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1 TABLE OF CONTENTS

Acronyms Message from the Bureau Head Structure

Organogram, Tigray Health Bureau Organogram, Wereda Health Offices

2 3-4 5-6

District Boundaries and Health infrastructure progress District Health Profiles

Tsegedae Welkeit Kafta Humera Tahtay Adiabo Laelay Adiabo Tahtay Koraro Asegede Tsimbila Tselemti Medebay Zana Tahtay Maichew Mereb Leke Laelay Maichew Naedir Adiet Adua Ahferom Werie Leke Kola Tembien Tanqua Abergele Degua Tembien Gulomekeda Erob Saesie Tsaeda Emba Ganta Afeshum Hawzien Wukro Atsibi Wenberta Enderta Samre Saharti Hintalo Wajirat Alaje Endamohoni Raya Azebo Ofla Alamata Mekelle Zone

32-33 34-103

34-35 36-37 38-39 40-41 42-43 44-45 46-47 48-49 50-51 52-53 54-55 56-57 58-59 60-61 62-63 64-65 66-67 68-69 70-71 72-73 74-75 76-77 78-79 80-81 82-83 84-85 86-87 88-89 90-91 92-93 94-95 96-97 98-99 100-101 102-103

Background Introduction Challenges Regional Health Profile

Indicators Demographics and health services coverage Map: Tigray health institutions and catchment areas Population Reproductive age females Health professionals at institutions and Office Health facilities Medical Services Drug retail outlets Health services status and expansion S tandard versus existing staffing Ongoing staff training Ongoing construction Top ten causes of outpatient visits, admissions and deaths Clinics and Health Posts, total Hospitals and Health Centres, total Hospitals and Health Centers, female Hospitals and Health Centers, under 5 children Major communicable disease Major reportable communicable diseases Case fatality rates HIV AIDs Malaria Tuberculosis and leprosy Maternal and child health Eye diseases Sanitation and education Budget and expenditure Recurrent budget summary Capital budget summary Recurrent budget details Health Service Access and Utilization Comparison of hospitals

7 8 9

10-31 10-11 12-13

14-16

17-18

19-23 19 19 20 21-22 23-24 25 26 27 28-29

Contact information

Telephones Tigray Health Bureau Telephones Wereda Health Offices Email addresses

104-106

104 105

30-31 31

Acknowledgements

107

2 ACRONYM

AIDS ANC AURI ART BCG CBRHA CDD CHA CHW CL CVS DHO DOTS DPT EPI GI GPS HTN HSDP HIV HMIS HO HEWs KUSHET

Acquired Immunodeficiency Syndrome Antenatal Care Acute Respiratory Tract Infection Anti retroviral Treatment Bacille -Calmette -Guerin (Tuberculosis Vaccine) Community Based Reproductive Health Agents Control of Diarrheal Diseases Community Health Agent Community Health Workers Clinic Cerebro Vascular system District Health Office Direct Observed Therapy Diphtheria Pertussis Tetanus vaccine Expanded Program on Immunization Gastro Intestinal Global Positioning System Hypertension with heart disease Health Sector Development Programme Human Immunodeficiency Virus Health Management Information System Health Officer Health Extension Workers Village

HP HS ICT IMCI ITN IUD MB MCH MD MS OPV PB PHCU PHW PF PM PMTCT PTB PV STI/D TABIA TB TBA TRHB TT VCT WEREDA

Health Post Health Station Information, Communication Technology Integrated management of child hood illnesses Insecticide treated nets Intra Uterine Device Multibacillary Maternal and Child Health Medical Doctor All other diseases of musculoskeletal System Oral Polio Vaccine Paucibacillary Primary Health Care Unit Primary Health Workers Plasmodium Fa lciparum Plasmodium Malariae prevention of mother to child transmission Pulmonary Tuberculosis Plasmodium Vivax Sexually Transmitted infections (diseases) Sub-District Tuberculosis Traditional Birth Attendants Tigray Regional Health Bureau Tetanus Toxoid Voluntary Counseling and Testing District

3

Message from Bureau Head

Dear Readers, For the third year in a row, we have now belatedly come with the information you definitely need on the activities of the health bureau in Tigray. When you want to work with us, we hope, the 2003/4 (1996 EC) profile will give you a bird's eye view of the health system as a whole. But there are great strides since the end of the Ethiopian calendar year of 1996. To update you, I will mention only some. Thirty three health officers graduated recently from the University of Mekelle trained in collaboration with the regional hospital in the city. Most of them were deployed to the districts, doubling the number of health officers in Tigray. There are over 100 of them enrolled currently and trend will give our district health system a capacity unparalleled any where in Ethiopia. We've also started training emergency surgeons in Axum in collaboration with Medicne du Monde funded by UNFPA. We expect that several teams of emergency surgeons will be made available at the district level and contribute greatly in the reduction of maternal mortality due to obstructed labour. Our wartime experience in Tigray has given us the opportunity to appreciate the need for critical service of emergency care not only for the forces of combat but also and even more significantly to the mothers living in remote areas and affected by a generation long famine and under nutrition. Another major development of our health system is the training of 1200 health extension workers all females to be placed in 600 health posts of rural districts. In the year 2005, all construction work of HPs and training of the HEWs will be done and the deployment of these community health workers will greatly improve the health service coverage, particularly the promotive and preventive aspect of the health care delivery. It is not only the opportunities but also the challenges that might need to be mentioned here. There is a very high turn -over of senior health professionals, medical doctors in particular, through out Ethiopia and more is from Tigray. The main reason is, we are told, better payment by other countries and perhaps the private sector in the capital, Addis Ababa. In the year 2005, not a single medical doctor showed up to Tigray for employment, although we known that the Federal Ministry of Health did assign several fresh graduates. (Every year 120-150 fresh medical doctors graduate in Ethiopia). There is an additional spree of quick specialization of general practitioners in Ethiopia. Without acquiring adequate clinical experience as general practitioners, the doctors hurry up to be surgeons, internists and what not. This is an unwelcome trend which could have been checked by concerned higher learning Institutes. Never the less the high level of attrition of medical doctors should be addressed by increasing the number of Medical schools. This is a long-term and an expensive strategy. Medium term and less expensive alternative could

