Eritera : final country report

SEATS" support focused on: (1) family planning (FP) service delivery; (2) youth access to FP and reproductive health (RH) care; and (3) safe motherhood (SM). SEATS faced tremendous challenges -- the isolation of rural populations from health facilities (themselves often damaged by the war), the country"s rugged terrain, cultural and religious barriers to FP, largely untrained (in FP) health workers, very weak contraceptive logistics systems, and renewed border conflict with Ethiopia and the subsequent evacuation of expatriate advisors. Nonetheless, significant strides were made in access to quality and sustainable FP/RH services, particularly in regard to clinical skills; information, education and communication (IEC); management systems; and institutional capacity building. Collaboration with national partners and international agencies, as well as with other cooperating agencies (CAs), enhanced results, and important lessons were learned for future programming. Most importantly, the leadership, growing awareness, knowledge, and commitment of the Ministry of Health (MOH) and other government officials augur well for the future. Key lessons were as follows. (1) Training. (a) Where people are determined, learning and training can continue even under difficult circumstances. Despite initial difficulties, the MOH allowed SEATS to support basic FP clinical training for nurses and health assistants, even when the country was engaged in a border war with Ethiopia. (b) FP and interpersonal communication and counseling (IPCC) training motivate service providers. Health assistants and nurses who participated in IPCC and FP training took extra interest in their work, communicating more with clients and better satisfying clients. (c) Teaching materials for health workers should be in local languages and be culture-specific. During life-savings skills (LSS) training, sessions were best understood when facilitators used the Tigrigna language. Training in Eritrea is typically done in the local language. (2) Service Delivery. (a) The material requirements of service delivery staff increase with training. After FP training, the health assistants and nurses in health stations and centers requested supplies to ensure better infection prevention practices. Their desire to broaden the method mix and contraceptive choices for clients led to additional supply and commodity requests. Likewise, after LSS training, the midwives requested supplies and equipment to better serve their patients. (b) LSS leads to a beneficial change in staff attitude. Service providers were observed to communicate more with clients during the different stages of pregnancy after LSS training. (c) Successful programs may help change official policies. In light of the success of SM and LSS training programs, and the increased sensitivity to the level of maternal mortality in Eritrea, the MOH began training health assistants in the critical elements of midwifery, an area in which they were previously not expected to assist. (3) Sustainability. For continuity of a national program, MOH commitment is essential. Senior MOH officials recognize the importance of the SM program and have started leveraging resources from UNFPA for the training of physicians in emergency obstetrics (ongoing) and for LSS training for midwives in additional zones. The MOH also plans to integrate LSS training into both pre-service and in-service training for health assistants and other health workers.