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USAID Yemen Basic Health Services
Assistance to Marib Governorate

March, 2006

The new facilities visited on Wednesday 23 march 2006 in Marib governorate by the Minister of Public Health and Population, Dr Abdulkarim Yahia Rasa’e and the US Ambassador Thomas Krajeski are the latest in a series of health sector interventions by USAID in the governorate of Marib which reached more than a million US Dollars in the last 18 months in addition to 2 million dollars for the President’s Hospital.  Furthermore, USAID has recently launched a new basic health services project to continue it support to Marib and four other neighboring governorates and will be looking to improve facilities, train staff, expand mobile teams services and develop health education in collaboration with health providers, local councils and local leaders.

USAID Yemen Basic Health Services ProgramSupport to Health Care Facilities

There were 9 facilities renovated or rebuilt in this governorate through the USAID assistance (CATALYST project) including some housing for providers. Renovated facilities received new medical equipment and all district facilities personnel received some training as well. To help the Health office follow up on these facilities and monitor their activities the Health Office needs better supervision and more intensive follow up to make these health facilities fully functional. Thus USAID provided today the keys to a new vehicle that will help the health office in Marib be prepared to better supervise health facilities and ensure they have all the support they need. This vehicle (Toyota double cabin Hi-Lux truck) is intended for the Governorate health office for the needs of the Reproductive Health Program particularly to facilitate supervision and monitoring of the health facilities, provision of in-service training (part of supervision) and for distribution of RH supplies as needed. The vehicle is also intended to use as a back up to the mobile team vehicle if needed. The BHS project will also train supervisors from the governorate and district levels to enable them to carry out their duties and will send teams of doctors and midwives to help the staff in these facilities and improve management, organization and the overall quality of services.

Currently there are 38 midwives in training who will graduate in September this year and will need to be placed in health centers that need them. The Governorate leadership, the Local Councils and the Health Director office need to make sure that more midwives and doctors are appointed in these facilities and in others to provide adequate services to the public. Without such personnel the equipment and renovations will be of no value to the people.

Health Facility Extension in Medghal Health Center

USAID has provided much support to this facility which is now becoming a district hospital. To improve the quality of care and strengthen management USAID has built an extension that includes space for health education and training, administration and more importantly staff housing that will make it more attractive for providers to live and serve in Medghal. The new building includes:

  • Ground Floor, Management Offices (5 Rooms) and Education/Training Room
  • First Floor, 2 Staff housing Unit (3 rooms + Kitchen + Bath/each) + Furniture

New Surgical Unit for Comprehensive Emergency Obstetric Care

A new wing was built for the district hospital in Hareeb and will provide comprehensive Emergency Obstetric Care to the inhabitants of this area – the second populated area after Marib district – This service will provide relief to the El Juba hospital which used to receive all the cases from Hareeb. A team of physicians is already in place and will now have the working conditions to begin providing much needed services in obstetric care. The new wing was built and equipped and includes:

  • 2 Operations Rooms
  • 1 Intensive Care Room
  • 1 Duty Staff Station Room
  • 1 Sterilization Room
  • 2 Changing Rooms with baths

The medical equipment & furniture includes:

  • 1 Operation Table
  • 1 Ceiling Lamp
  • 1 Complete Anesthetic Machine
  • 4 Surgical Sets
  • 2 Heavy Duty Cautery Machine
  • 8 Instrument Trolleys
  • 2 Suction Machines
  • 1 Intensive Care Bed with Monitor
  • 1 Steam Sterilizer
  • + Needed furniture

El Kara Rural Hospital

El Kara: The health center – denominated as rural hospital - was equipped by the CATALYST project (ultrasound, ECG and Sterilizer plus lab equipment); staff was trained.

Health Training Institute

Training of 45 midwives is taking place in Marib Health Institute since September 2004 and candidates will graduate this year in September. Midwives were selected by the project in full cooperation with local health officials and local community leaders in areas that have a shortage of midwives and will go back to serve in their villages after graduation.

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USAID Yemen Basic Health Services
Program Promises Improvements in Access to Reproductive and Child Health Services

March, 2006

SANA’A – March 8, 2006. USAID today officially launched a three-year, $15 million Associate Award presented to Pathfinder International through the Extending Service Delivery (ESD) Project to improve maternal and child health (MCH) in five of the poorest governorates in Yemen.   Health indicators in these areas are among the weakest and populations are hard to reach due to difficult terrain and harsh economic, cultural, and social conditions.