4 be to train the nearly 1000 health officers in clinical emergency care (medical, surgical, obstetric and pediatric) as well as biostatistics and health service planning and management. We are proposing this idea deliberately because we want to overcome the crisis of a critical human resource in Tigray as well as rural Ethiopia as a whole. Finally, a word of caution will about the quality of our profile. This profile is a result of a hard-working team at the HMIS of our health Bureau. They have tried their level best to collect and analyze relevant information for our readers. And yet, you will find some numbers that might raise your eye-brows. It is better reported than not because data that come from the lower levels of the hea lth system is better left as it is rather than contaminating it for the sake of `cleaning'. Lack of standard diagnosis and low level of clinical skills as well as diagnostic facilities are the obvious reasons for the discrepancies. Therefore, caution is ne eded in referring to some rates of morbidity and mortality. Looking forward for your constructive comments. In partnership GebreAb Barnababs (PhD) Head, Tigray Health Bureau January 2005, Mekelle, Tigray

5

OrganogramTigray Health Bureau

Bureau Head Dept of human Resource Development Dept of Planning, Progrmaning, and Project

personnel

Project Planning, and Monitoring Evaluation Health Management Information Systems (HMIS) Engineering

Training

Regional Training Centers

Finanace Service Public Relation Service

Audit Inspection Service

Deputy Bureau Head

Dept of Disease Prevention and Control

Dept of Health Services, research

Dept of Control of Malaria and Other Vector Borne Diseases

Dept of Medical Equipment, Supplies and Drug Administration

Hygiene and Environmental Health Maternal Child Health IEC and Health Extension Package Epidemiology and Surveillance Tuberculosis and Leprosy

Health Services

Vector Biology

Procurement and supply Pharmaceutical Storage, Monitoring and Distribution Equipment/Supply Management, and stores Techno-center

Zonal Hospitals Drug Licensing, Inspection and Tradition Medicine Research Center Laboratory

Community-Based Prevention

General Service

6

Organogram District Health Office

District Health Office Head

District Hospital

Disease Prevention and Control Division

Human Resource Development, Health Services and Planning

Training Expert EPI Coordinator Malaria and Other Vector Born Disease Section Health Service Expert Vector Biology Control Expert Epidemiology and Surveillance Expert Community Based Expert IEC and Extension Package Expert Environmental Health Expert Personnel Officer Pharmacy Expert

MCH Expert

Statistician

7

Background

Tigray is the northernmost national regional state of Ethiopia and is located between latitude 12o and 15o north. The region is divided into northwestern and southern lowlands (700-1500 metres above sea level) and central highlands (1500-3000 metres above sea level). The region covers 54,572.6 square kilometers. Tigray is bounded on the north by Eritrea, on the south by the Amhara Regional State, on the east by the Afar Regional State, and on the West by Sudan. MISSION STATEMENT Bureau of Health, Government of the National Regional State of Tigray Our mission is to establish a leading health system in Africa, with excellence in community-based, household-level disease prevention, and to create a healthy and happy society that will bring fast economic development for our country. In support of our mission statement we are committed to: Health Service Delivery and Quality of Care : To increase the vaccination coverage from current figures to over 90%, and maintain/sustain the same at all times. Expansion of Health Services: To construct a health post per tabia to reach 100% health service coverage in the region. Human Resource Development: To staff all health institutions in our region as per the national standard and other international standards, and to continuously improve the knowledge and skill of our staff by providing short and long-term training opportunities. Pharmaceuticals: To equip all health institutions in Tigray with equipments as per the national standard, and to supply all health institutions in Tigray with essential drugs as per the national standard. Information, Education, Communication, and Health Extension Package : To involve all households in creating healthy environments by introducing the health extension package. Using every available means of communication, to inform and educate our society to bring about behavioural change, especially in diseases like HIV/AIDS. Health Management: To introduce and practice best health management methods in our health institutions and the various community-based programmes, to enhance quality of care and our society's satisfaction. Health Information: To introduce a simple and modern information system that can be used to make better planning decisions in our decentralized and resource poor areas. Health Care Financing: To introduce an effective, efficient and equitable heath care financing system that will empower our heath institutions to manage the scarce resources allocated to them, and work on local means of raising and revolving funds from the community. Monitoring and Evaluation: To make assessment through monitoring and evaluation an inte gral part of every programme, so that we are aware of how we are progressing towards our goal of better health. To make all objectives nothing but result oriented. Health Research : To conduct operational health research based on the priority health problems. To continually improve the health system based on our research findings. Public-private partnership: To encourage and support private investors to be engaged in health-related investments.

8

Introduction

This Health profile presents a selection of significant facts and figures for Tigray Region and its 34 weredas. It provides information as indicators, so that Tigray can be compared to other regions in Ethiopia and other countries. The indicator formulas are given so that readers know how rates were calculated. Most indicators are those used by the Ethiopian Ministry of Health (MOH); others were suggested in the report of the Midterm Review of the Health Sector Development Program (HSDP), 2001. Not all indicators are helpful in our situation. In such cases, we have commented about the problems with the indicator. Data sources Tigray's health services are provided predominantly through the government sector. Although a few NGO institutions report regularly, almost all information included in this pr ofile is compiled from government health institution and health office reports. Sources of health data include routine reporting forms, narrative reports from institutions and wereda health offices, and special surveys and initiatives to collect informatio n for the profile. No private health institution data are included in this survey. Data completeness Since 1993 EC, routine monthly health reports from each institution in Tigray have been entered into an EpiInfo database in the HMIS Division. This has allowed for disaggregation of data to the wereda level, an important advantage after decentralization. For 1994 the monthly institution reporting performance was very high, and 99% of expected monthly reports were received during the year. Mortality data Except for case fatality rates, mortality rates are not reported from institutions, since community surveys have shown that almost all people die at home. The maternal and under 5 mortality rates cited are from the

1995 EC community -based mortality survey carried out by the Tigray Health Bureau in over 19,000 rural households.

Population data Wereda and regional population data by age group are extrapolated figures from the 1994 GC Tigray census. Personnel data Personnel data are for staff in clinic assignments only. Information was collected directly from all institutions in Sene 1996 EC. Time period The 12-month period reported here covers the 1996 Ethiopian calendar fiscal year, from Hamle 95 (July 2003) through Sene 1996(June 2004). Months refer to Ethiopian calendar months. Financial information Financial information is in Ethiopian Birr. Maps Maps were produced in the HMIS Unit using ArcView software. Region, wereda, and tabia boundary files, and road files were provided to the HIS Unit by the Bureau o Planning and Economic Development. The HMIS f unit collaborated in this field mapping, and in developing the computerized database. During mapping, the Tigray Health Bureau team collected detailed village information, including population, altitude, walking time to nearest institution, and type and number of community health workers in the village. This database has provided important information for the profile. Visualizing distribution of services and diseases helps with planning and with assessment of se rvice provision. Data quality Data completeness does not necessarily ensure data quality. We welcome critical assessment of data quality, and corrections.

