the well-established infrastructure of the Ethiopian Ministry of Health.
Through RISE, the Ethiopian Ministry of Health integrates Smart Start into Ethiopia’s national health promotion program. This integration aims to reach 1 million girls by 2025 and empower married girls and their husbands in rural areas to make informed family planning decisions. This initiative is a crucial step towards strengthening the country’s health system and improving the well-being of young married couples.
LEARNING FROM THE HEALTH SYSTEM STRENGTHENING PROGRAM
Despite proactive measures, RISE faced challenges in achieving its goals, so a one-month acceleration plan was introduced in 2022. A key finding from this plan was the untapped potential of the Primary Health Care Units (PHCU). The underutilization of the PHCU system within the Ethiopian health system proved to be a critical factor hindering the success of RISE. This challenge directly results from the limited experience in managing a revolutionary health system project of this magnitude.
In the Ethiopian health system, the Primary Health Care Unit (PHCU) links the hospitals, health centers, and health posts and ensures better community health outcomes. While PHCUs primarily consist of health centers in urban areas, they also include health posts in rural areas and serve as the final component in the Ethiopian health system structure (see figure below).
UNLOCKING THE POTENTIAL OF PRIMARY HEALTH CARE UNITS
Given the underutilization of the Primary Health Care Unit (PHCU) and the existing capacity gap in the health centers that hinders the efficiency of the system in supporting the RISE program, the Federal Ministry of Health (FMOH) in collaboration with its technical partner PSI Ethiopia has prioritized improving the capacity in these health centers. The aim is to enable them to support the RISE program effectively by building stronger links with health extension workers. This strategic campaign to build capacity and raise awareness across the PHCU network aims to enable the health centers to support the community better. Ultimately, this initiative seeks to integrate the RISE program into daily operations.
The reintegration of PHCUs into the RISE program chain has resulted in a more comprehensive and inclusive reporting structure. The health centers now actively monitor and support the Health Advisors, Smart Start Navigators, Community Influencers, and Community Engagement Initiatives. This new approach ensures that every level of PHCUs, from rural health posts to urban health centers, is actively contributing to the success of RISE.
THE IMPACT OF PRIMARY HEALTH CARE UNIT INTEGRATION
The active involvement of PHCUs through capacity building and close monitoring of the RISE program has brought significant benefits. The health centers now play a central role in the collection of reports and provide immediate support both in terms of technical and human resources.
Sister Zhara Ali, Director of the Afambo Woreda Health Center, highlights the central role of the health centers, which has led to a remarkable 65% increase in contraceptive use at the Afambo Health Center.
“We supervise six health posts under this health center, collect reports, and provide close technical and human resource support. Previously, the health posts were directly under the woreda health offices. Still, now the health centers supervise them and provide technical support,” said Sister Zhara, the head of the health center in Afambo Woreda.
The impact is seen in numbers (see figure below) and felt at the community level. As part of the PHCUs, the health centers have become knowledge dissemination hubs, ensuring that Smart Start’s innovative approach reaches even the most remote corners of Ethiopia. The integration of PHCUs has enabled health workers to provide targeted support and make family planning more accessible and culturally relevant to their communities.
CONCLUSION
Integrating PHCU into the RISE program represents a strategic direction that increases focus, depth, and inclusivity. This comprehensive approach ensures the success of RISE as it relies on the combined efforts of health centers, health posts, and primary hospitals working seamlessly together within the PHCUs. This is an essential step towards sustainable impact and positive change in Ethiopia. RISE program emphasizes the importance of understanding and leveraging existing government structures when scaling up initiatives and integrating to government health system. The PHCU, previously underutilized, has become a catalyst for change and demonstrates that Smart Start integration in the primary health care unit is paving the way for enhanced health systems in Ethiopia.
