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1 PLACEMENT OUTLINE COVERSHEET To: Programme Manager: Griet Dufraimont Zebiba Getachew Date: August, 2013 Ref. Number Job Title: Country: Programme Area VSO Goal(s): Employer: New Employer? Yes/No Employer Type: Address of placement location: ETH0587/0011/0001 Pediatrician Ethiopia Health Health and Social well being Alamata Hospital Yes Government Hospital Tigray Region Alamata Hospital Firm? Yes/ No (with reason if tentative) New job or replacement? Firm New Earliest Start date: April 2014 Length of placement: (in months) One year with possibility of extension Potential for posting with a partner? No (unless partner is also volunteer)

2 PLACEMENT OUTLINE VSO tries to ensure that the information in Placement Outlines is accurate at the time of writing. However, VSO relies on information received from external sources and circumstances can change. Placement Outlines should be seen merely as a guide. VSO does not accept any liability in the event that any information is inaccurate. PLACEMENT PROFILE Overview of health in Ethiopia The Government of Ethiopia has recently developed a five-year Growth and Transformation plan which aims to lead the country to be a middle income Country by the year Contributing to the Health Sector is major priority area of the government plan. Ethiopia has been implementing the Health Sector Development Programme (HSDP) since There have been encouraging improvements in the coverage and utilization of health services over the periods of implementation of the HSDP I, II and III. However, there is still a significant gap in terms of access and quality of services provided to communities. The major health problems of the country remain largely preventable communicable diseases and nutritional disorders. Despite major progress that has been made to improve the health status of the population in the last fifteen years, Ethiopia s population still faces a high rate of morbidity and mortality and its health status remains poor. According to the 2011 DHS report one in every 17 Ethiopian children dies before the first birthday, and one in every 11 children dies before the fifth birthday. Neonatal mortality rate is at 37/1000 live births; Infant mortality rate is at 59/1000 live births and under 5 mortality is 88/1000 live births. More than 90% of child deaths are due to pneumonia, diarrhea, malaria, neonatal problems, malnutrition and HIV/AIDS, and often to a combination of these conditions. These are very high levels, though there has been a gradual decline in these rates during the past 15 years. Ethiopia has one of the lowest maternal health care services in the world with skilled deliveries of 10.8% and mothers getting ANC at 34% (DHS 2011). The maternal mortality rate of Ethiopia is 676 per 100,000 live births. The major causes of maternal death are obstructed/prolonged labour, ruptured uterus, severe pre-eclampsia/eclampsia, and complications from abortion. Shortage of skilled midwives, weak referral systems at health centre levels, lack of adequate BEmONC and CEmONC equipment, and under financing of the service were identified as major supply-side constraints that hindered progress. On the demand side, cultural norms and societal emotional support bestowed to mothers, distance to functioning health centers and financial barriers were found to be the major causes (HSDP IV). To address this problem, the Federal Ministry of Health (FMOH) has exercised a massive expansion of the health system under HSDP IV. The core elements of the health policy are democratization and decentralization of the health care system, development of the preventive, promotive and curative components of health care, and assurance of accessibility of health care for all segments of the population. Maternal mortality reduction and child health improvement are one of these core objectives of the ministry. The Government of Ethiopia have formulated and implemented a number of policies and strategies that provide an effective framework for improving maternal and neonatal health. The Ethiopian government is investing a billion dollars in maternal mortality reduction and child health improvement in selected government sectors. Additionally the FMOH, with development partners, has initiated and is implementing several similar projects at national, regional and healthcare institutions to achieve the Millennium Development Goal (MDG) and Health Strategy Development Program 2015 (HSDP).