9

The Problems and Challenges In the existing HMIS, Tigray

1. There are no well-accepted national standard indicators to guide why information is collected. 2. There are new forms distributed by the national and regional department and programs without the active HMIS involvement , leading to a wild expansion in the number of forms and the amount of information collected. 3. There is a duplication of information collection, and a significant time burden for collecting and processing data at the institutions at the wereda level. 4. There are demands collection of increasingly detailed information from higher-level institutions, and lack of attention to improving information from peripheral institutions and community-based sources. 5. No standardized management information is included in routine HMIS forms. No routine information is collected about drug supply, or the status of medical equipment. Personnel and financial information is not routinely collected as part of the HMIS. 6. Age groups are not standardized. 7. There is no sex disaggregation by age group in routine reports below the health centre level. 8. There is no standardized disaggregation of data by institution level and there is inappropriate use of the same forms for all levels, despite service provision differences. 9. There has been no update of ICD codes since 1948 GC. 10. There is no recognition that decentralization requires change in information flow, and that all information does not need to pass from the wereda to the region, and from the region to Federal MOH. 11. There is no standardized software based information management system in the country. 12. There is no system for maintaining computers and communication systems. 14. There is no standardized training for HMIS staff. 15. There is no system for data compilation or analysis at federal level. 16. Feedback from federal level to regions and from the region to the weredas is not enough. 17. No effective ongoing system at federal level for updating the HMIS system. STRATEGIES for improving the HMIS system in 1997 and beyond 1. Assign responsibility and accountability to HMIS units for improving the system. 2. Agree on indicators and dat to be collected. a 3. Collect information for action at wereda and regional level 4. Revise and reduce reporting forms and variables. 5. Update ICD and syndromic coding.. 6. Standardize information flow for action at the wereda level. 7. Standardize and Computerize data management to the wereda level. 8. Standardize electronic communication for transfer of information. 9. Establish systems for maintenance of computers and communication systems. 10. Establish systems for sharing information of HMIS Divisions with other departments. 11. Standardize formats for summary information dissemination: indicators graphs, tables, and trends. 12. Minimize unnecessary upward transfer of information.

10

CATEGORY AND INDICATOR Vital Statistics Total Population of Region Population Growth Rate Expected Pregnancies Expected Deliveries Children Under Five Years Children Under One Year Female 15-49 Years Infant Mortality Rate, 1995EC Under 5 Mortality Rate, 1995EC Maternal Mortality Ratio, 1995EC Health Facilities and Coverage (see following maps) No. Hospitals Functioning (excluding Specialized) No. Health Centers Functioning No. Health Posts Functioning No. Health Stations Functioning No. of Health Facilities per 100,000 Population % of Population Covered By Health Post % Live <2 hour walking time one way (10 km) from nearest facility % Live >2 hour walking time one way from nearest facility % population With CHWs in Kushet % Population With TBA in Kushet % Population With CBRHA in Kushet Utilization Curative Service OPD New Consultation per Person Admissions per Person Admission Percent of New OPD Attendants Health Service potential Coverage Utilization Reproductive Health Service ANC New Consultation Coverage Deliveries Assisted By Trained Professional Health Workers (HW)* Caesarian Section Percent of Deliveries Assisted by Professional HW Postnatal Coverage Contraceptive Prevalence Rate Adjusted Contraceptive Prevalence Rate Utilization EPI Service BCG Children Under 1 Coverage DPT3 Children Under 1 Coverage Measles Children Under 1 Coverage TT2 Coverage Non Pregnant Women TT2 Coverage Pregnant Women VALUE REMARKS AND FORMULAS

4,113,000 Official extrapolation from 1994 GC Tigray census 2.8% CSA 183,851 4.47% of total population, from HSDP-1 MTR 183,851 As above 740,340 18% of total population, from HSDP-1 MTR 172,325 4.19% of total population, from HSDP-1 MTR 975,528 Official extrapolation from 1994 GC Tigray census 61 No. under 1 deaths/no. live births X 1000, community- based survey every 2 years, 19,240 rural houses 90 No. under 5 deaths/no. live births X 1000, community-based survey every 2 years, 19,240 rural houses 551 No. pregnancy related deaths*/no. female 15-49 yr X 100,000, 19,240 rural houses 12 Per population: 1:325,083 34 Per population: 1:150,038 163 Per population: 1:24,382 168 Per population 1:33,059 9.2 MTR indicator: not very useful or meaningful 40.2 (Health Post + Clinc to be downgraded) X 5000/population X 100 68.5 From GPS survey at exch village 31.5 From GPS survey at each village 83.4 From GPS survey at each village (excluding Mekelle) 89.4 From GPS survey at each village (excluding Mekelle) 57.2 From GPS survey at each village (excluding Mekelle) 0.39 New clinic+ new hospital +new health center outpatients/population: 0.10-2.00 West Africa-East Africa 0.009 Admissions/population Standard = 5% for good referral system 61.5 (# healh center X25,000) + (# Clinic X10,000) / Total population 49.6 First ANC visit/expected pregnanciesX100 30.3 Normal delivery +Csection /expected pregnanciesX100 (*standard indicator includes TBA: don't have) 1.1 Csection /(normal delivery+ Csection )X 00 (*standard indicator includes TBA: don't have): expect=2-5% 30 Postnatal visit/expected pregnancy X 100 47.8 New acceptors +repeat acceptors all methods/female 15-49X100 THB indicator: (Method users excluding condom/expected consumption/yr/method)/female 15-49X100 84 86 98 26 30

11

CATEGORY AND INDICATOR Child Clinic Service Percent Under 5 Children Weighed Percent Under 5 Children Under Weight TB/HIV/AIDS TB Case Notification Rate per 100,000 Population TB Treatment Success Rate Percent Health Facilities With DOTs Percent Hospitals With Blood Safety Testing Percent Hospitals With VCT Percent All Institutions With VCT Malaria Clinical Malaria Incidence per 100,000 Population Percent Malaria Outpatients Treated At Village Level By CHWs Pharmaceutical supplies Percent of Essential Drug Availability Human Resources No. Staff in Teaching Institutions Training School Output Total Health Staff per 100,000 Population Physician: Population Ratio Nurse: Population Ratio Nurse: Institution Ratio New Consultations per Nurse per Year New Consultations per Nurse per Month New Consultations per Nurse per Working Day No. Health Personnel That Entered Service No. Health Personnel That Left Service Management Reporting Performance of Health Institutions Reporting Performance Hospitals Reporting Performance Health Centers Reporting performance Clinics Reporting Performance Health Posts Finance HSDP Average Budget Allocation per Person per Year in Birr HSDP Average Expenditure per Person per Year in Birr Absorption Capacity Percent Donor Assistance Percent Contribution from Loans Percent Government Contribution Percent Recurrent of Total Budget VALUE REMARKS AND FORMULAE