Called the Yemen Basic Health Services Program (BHSP), the award is in support of the Yemen Ministry of Public Health USAID Yemen Basic Health Services Programand Population’s efforts in these governorates. It will focus on achieving increased access to quality health services and participation at the community level and on increased health knowledge and improved behaviors at the community level.

Dr Arwa El Rabie, Deputy Minister of Public Health and Population who presided the launching ceremony stated her appreciation for the quality of the assistance provided by USAID and indicated her satisfaction with the results of the last two years and the quality of the cooperation between the USAID projects and her department. She stated that the top priorities of the Ministry of Public Health and Population include family planning coverage, safe motherhood, and improving community participation and involvement.

In his opening speech, Dr Michael Sarhan, the USAID director in Yemen reiterated USAID’s commitment to support the Government of Yemen improve its health services in addition to its commitment to improvements in other sectors such as education, agriculture and democracy. Dr  Sarhan also stressed the importance of coordination with other donors’ projects as well as with the non governmental sector. Dr Serhan emphasized the importance of ownership by the Yemenis of this and other USAID funded projects as being a primary condition for success.

The BHSP immediately succeeds the successful completion of the CATALYST project (2004-05), which Pathfinder also implemented. CATALYST addressed high levels of maternal and infant mortality in the poorest and most isolated regions of the country by refurbishing health facilities; training family planning and reproductive health personnel in emergency obstetric services, antenatal and postnatal care, birth spacing, and neonatal and child health services; and by deploying mobile outreach service teams and improving health education and counseling capacity in health facilities.

The BHSP interventions will build upon the above achievements and those of other USAID projects in the area, giving priority to making existing refurbished facilities fully functional before embarking on new refurbishments. The BHSP will also emphasize community mobilization and education to create a supportive environment conducive to progress in public use of health services and their adoption of healthful practices.

Some of the interventions of the BHSP include:

  • Supplying and refurbishing health facilities;
  • Establishing mobile teams to bring services to underserved areas;
  • Training of health facility staff in the delivery of quality reproductive health and maternal and child health services;
  • Strengthening of facility-level management systems;
  • Strengthening of reproductive health and maternal and child health counseling services at facilities;
  • Training of community midwives implementing rural outreach activities;
  • Mobilizing of community outreach workers, local council members, teachers and agriculture extension workers, and
  • Developing and disseminating health education messages.

The BHSP will involve Yemeni nongovernmental organizations and work in close collaboration with relevant government agencies and local authorities , including women’s groups, religious leaders, and professional associations. It will coordinate with other health and non-health projects implemented with USAID funding, as well as with other donors’ projects. It will primarily rely on employing local expertise, but will call upon experts from the ESD staff based in Washington, DC, and other sources as needed.

Hosted by the Ministry of Public Health and Population, the project launch was an opportunity to share project details with all stakeholders who comprise several entities in addition to the Ministry of Public Health with its governorates offices such as the Social Development Fund, the Public Works Project, the High Institute for Health Sciences, relevant nongovernmental agencies, health and community officials from the five governorates (Amran, El Jawf, Sa'ada, Marib and Shabwa), USAID and other donor representatives.

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USAID to Support the Rehabilitation of the Jadaan Cistern in Thula

January, 2006

The town of Thula, like many mountain towns in Yemen, harvests rainwater in cisterns to use for household water supply. This practice allows the community to make the best use of extremely scarce water resources. However, rainwater can become contaminated as it flows through collection channels into the cistern. Thula CisternWater stored in open cisterns can also become spoiled from animal wastes, trash, and dirt from clothes, shoes, hands and buckets as women and children collect water. Drinking contaminated water can cause many different diseases, such as diarrhea, typhoid fever and Giardiasis. Coming into direct contact with this water (while collecting water, or swimming in the water) can cause skin rashes and possibly skin infections.

To help improve and protect health of people living in the community of Thula, USAID is sponsoring the reconstruction of the main cistern, the Jaadan Cistern. The plan to reconstruct the cistern carefully considered the historical and cultural importance of the town of Thula. The rehabilitation will use mainly natural stone materials, and will use a traditional Yemeni plaster called “qadad.” The contractor selected for the project has a long family tradition in the use of qadad and is an expert in the special techniques needed for its proper application.