3 Background information about Alamata Hospital Alamata hospital provides services in Medical, Surgical, Gyn/Obs and pediatrics departments both at outpatient and inpatient level. The hospital has 120 beds for inpatient services in the 4 departments. The hospital have 56 nurses, 6 midwives, 2 general practitioner doctors, 1 Internist, 1 surgeon and 1 masters in pediatrics and 77 support staffs. The hospital provided services to Under 15 children s at outpatient level and 1556 under 15 children s at inpatient and under 5 children outpatient level and 1135 under 5 at inpatient from Sept Sept Headlines: to include any recent programme developments or achievements, future developments Page: 3 Ethiopia has been implementing a 20 years rolling Health Sector Development Plan (HSDP) since 1997/8 (1990 EFY). The HSDP is meant to serve as a comprehensive national plan and as a guiding framework for further Regional and Woreda detailed planning and implementation of the Health Sector development activities for the period of five years. It is developed in line with the bigger policy frameworks like MDG. Very recently, the HSDP III is finalized and the IV one is being introduced to guide the health sector activities for the period of 2010/ /15. The HSDP IV is developed in line with the recently developed Growth and Transformation Plan which aimed at leading the country to be a middle income country by The HSDP IV has prioritized six areas: maternal and new born, child health, HIV and AIDS, TB, malaria and Nutrition. The MNCH targets of HSDP IV are; Increase Focused ANC 1+ from 68% to 90% and ANC 4+ from 31% to 86% Increase SBA from 18.4% to 62% Increase proportion of deliveries of HIV+ women that receive full course of ARV prophylaxis from 8% to 77% Increase Measles, Rotavirus and Pneumococcal immunization coverage to 90%, 96% and 96% respectively. Roll out C-IMNCI in all health posts and IMNCI in all health centers and hospitals Background and rationale for placement: To include how this placement builds on achievements/ activities of any previous volunteers with reference, where appropriate, to the relevant objectives in the Country Strategic Plan and Programme Area Plan. Page: 3 Ethiopia has been implementing a 20 years rolling Health Sector Development Plan (HSDP) since 1997/8 (1990 EFY). The HSDP is meant to serve as a comprehensive national plan and as a guiding framework for further Regional and Woreda detailed planning and implementation of the Health Sector development activities for the period of five years. It is developed in line with the bigger policy frameworks like the MDG (Millennium Development Goal). There has been encouraging improvements in the coverage and utilization of the services over the periods of implementation of the HSDP I, II and III. However, there is still a significant gap in terms of access and quality of services provided to communities. Very recently, the HSDP III is finalized and HSDP IV is being introduced to guide the health sector activities for the period of 2010/ /15. The HSDP IV is developed in line with the recently developed Growth and Transformation Plan which aimed at leading the country to be a middle

4 income country by The HSDP IV has prioritized six areas: maternal and new born, child health, HIV and AIDS, TB, malaria and Nutrition. The MNCH targets of HSDP IV are; Increase Focused ANC 1+ from 68% to 90% and ANC 4+ from 31% to 86% Decrease institutional maternal mortality rate to less than one. Increase SBA(Skilled Birth Attendance) from 18.4% to 62% Increase postnatal care coverage from 34% to 78%. Increase proportion of deliveries of HIV+ women that receive full course of ARV prophylaxis from 8% to 77% Increase proportion of asphyxiated newborns who are resuscitated and newborns with neonatal sepsis who received treatment from 7% to 75%, from 22% to 74%, respectively. Increase Measles, Rotavirus and Pneumococcal immunization coverage to 90%, 96% and 96% respectively. Roll out C-IMNCI (Community-Integrated Management of Neonatal and Childhood Illnesses)in all health posts and IMNCI in all health centers and hospitals VSO-E is keen to be part of this national priority area by working closely with the Government and development partners like Irish Aid This placement objective is in line with the Global Health goal strategy of VSO Stronger, more inclusive and accessible health systems so that the poorest and most vulnerable populations in the country can realize their right to health Overall placement purpose and specific placement/ partner objectives: these are subject to change- the final work plan will be subject to agreement between the volunteer, the employer and VSO at the start of the placement The objective of the volunteer work is to transfer skill and knowledge particularly to the pediatrics department staff and generally to overall hospital staff. The knowledge and skill acquired is expected to improve the quality of service and the competence of the medical doctors in the pediatric department. The volunteer would also get experience on how the system are run and function in low resource setting and would also have an exposure to a different pattern of diseases from country of origin. Likely duties and responsibilities of the volunteer: these are subject to change- the final work plan will be subject to agreement between the volunteer, the employer and VSO at the start of the placement Engage in the clinical services provision for pediatric age group patients ; Performs medical examinations to the pediatric age group and requests for diagnostic workups or laboratory examinations as needed to diagnose health conditions/outcomes and Prescribe medicine and treatment procedures Conduct neonatal and pediatric morbidity and mortality audits. Refer difficult and complicated pediatric cases as necessary to referral hospitals Disseminate information on complicated pediatric cases during medical conference and morning sessions in the hospital Involve to improve the trend in documentation of patient history and other clinical procedures Share skills to nurses, doctors and other staff particularly in the pediatric department to improve the quality of care provided. Collaborate with hospital staffs to strengthen/ Establish the Neonatal intensive care unit Engage in the diagnosis and treatment of neonates Provide on job-training for the staffs on neonatal diagnosis treatment and care