46.7 Under 5 children weighed/under 5 population X 100 66.6 <60%+60-80%/under 5 children weighed 188.4 PP+PN+EP+Relapse+Fail+Default/populationX100,000: Africa range=200-400 80.9 PP completed + cured/PP patients X 100 51 Direct Observable Treatment of Tuberculosis 100 All 12 Hospitals 100 All 12 Hospitals 8.2 THB indicator Health Facilities with VCT /Total Health Facilities X 100 23072 New outpatient Hospital, HCenter, Clinic + CHW-treated malaria patients/population X 100,000 64 90 Survey done by Ministry of Health and WHO,Octeber 2003 30 Only health professionals in Axum and Mekelle Training Schools 171 Total Number of Trainees Graduated In Mekelle and Axum Training Schools. 1.049305556 All health professionals from Primary health worker up to Medical specialist (Institution Based Only) 1.70192 Institution-based only 2.8908339 Institution-based only 3.03 Institution-based senior clinical nurse+junior clinical nurse/no. health institutions 1:1586 Total new outpatient visits/(senior clinical nurse+ junior clinical nurse at institutions) 132 Total new outpatient visits/(senior clinical nurse+ junior clinical nurse at institutions)/12 mo 6 Total new outpatient visits/(senior clinical nurse+junior clinical nurse institutions)/12 mo/25 workdays/mo 347 All Health Professionals recruited in 1996 E.C 113 All Health Professionals that leave service due to different reasons 98.8 Received reports/Expected reports X 100 (Expected reports = Number of institutions X 12 months/year) 100 100 98 97 26.9 Recurrent + capital budget allocated/population 23.8 Recurrent + capital budget expended/population 93.4 Expenditure/Allocated budget X 100 35.1 Total Donors Contribution 23 IDA Loan 64.9 Government Treasury 27 Recurrent budget/Recurrent + capital budget

12

13

Population

Male 0-4 58,818 5-14 101,589 15-44 165,309 45-64 31,145 65+ 11,139 Total 368,000 Age Urban Female 50,385 94,421 174,709 42,761 15,724 378,000 Total Male 109,203 291,302 196,010 458,887 340,018 681,735 73,906 165,139 26,863 59,937 746,000 1,657,000 Rural TOTAL Female Total 295,649 586,951 696,154 453,155 912,042 1,108,052 714,437 1,396,172 1,736,190 185,204 350,343 424,249 61,555 121,492 148,355 1,710,000 3,367,000 4,113,000

Population Pyramid

Tigray, 1996 EC

Age group

80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 400 300 200 100 0 100 200

Male Female

Health Professionals working at Type Specialist Medical Doctor Health Officer Senior Clinical Nurse Junior Clinical Nurse Junior Midwife Pharmacy Technician Junior Pharmacy Technician Laboratory Technician Junior Laboratory Technician Environmental Health Worker Junior Environmental Health Worker Health Assistant Junior Health Assistant Primary Health Worker Primary Midwife Community Health Agent (CHA) Traditional Birth Attendant (TBA) R.Health Agents (CBRHA) Institutions Number Per Population Office 27 1:152333 2 43 1:95651 4 26 1:158192 44 414 1:9935 128 552 1:7451 9 156 1:26365 0 66 1:62318 36 63 1:65286 10 84 1:48964 0 67 1:61388 0 26 1:158192 41 36 1:114250 4 662 1:6213 34 369 1:11146 0 148 1:27791 0 122 1:33713 0 2,810 1:1464 0 4,270 1:963 0 1,869 1:2201 0

300

400

Thousands

Tohousands

Reproductive Age Female

Age 15-49 Female 975,528

Drug Retail Outlets

Type Number Per Population Pharmacy 15 1:274200 Drug store 1 1:4113000 Rural Drug Vendor 223 1:18444 Total 239 1:17209

Medical Service

Activity Hospital Health Center Total Major Surgery 5,374 6 5,380 Minor Surgery 11,130 112 11,242 Out patient Inpatient X-ray 14,562 4,587 19,149 Laboratory 362,355 26,120 388,475

Health Facilities

Type Number Per Population 1:342750 Hospital 12 1:120971 Health Center 34 1:24482 Clinic 168 Health Post 163 1:25233 Total 377

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Comparison of standard Health professional staffing to Existing staffing by type of Health institution Sene, 1996 EC Standard = standard number per institution X number of instiutions, per Tigray Regional Government Standard 1991 EC Type of institution TOTAL S.N Category of Professional Zone Hospital District Hospital Health Center Clinic Health Post Existing Existing Existing Existing Existing Standard Year 95 Year 96 Filled (Gap) 1 Doctor, specialist 25 2 0 0 0 44 17 27 61% (39%) 2 Doctor, general practitioner 21 21 1 0 0 184 42 43 23% (77%) 3 Community health specialist (PhD) 0 0 0 0 0 5 0 0 0% (100%) 4 Community health professional (Health Officer/Field 5 6 15 0 0 80 19 26 33% (67%) 5 Nurse, professional (BA) 1 0 0 0 0 10 0 1 10% (90%) 6 Nurse, advanced specialized (2 year course) 24 0 0 0 0 70 10 24 34% (66%) 7 Nurse, specialized (1 year course) 5 3 0 0 0 277 11 8 3% (97%) 8 Nurse, clinical 79 88 160 87 0 869 387 414 48% (56%) 9 Nurse, clinical, junior 45 56 91 280 80 1,199 549 552 46% (54%) 10 Nurse, public health 0 0 12 0 0 68 9 12 18% (82%) 11 Nurse, midwife 7 15 0 0 0 126 22 22 17% (83%) 12 Nurse, midwife, junior 13 0 50 93 0 530 155 156 29% (61%) 13 Health assistant 124 89 249 166 34 1,640 677 662 40% (60%) 14 Health assistant, junior 60 8 141 160 0 864 349 369 43% (57%) 15 Primary health worker 0 0 0 0 148 163 124 148 91% (19%) 16 Primary midwife 0 0 0 0 122 163 109 122 75% (25%) 17 Ophthalmic medical assistant 3 4 0 0 0 24 7 7 29% (71%) 18 Optometrist 0 0 0 0 0 5 0 0% (100%) 19 Medical laboratory technologist 0 0 0 0 0 29 0 0% (100%) 20 Medical laboratory technician 30 24 30 0 0 85 66 84 99% (1%) 21 Medical laboratory technician, junior 0 0 37 30 0 223 57 67 30% (70%) 22 Pharmacist 0 0 0 0 0 24 0 0% (100%) 23 Pharmacy technician 24 18 24 0 0 109 52 66 61% (39%) 24 Pharmacy technician, junior 0 0 38 25 0 236 12 63 27% (63%) 25 Environmental health technician 5 1 20 0 0 51 25 26 51% (49%) 26 Environmental health technician, junior 0 0 26 10 0 34 15 36 106% 27 Radiology technician 8 1 0 0 0 29 12 9 31% (69%) 28 Radiology technician, junior 5 3 0 0 0 29 6 8 28% (72%) 29 Dental technician 3 1 0 0 0 24 3 4 17% (83%) 30 Physiotherapist 1 0 0 0 0 24 2 1 4% (96%) 31 Physiotherapy assistant 14 4 0 0 0 24 18 18 75% (25%) 32 Technocenter person 0 0 0 0 0 24 0 0% (100%) 33 Social worker 1 0 0 0 0 12 3 1 8% (92%) SUB-TOTALS 503 344 894 851 384 7278 2658 2976 41% (55%) Filled 42% 30% 45% 32% 79% 41% 41% (Gap) 58% 70% 55% 68% 21% 59% 55%