This is one of the four components of USAID’s environmental health program that was designed through consultations and focus groups conducted with community and local council members in the district of Thula. In addition, the project conducted a survey of 269 households in 12 villages to understand local knowledge and practices related to water, sanitation and hygiene. A locally elected project oversight committee composed of five men and five women will work with the local council to raise awareness of community members, including children, on their role in keeping the cistern clean and assuring its maintenance.

The rehabilitation project will begin in early February and is expected to be completed in four months.

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Turning on the Lights in Habbaba

Yemen's health indicators are among the poorest in the region, and the constraints to improving them are particularly severe in the current economic climate. Allocation of funds is highly centralized, and has been traditionally directed disproportionately to hospitals and to urban areas. The ROYG spent about YR 12 billion on health in 1998, and, of that, very little was devoted to operations and maintenance, which has led to inadequate supplies and poor utilization-especially at peripheral facilities, many of which remain unstaffed and without electricity . In rural areas, only 24% of the people have access, and overall, about 42% of the people have access to government facilities. Lack of access due to limited geographic coverage is compounded to some extent by lack of cash needed to receive care: the indirect costs of transportation to facilities are added to the direct costs of paying the fees required to receive care and/or prescription drugs. Access to needed care for women is also constrained by social constraints in traditional areas-their need for male escorts to the facility and their need to be seen by women health workers, who are not readily available at health facilities in most of the country.

On a trip to the Governorate of Amran last summer, the USAID-funded PHRplus/Yemen team visited the public health facility in the village of Habbaba, serving 594 households from 4 villages. The facility appeared well-staffed, including a female provider, well-managed, and accessible to nearby villages. It even had a private laboratory set up where user fees were collected to pay for lab tests. When asked what they might need to improve the quality of care, the staff unanimously declared, "electricity and a phone line." With electricity they could extend their hours of service and open the possibility of obtaining more sophisticated equipment. Better equipment would enable the facility to provide additional services thus decreasing referrals to Sana'a and the additional travel expense and risks that the patients previously had to endure. A phone line would enable them to have a fax and communicate with the Governorate Health Office and hospitals in Sana'a for referral of emergency cases. When asked about the investment for this request, PHRplus discovered that the cost would not exceed $600. The Director of Health for Amran who participated in this visit offered to cover electricity and phone bills from his budget. Done!

Once connected, PHRplus presented the Habbaba Center with a combination phone/fax/photocopy machine and USAID's Catalyst Project provided an ultrasound and ECG machine plus autoclave (sterilizer) equipment. This was followed by training of the center's physician. There are future plans for PHRplus to provide VCR equipment to support health education, and Catalyst plans to introduce minor renovations.

The Habbaba Center provides reproductive health and family planning services, routine vaccinations, health education and laboratory testing. Facility staff includes a general practitioner medical assistant, pharmacist, lab technician, community midwife, primary health care worker and two support staff. According to the recently completed health facility survey, also funded by USAID/Yemen, only 31% of health facilities in Amran currently have electricity.

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USAID/Yemen Supports the Ministry of Public Health and Population's Health Facility Survey

The Ministry of Public Health and Population's General Directorate of Health Information and Statistics, through the support of USAID's Partners for Health Reformplus Project, will pilot the first phase of the health facility survey in Amran in October 2004. USAID's support will include the five targeted governorates of Amran, Al Jawf, Shabwa, Mareb and Sa'adah. The survey will inventory all private and public health facilities in each district and will use GPS to pinpoint the exact locations of villages and health facilities. In addition, the ten survey teams will take digital photos of the facilities in order to document their condition.

Each team will include a team leader from the Ministry of Health and surveyors from the governorate. These teams will be trained in the use of GPS, digital cameras and how to use the survey instrument. Information collected will include: type of facility, location, staffing, services provided, equipment, records kept, availability of drugs, budgets and resources, problems and obstacles, and reproductive health.

Survey results will be analyzed at the central and governorate levels; the information will be disseminated to each governorate through workshops which will also provide training in analysis and use of data. The data will be used to produce a geographic information system (GIS) as part of the health information system (HIS) at the central, governorate and district levels and will provide key information for planning and decision making.

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