5 Assist the hospital in providing quality pediatric and neonatal health care and education to undergraduate students Perform other related functions prioritized by the volunteer and the hospital management as necessary. VOLUNTEER PROFILE Professional skills/ competencies: Essential Medical Doctor, Specialty in Pediatrics and Child Health Desirable Project development and fund raising skill Professional qualifications and experience: Essential At least three years experience as Pediatrician Desirable Teaching experience Experience of work in resource limited setting/developing countries Experience in development of project to potential donors Personal Qualities: Willingness to work in a relatively engaging working environment enjoying a busy schedule Commitment to make a difference in life of children Good networking and communication skills to liaise with relevant stakeholders Willingness to work in an environment where there is limited financial and human resources Respectful of cultural values PLACEMENT SPECIFIC INFORMATION for general location & organisational information please see Volzone Potential sources of Professional Support i.e. line manager/ counterpart/ volunteers and Programme office including distance to and time taken The concept of line management is often not well developed in Ethiopian health systems. The Medical Director will provide leadership support for the success of the placement. There are Heath Officers, doctors and nurses whom the volunteers should work with in close collaboration. VSO places many health volunteers and these are a vital source of support. Contact details will be available from the VSO-E Health Sector team both before arrival and during in-country training. These may be volunteer placed within Addis and outside of the capital and support is more by phone and contact. Fellow volunteers can not only offer clinical advice and emotional support, but can also be very useful for arranging joint teaching or research projects. The Programme Office is an important source of support, both in administration and programmatic areas. Each volunteer has link Program Manager who can provide him/her the required programmatic support while the Program Support Officer is responsible for providing administrative support. The Program Office has occasional small grants to support any relevant capacity building initiatives.