15

Health Service Expansion through staff Training and Health Facility Construction

Human Resource Development 1.1 In-country training S/N 1 Name of School Mekelle-MLHIT Type of Training Generic Nurses Generic Pharmacy technicians Generic laboratory technicians up grading nurses up grading Pharmacy technicians up grading laboratory Generic Nurses Generic Environmental health up grading nurse Junior clinical nurse Junior laboratory technician Junior midwife Junior pharmacy technician Junior environmental technician up grading Eenvironmental health MPH Medical Specialization BSC nurse BSC Laboratory techniologist BSC Anaesthesia BSC Environmental health BSC Management BSC Accounting Accounting Diploma Social Science Marketing Diploma management Status Correspondence Correspondence Correspondence Annual Intake output 1996 Male Female Male Female Total 105 7 19 2 17 2 88 71 20 9 15 9 114 5 25 3 36 12 30 23 53 14 13 27 17 13 30 22 5 27 30 4 34 6 2 0 6 1 1 0 1 1 1 0 5 0 1 3 9 8 5 2 1 Male Female Remark 4 3 1 5 3

Health Facility Construction, Rehabilitation and Expansion

Type New Zonal Hospital District Hospital Health Centers Health Stations Health Post Training School Regional Health Bureau Wereda Healht Office Total 4 200 4 20 1 1 4 194 2 15 1 1 4 1 1 5 Constraction Activities Ongoing Expantion Equieped Furnished

2

Axum-MLHTI " "

" A.A.U " " " 4 Gonder University 5 Jimma University 6 Mekelle University " " " " " 1.2 Abroad S.N Type of Training 1 MBA 2 Hospital Management 3 Ph.d TOTAL 3

Existing Vs Standard Health Professional Staffing

At Existing Health Facilities, Sene 1996 EC

2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0

Zonal Hospital District Hospital Health Center Clinic Health Post

year 96 Standard 96

Health Man power

16

Top Ten New Outpatient Cases: Clinic And Health Posts

Rank 1 2 3 4 5 6 7 8 9 10 All New Cases All New Female Cases Diagnosis Total Rank Diagnosis MALARIA 244,286 1 MALARIA TB, EXTRA PULMONARY 127,890 2 TB, EXTRA PULMONARY DIARRHEA 95,893 3 DIARRHEA INTESTINAL PARASITES 91,127 4 OTHER DISEASE OTHER DISEASE 76,507 5 INTESTINAL PARASITES EYE INFECTION 67,076 6 EYE INFECTION SKIN INFECTION 47,588 7 GASTRITIS, DUODENITIS GASTRITIS, DUODENITIS 42,531 8 ANEMIA ANEMIA 37,556 9 SKIN INFECTION COUGH, INFLUENZA 36,358 10 COUGH, INFLUENZA TOTAL TOP 10 CASES 866,812 TOTAL TOP 10 FEMALE CASES TOTAL CASES 1,092,915 TOTAL FEMALE CASES Total 95,449 53,247 38,700 33,855 33,665 30,665 23,667 19,568 18,005 15,105 361,926 458,019

Top Ten New Outpatient Cases, Admissions, Deaths: Hospital And Health Center

Rank 1 2 3 4 5 6 7 8 9 10 All New Outpatient Cases All Admissions All Deaths Diagnosis Total Rank Diagnosis Total Rank Diagnosis Total 1 MALARIA, UNSPECIFIED MALARIA, UNSPECIFIED 80,533 4,701 1 MALARIA, UNSPECIFIED 236 AURI 56,019 2 NORMAL DELIVERY 3,948 2 MALARIA, PF 151 3 MALARIA, PF SKIN INFECTION 40,589 2,984 3 TB, RESPIRATORY 139 HELMINTH, OTHER 34,234 4 PNEUMONIA, OTHER 1,856 4 PNEUMONIA, BRONCHO 107 GASTRITIS, DUODENITIS 31,407 5 TB, RESPIRATORY 1,275 5 LEISHMANIASIS 106 INFECTIOUS, PARASITIC, OTHER 29,405 6 PNEUMONIA, BRONCHO 1,195 6 PNEUMONIA, OTHER 98 PNEUMONIA, BRONCHO 26,063 7 ACCIDENT, OTHER 1,141 7 AIDS 57 8 ABORTION MALARIA, PF 24,219 1,017 8 PNEUMONIA, LOBAR 45 AMOEBIASIS 21,362 9 EYE, CATARACT 914 9 GASTROENTERITIS, 2+YR 39 GENITOURINARY, OTHER 20,120 10 PREGNANCY, OTHER 797 10 RHEUMATIC, CHRONIC 37 TOTAL TOP 10 CASES 363,951 TOTAL TOP 10 ADMISSIONS 19,828 TOTAL TOP 10 DEATHS 1,015 TOTAL OUT PATIENT CASES 791,192 TOTAL ADMISSIONS 37,043 TOTAL DEATHS 1,765

17

Top Ten Female Outpatient Cases, Admissions, Deaths: Hospital And Health Center

Rank 1 2 3 4 5 6 7 8 9 10 All New Female Outpatient Cases Diagnosis MALARIA, UNSPECIFIED AURI GASTRITIS, DUODENITIS SKIN INFECTION HELMINTH, OTHER INFECTIOUS, PARASITIC, OTHER PNEUMONIA, BRONCHO GENITOURINARY, OTHER MALARIA, PF HYPERTROPHY TONSIL TOP 10 FEMALE CASES TOTAL FEMALE CASES All Female Admissions All Female Deaths Total Rank Diagnosis Total Rank Diagnosis Total 31,409 1 NORMAL DELIVERY 3,859 1 MALARIA, UNSPECIFIED 75 25,193 2 MALARIA, UNSPECIFIED 2,015 2 MALARIA, PF 72 17,518 3 MALARIA, PF 1,343 3 TB, RESPIRATORY 52 15,984 4 ABORTION 1,012 4 PNEUMONIA, BRONCHO 38 14,674 5 PNEUMONIA, OTHER 794 5 PNEUMONIA, OTHER 38 11,896 6 PREGNANCY, OTHER 793 6 AIDS 22 11,506 7 ABORTION, SEPSIS 762 7 GASTROENTERITIS, 2+YR 19 10,939 8 TB, RESPIRATORY 577 8 RHEUMATIC, CHRONIC 19 9,736 9 PNEUMONIA, BRONCHO 503 9 PNEUMONIA, LOBAR 15 9,255 10 EYE, CATARACT 438 10 DYSENTERY, BACILLARY 13 158,110 TOP 10 FEMALE ADMISSIONS 12,096 TOP 10 FEMALE DEATHS 363 342,507 TOTAL FEMALE ADMISSIONS 19,552 TOTAL FEMALE DEATHS 656

Top Ten Under 5 Outpatient Cases, Admissions, Deaths: Hospital And Health Center

All New Under 5 Outpatient Cases All Under 5 Admissions Rank Diagnosis Total Rank Diagnosis 15,675 1 PNEUMONIA, OTHER 1 AURI 2 MALARIA, UNSPECIFIED 15,547 2 MALARIA, UNSPECIFIED 3 PNEUMONIA, BRONCHO 12,748 3 PNEUMONIA, BRONCHO 4 HYPERTROPHY TONSIL 11,781 4 MALARIA, PF 5 GASTROENTERITIS, < 2YR 10,584 5 GASTROENTERITIS, < 2YR 6 SKIN INFECTION 9,134 6 DYSENTERY, BACILLARY 7 HELMINTH, OTHER 7,491 7 PNEUMONIA, LOBAR 8 DYSENTERY, UNSPECIFIED 7,122 8 MARASMUS 9 INFECTIOUS, PARASITIC, OTHER 6,409 9 AURI 10 PNEUMONIA, OTHER 6,369 10 SKIN INFECTION TOP 10 UNDER 5 CASES 102,860 TOP 10 UNDER 5 ADMISSIONS TOTAL UNDER 5 CASES 168,837 TOTAL UNDER 5 ADMISSIONS All Under 5 Deaths Total Rank Diagnosis Total 758 1 PNEUMONIA, BRONCHO 58 703 2 PNEUMONIA, OTHER 46 701 3 MALARIA, PF 35 503 4 MALARIA, UNSPECIFIED 26 487 5 PNEUMONIA, LOBAR 24 266 6 GASTROENTERITIS, < 2YR 19 252 7 DYSENTERY, BACILLARY 17 150 8 MARASMUS 11 124 9 MALNUTRITION, OTHER 10 113 10 MENINGITIS, OTHER 9 4,057 TOP 10 UNDER 5 DEATHS 269 5,844 TOTAL UNDER 5 DEATHS 380

18

AFP Surveillance Number Of Cases Detection Two Stools Case Investigation Stool Reaching Lab Expected Reported Rate Within 14 Days Within 48 Hours Within 72 Hours 19 36 189 32(88.8%) 35(97%) 36(100%) Compiled: Weekly Reportable Diseases Meningococcal Meningitis Measles NNT Whooping Cough Cases Deaths Cases Deaths Cases Deaths Cases Deaths 683 23 33 0 0 0 228 8 Compiled: Quarterly Reportable Diseases STD Leishmaniasis Schistosomiasis Cases Deaths Cases Deaths Cases Deaths 5,362 0 3,492 0 1,055 0

Compiled: Monthly Reportable Diseases Bacillary Dysentery Rabies/Dog Bite Typhoid Fever Relapsing Fever Cases Deaths Cases Deaths Cases Deaths Cases Deaths 37,989 48 1,021 12 495 1 135 1

Case Fatality Rate

Tigray, 1996 EC

15% Year 95 Year 96

Health Insititutions with VCT, STI, HIV Sentitnel, PMTCT and ART Service Tigray, 1996 EC

10%

5%

5.1%

0% M. meningites Malaria TB-Respiratory Pneumonia

3.4%

5%

7.2%

Number of Institution

10.9%

10.8%

10.9%

7.6%

Hospital Health center Clinic

VCT STI Sites Sentinel/HIV

Health post

ART

PMTCT

19

HIV Prevalence Among VCT Clients Tested At Hospitals And H/Center

Age group 0-4 5-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ Total Screened Positive cases Age Specific VCT Clients Male Female Total Prevalence 37 1 2 3 8.1 228 4 10 14 6.1 4,817 32 145 177 3.7 5,649 262 271 533 9.4 4,133 372 219 591 14.3 1,916 309 90 399 20.8 932 121 39 160 17.2 434 83 24 107 24.7 236 44 12 56 23.7 174 10 5 15 8.6 18,556 1,238 817 2,055 11.0

AIDS Prevalence In clinical Suspect Tested at 12 Hospitals, Tigray, 1996 EC

50+ 45-49 40-44 35-39 30-34 25-29 20-24 15-19 5-14 0-4

HIV Prevalence, Tigray, 1996 EC

Male

0%

50+ 40% 14%

10%

45-49 47% 30% 40-44 54% 22%

20%

35-39 43% 32%

30%

30-34 40% 34% 25-29 39% 33%

40%

20-24 31% 32% 15-19 10% 27%

50%

5-14 23% 19%

60%

0-4 40% 14%

female

80%

73% 65.7% 60.8%

Year 94

Year 95

Year 96

60%

HIV Prevalence Blood Donors

Donors Positive 926 30 % 3.2

HIV Prevalence Pregnant Mothers At Sentinel Sites

Subjects Positive 2,720 154 % 5.7

40%

Coverage of Service

20%

12.1% 13.2% 11% 3.7% 2.6% 3.2%

0% Clinical Suspecst VCT Clients Blood Doners

Hospital H/Center % Number (%) Number (%) VCT 12 (100) 21(62) Sti 1 (8) 27(79) Sentinal/HIV 1 (8) 5(15) PMCTC 3 (25) 1(3) Service