6 Risks and assumptions There is enthusiasm for change at Alamata hospital, but also great expectation. The volunteer will need to explain their level of expertise early in the placement, and negotiate a work plan which both parties are happy with, while being appropriate to the volunteer s clinical experience. There is an assumption that the volunteer is content working independently and supervising other practitioners and this will need to be addressed early if this is not the case. Occupational health is poorly developed in Ethiopia, but basic provision is made at Alamata. Gloves and hand-washing facilities are readily available, and rapid bedside HIV tests are available in cases of needle-stick injury where the patient does not know their status. Goggles are rarely available although protective clothing (scrubs) are available clean each day from the hospital laundry. Alamata Hospital does not have an occupational health department. The volunteer must ensure they have their post-exposure prophylaxis medication before starting clinical work. There is also endemic Hepatitis B and C, which should be considered in case of accidental inoculation. There is a need to have a License to do clinical practice. To this end relevant testimonials are required (CV, authenticated degree and recommendation letter from previous employer). Once these documents are collected, the Program Office in collaboration with the partner organization will process the License. It is learned that the License can be secured within two weeks if all requirements are fulfilled. However, there is no need for License for teaching. But so far there is no indemnity scheme in Ethiopia for medical practitioner. According to the Ethiopian Civil code Art.2031, a person will be liable for a professional fault only...where...s/he is guilty of imprudence or of negligence constituting definite ignorance of his/her duties". Terms and Conditions These should be placement specific and could relate to annual leave, hours of work, work related travel and work place conditions etc. Annual leave- 21 days excluding holidays and weekends. The working hour is from 8:30 a.m. - 5:30p.m., and there is one hour lunch break. The situation might demand more working hours during week days and even in weekends, but this all depend on the willingness of the volunteer. Resources available at the placement Including internet access and communication facilities There is access for internet, mobile service, and public telephone and post office. Commercial Bank of Ethiopia has a branch office. There is a Telecommunications center where local and international calls can be made. The Hospital will also provide shared office space, and basic office furniture. It is advisable to come with own laptop. Language requirements The official regional language is Tigrigna while the national language is Amharic. Hence, most people speak both languages. The students and staff can speak and listen to English without any difficulty. But the children and their parents might not understand a single word of English and while dealing with patients, the volunteer shall be assisted by a translator (staff on Duty) Security Local security issues which are not mentioned in the Country Security Paper Alamata is considered as safe town. People are generally helpful and friendly and it is possible to have friendships with local people. Medical (i) Distance and traveling times from Programme office and nearest major center The three identified Hospitals (Hayat, St. Gabriel, and Korea) located in Addis Ababa to give service to staff and volunteers are located in the city. They are 5-10 minutes drive from the program Office. The Korea Hospital and St Gabriel are the two best equipped local hospitals and can provide

7 comprehensive medical services. In Addis there are additional well equipped private hospitals that give service 24 hours. For general / minor health concerns VSO have a contract with Dr Melaku Ferede, a general internal medicine specialist with a clinic 10 minutes drive from the Programme Office. He has long experience of treating expatriates and can provide basic laboratory services in-house. Address: Silasse Higher Clinic PO Box Addis Ababa Tel cell phone (24hrs) (home) and (office) (ii) Common health complaints in the placement location Gastrointestinal disorders are common in Ethiopia, even among the local population. In Alamata the water supply is treated but the integrity of the water supply is not perfect and cases of Giardiasis are common. These are easily avoided by boiling and filtering drinking water. See previous entry regarding Occupational Health. (iii) Risk of malaria There is no risk in Alamata but other highland areas have sporadic outbreaks following the long summer rains. Bear in mind that travel maps available in the UK showing malarial risk in Ethiopia are not consistent with local experience. Motorbike riding essential Yes/No If motorbike riding is not required please give details of any available transport To travel within the city there are bajajs and min-bus Likely accommodation State if accommodation is shared and availability of electricity and water VSO will arrange accommodation in the town based on the set standard. Electricity and water supplies are both reasonably reliable in Adigrat town as the power shortage problem is well addressed recently. But there might be interruptions for few hours and even days. The volunteer may have to share with another volunteer of same sex but will definitely have his/her own bedroom. More concrete details of the accommodation to be provided would be available on arrival in Ethiopia. Any additional information not covered above or on Volzone regarding this placement? Alamata is a town located in northern Ethiopia and it is located in the South Zone of Tigray region. It lies 183 kilometers south to Mekelle and 600 kilometers from Addis Ababa.

Job pack: Gynecologist /Obstetrician TRHB

Job pack: Gynecologist /Obstetrician TRHB Country Ethiopia Employer Tigray regional health bureau : The placement covers 4 hospitals in Tigray region Duration 6 months Job purpose The overall placement