20 MALARIOUS KUSHETS AND DISTRIBUTION OF IMPREGNATED BEDNETS (ITNs) Tigray, 1996 EC

ITNs coverage, Tigray, 1996 EC

Wereda

Kafta Humera Tsegedae Welkait Settlment T/Adiabo L/Adiabo T/Koraro A/Tsimbla M/Zana T/Abergele K/Tembien Merebleke Raya Azebo Alamata 0 20 40 60 80 100 120

% Kushet Population House holds

Population with at least one ITNs House holds with one ITNs Total ITNs distribution

= 612, 078 = 184,302 = 207,350

21

Residual Insecticide House Spraying Operation Kushets Sprayed Unit Structures Sprayed People Protected Insecticide utilized (quintals) Cost Birr Total Operational 432,653 Total Cost Birr Per Head Protected 6.39 Operational Cost Birr Per Unit Structure 2.00

Per Unit Per Head Structure Protected 12.38 1.00

CHW Reporting Performance Total Mean % Expected Reporting Reports 1x/month 993 944 Received 95%

D=470 443 214,450 415,165 265,383,857 M=130 D=DDT 75%, M=Malathion 50%, F=Fenitrothion 40%

Bednet Distribution Wereda Tahtay Adiabo Laelay Adiabo Tahety Koraro Kafta Humera Tsegede Kola Tembien Alamata Aagede Tsimbela Walkaiet Raya Azebo Total

Kushets Total House Nets Money Covered Holds Distributed Collected 20 5,358 5,996 89,940 8 2,562 2,562 2,145 3 1,732 1,732 15,980 12 6,624 8,157 17,520 2 303 309 1,605 7 1,461 1,461 17,760 4 1,242 1,242 11,640 11 5,623 5,623 52,290 8 2,991 3,261 31,695 47 12,758 13,651 7,735 122 40,654 43,994 248,310

Malaria patients by Treatment site and Month

Tigray, 1996 EC

CHW 120 100 80 60 Thousands CLINIC OUTPATIENT INPATIENT

Malaria Diagnosis And Treatment By CHWs CHWs Patients % % Treating With Treated Females Children Fansidar Under 5 993 607,805 39% 10%

40 20 0 11 12 1 2 3 4 5 6 7 8 9 10 Month/Year Ethiopian Calander

22 INSTITUTIONS WITH TUBERCLOSIS DIRECTLY OBSERVED THERAPY SHORT COURCE (DOTS)

23

Tuberculosis Cases

Type Pulmonary Positive Pulmonary Negative Extra Pulmonary Relapse, Failure or Default TOTAL Number 2,019 2,425 3,167 139 7,750 % 26 31 41 2 100

Leprosy Case Finding

Total cases All 277 PB 21 MB 256 All 249 New cases PB 19 MB 230 All 19 Replapses PB 2 MB 17 All 8 Defaulters PB 0 MB 8 All 1 Others PB 0 MB 1

Treatment Results Smear + PTB Short Course

Cured 1,820 Completed 207 Died 256 Failure 16 Default 82 Transfer 126

Treatment results of New smear +ve PTB Cases Treated with shourt Cource Cheomtherapy Tigray, 1996 EC

80% Year 95 70% 60% 50% 40% 30% 20% 10% 0% Cured Completed Died Failer Default Transfer Year 96

Leprosy Case Notification Tigray, 1996 EC

Relapse 6.9% Defaulter 2.9% Others 0.4%

New 89.9%

Multibacillary 92.4%

Paucibacillary 7.6%

24

Antenatal Service

1

st

Pregnancy, Delivery and Neonatal Conditions

visit 2nd visit 3rd visit

21,143

visit and more

4 299

th

Maternal Condition

Normal Delivery 58,749 Caeserean Referral Postnatal Section 630 342 Visits 60,057 1,928 Abortion Deaths Due To Pregnancy and Delivery 156 59,538 Total Births

Neonatal Condition

Low Birth Weight (<2.5kg) 572 393 Stillbirth Deaths Within 28 Days 222

125,440 123,406

Family Planning

Activities New Acceptors Pills 131,153 Depot Provera Norplant 108,597 94,266 224 0 IUD 0 0 Condoms 83,394 60,671 Others 142 91 Total 323,510 415,193

Out reach Polio Vaccine

Repeat Acceptors 260,165

Growth Monitoring

Total Number Of Children Examined 458,502 38,351 260,057 159,886 <60% 60-80% >80%

Immunization Coverage of women

TT2 + Non Pregnant Eligible Achieve 996,045 257,835 TT2 + Pregnant % 30 % Eligible Achieve 26 153,373 46,500

Immunization Coverage of Under 5 Children

Sites Static BCG Measles DPT3 OPV3 0-11 Months Fully Immunized Achieve 96,548 % 74 Out Eligible Achieve % Eligible Achieve % Eligible Achieve % Eligible Achieve % Eligible Reach 191 1,175 161,167 135,807 84 143,918 140,380 98 145,295 124,590 86 145,891 124,082 85 131,182

25

All Eye Diseases

Out patient new cases Admissions Hospital/Health Center Clinic /Health Post Hospital/Health Center Number % of total Rank Number % of total Rank Number % of total Rank 51,087 6.5 3 67,076 14.7 6 1,185 3.2 7

Quiha OpthalmicTraining Center, Eye Surgery, 1996 EC Site Major Minor Static 1024 1166 OutReach 1842 Total 2866 1166

Health Institution with Eye unit Type Number % Hospital 7 58 Health Center 2 6 Clinic 5 3 Health Post 7 4 21 71 Total

New Eye outpatient cases At Hospital and Health Center Tigray, 1996 EC

Year 95 Year 96

Cataract

Glaucoma

Trachoma

Inflamatory

Others

0% 5% 10% 15% 20% 25% 30% 35% 40%

Eye Surgery

26

Environmental Health Activity

Springs Total 3,031 Inspect 487 Wells Total 6,072 Inspect 2,274 Hotels, Bars Total 3,886 Inspect 3,215 Waste Disposal Total 35,179 Inspect N/A Factories Total 1,512 Inspect 1,405 Health Facilities Total Inspect 394 233 Houses Total 496,094 Inspect 41,280

Health Education

Site Topic EPI HIV STD Hospotal/Health TB Center (50%) Environmental sanitation Reporting Performance Malaria Diarrhea MCH Others All Topics Sub Total Clinic/Health All Topics sub Total Post (83%) reporting All Topics Total performance Number of Number of Secessions Attendants 559 20,419 1,147 78,866 44 4,861 419 20,872 372 33,280 479 35,619 214 9,770 762 33,361 1,209 65,267 5,205 302,315 69,896 80,306 5,915,212 6,519,842

Protected wel

27

Total Capital and recurrent Budget by HSDP, 1996EC

Component

Health Service delivery and quality of care Health Facility construction, rehabilitation and expansion Human Resource development Pharmaceutical and Medical equipment Information ,education and Communication Health Management and Information system Monitoring, Evaluation and research Health Care Financing Total

Budget Type by Percentile, 1996 EC

Allocated

64,910,754.07 34,131,335.15 5,993,384.64 1,498,201.51 383914.22 972,201.41 2,236,032.39 303,402.00 110,429,225.39

% utilized % component

93.6 95.6 89.6 81.0 59.2 97.6 81.0 100.0 93.4 58.8 30.9 5.4 1.4 0.3 0.9 2.0 0.3 100.0

(Total Budget =110,429,225.39)

Capital 73%

Recurrent 27%

Total Capital and Recurrent Budget by Source

Tigray Health Bureau, 1996 EC

IDA

23.3 28.1

Italian

Government

64.9

35.1

Donors

15.3 14.2

0.9 8.8 9.4

MOH Ireland Aid Uncief N.B Figures are in percentage WHO Others

28

Recurrent Budget Details From Government Treasury

Budget Item Salaries, Allowances Public utilities Travel, Subsistence Printing, Advertising Maintenance buildings, equipment Maintenance vehicles Rents Contracts Food stuff Medical equipment, supplies Uniforms, clothes, bedding Petrol, lubricants Office supplies Other material, supplies Grants to institutions Equipment purchase Total Regional Bureau Allocated % Spent 2,359,384 96 84,221 100 565,100 100 30,420 100 28,990 99 246,000 100 110,858 100 3,000 100 0 3,208,500 99 24,150 100 124,500 100 34,996 100 1,650 100 0 0 6,821,769 99 Zonal Hospital Allocated % Spent 9,809,966 100 461,600 98 65,200 99 116,000 99 56,000 100 88,280 100 0 0 1,114,570 100 885,000 99 187,200 99 74,000 100 33,172 98 13,000 97 0 0 12,903,988 99

` District Hospital Primary Health Care Unit Allocated % Spent Allocated %Spent 7,712,182 100 19,382,979 87 346,550 100 222,951 92 54,920 97 473,288 88 102,100 96 280,976 100 45,000 141,593 93 97 73,000 644,400 91 98 0 175,369 100 0 10,000 100 800,000 100 15,000 16 436,000 100 2,708,986 89 154,720 100 332,914 93 83,000 100 522,674 94 26,364 97 241,262 66 8,000 99 16,914 100 0 49,700 100 0 175,591 59 9,841,836 99 25,394,598 93

Training schools Total Allocated % Spent Allocated % Spent 917,836 96 40,182,347 96 115,002 99 1,230,324 98 53,000 100 1,211,508 97 20,150 98 549,646 99 31,000 98 302,583 97 42,000 100 1,093,680 98 6,000 100 292,227 100 120,960 99 133,960 100 487,200 100 2,416,770 79 61,000 97 7,299,486 97 92,432 96 791,416 98 35,000 100 839,174 99 35,000 100 370,794 92 53,000 99 92,564 99 0 49,700 100 6,000 97 181,591 78 2,075,580 99 57,037,771 95.0

Recurent Budget Allocation Tigray Healh Institutions, 1996 EC

RHB

Zonal Hospitals

District Hospitals

PHCU

Trraining Schools 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28

29

Health Services Access and Utilization

One way Walking Time To Nearest Health Facility

Time Less than two hours Above Two hours Estimated Distance Within 10 km More than10 km % Pop. 68.5 31.5

Population with access to Community Health Agents

Type CHW TBA RHW % Kushet %Population 84.4 84.4 89.1 89.1 61.2 57.2

% Population by Altitude

< 2000 Masl 43.8 > 2000 Masl 56.2

Institution Humera District Hospital Dansha District Hospital Adua District Hospital Abi Adi District Hospital Wukro District Hospital Alamata District Hospital Quiha District Hospital District Hospital Sub-total Shire Zonal Hospital Axum Zonal Hospital Adigrat Zonal Hospital Maichew Zonal Hospital Mekelle Hospital Zonal Hospital Sub-total All Hospital Total (12) All Health Center Total (34) All Clinic Total (168) All Health Post Total (161) All Facility Total

Number

New Outpatient Cases % of yearly total seen in all hospitals in all facilities 9.6 1.4 5.7 0.8 8.0 1.2 9.4 1.4 14.4 2.1 3.9 0.6 8.2 1.2 59.1 8.7 7.1 9.3 7.1 7.1 10.3 40.9 1.1 1.4 1.0 1.1 1.5 6.1

Number 1,519 1,859 1,676 3,545 3,013 1,311 3,847 16,770 2,180 1,523 2,684 2,639 6,105 15,131 31,901 5,217 0 0 37,118

Admissions % of yearly total admitted in all hospitals 4.8 5.8 5.3 11.1 9.4 4.1 12.1 52.6 6.8 4.8 8.4 8.3 19.1 47.4 in all facilities 4.1 5.0 4.5 9.6 8.1 3.5 10.4 45.2 5.9 4.1 7.2 7.1 16.4 40.8 85.9 14.1 0.0 0.0

% standard % recurrent staffing budget 20.2 29.8 32.7 28.0 39.3 20.8 37.5 29.8 35.3 53.1 35.3 25.7 60.6 42.0 35.6 44.6 31.7 78.5 39.3

23,205 13,862 19,356 22,902 34,997 9,401 19,905 143,628 17,361 22,562 17,171 17,243 24,994 99,331 242,959 461,160 692,746 244,727 1,641,592

17.3

22.6 39.9 45.0

84.9

30

31

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