Information meetings on the Enhanced outreach Strategy (EOS) and Increased

Supervision of the Screening Quality in Ethiopia.
Client: UNICEF-Ethiopia

Objective of the study: The main objective of the spot supervision is to improve the quality of nutrition screening data taken by health extension workers and community volunteers during the Enhanced Outreach Strategy (EOS) or Community Health Day (CHD) through supportive supervision and informationmeetings. The EOS or CHD is a twice-a-year event carried out in a campaign style. This is in addition to the routine health services regularly provided by health centers.  

The Enhanced Outreach Strategy (EOS) or the Community Health Day (CHD) and the Targeted Supplementary Feeding Programme (TSFP) or Therapeutic Feeding Programme (TFP) are interim  programmes of the Ethiopian government designed to temporarily mitigate the effects of chronic malnutrition and to save the lives of millions of children. Children and pregnant/lactating women are screened by health workers and community volunteers and categorized as nutritionally normal, moderately malnutritioned or severely malnutritioned. The moderately malnutritioned children and pregnant/ lactating women are referred to Targeted Supplementary Feeding Programmme (TSF) while those categorized as severely malnutritioned are referred to a Therapeutic Feeding Programme (TFP).

BDS-CDR’s task in this project was to help improve the quality of the screening data through supportive supervision and information meetings. This task was successfully accomplished by recruiting field supervisors with rich experience in nutritional screening. The supervisors were thoroughly oriented on the objective of the assignment, the screening process and the material needed to carry out the screening.


Methodology: To achieve the objective of the spot supervision, BDS- CDR recruited field supervisors with rich experience in nutritional screening. The field supervisors were given a thorough training in the general objective of the assignment and on a checklist of activities to be performed on the field.  They were also provided with the necessary materials that they would need to use in the field.  The supervisors used observation and their checklist as their data collection tools. The check list included activities such as campaign organization, Vitamin A administration, de-worming, nutritional screening, post-campaign activities and

The programme is a joint initiative between the Ministry of Health and the Disaster Risk Management and Food Security Sector and supported by UNICEF, WFP and other development partners. This project was conducted in a total of 93 targeted woredas, 2448 kebeles and 778 sampled posts in the Amhara, Oromiya, SNNPR and Tigray regions. checking on data quality, during the EOS/CHD campaign. Once in the field, the supervisors organized information meetings in collaboration with woreda officials. Then they observed screening campaigns and made careful recordings. After the observations, they held information meetings with the health workers and volunteers who conducted the screening campaign. During these meetings, the main issues discussed were: areas covered by the campaign, challenges, constraints, data quality and management problems, inclusion and exclusion errors, timely reporting, the importance of social mobilization, the role of BDS-CDR (as a provider of technical assistance), lessons learned and ways of improving future campaigns.


Major challenges and limitations : The study of the screening campaigns in the Amhara, Oromiya, SNNPR and Tigray regions reveals the following aggregate of challenges and limitations observed in one of the regions or the other:

•Low performance: the campaign coverage, i.e. the number of persons screened is much lower when compared with the micro-plan held for the year. This shows low performance.
•Failure to adhere to recommended measurement
techniques in identifying nutritional defects such as bilateral edema.
• Lack of quality in data maintenance.
• Lack of regular and reliable flow of information from regional to zonal and woreda focal persons usually due to poor roads and limited network coverage.
• The scattered location of sampled woredas making it difficult for efficient performance.
• Lack of adequate staffing.
• Lack of incentives for people who considered the screening campaign as not part of their regular duty.
• Lack of coordination/synchronization among Regional Health Bureaus and other stakeholders in arranging screening campaign schedules thus resulting in overlaps of programs.


Conclusion and recommendation : The study shows that EOS/CHD screening activities such as site organization, crowd management and anthropometric measurement techniques have shown marked improvement compared with performances during
the previous year. However, there are still gaps that need to be filled to bring about further improvement. The following recommendations are forwarded:

• The EOS/CHD campaigns must be strengthened and maintained as they have the potential of providing rich data on the nutritional status of children under 5 and on pregnant/lactating women vital for national planning on nutrition.
• The community should be involved more in the planning, implementing and evaluating EOS/CHD campaigns.
•UNICEF and other development partners should continue to support the national campaign to improve the nutritional status particularly of children under 5 and pregnant/lactating women.
• Performance-based incentives must be provided to solve the manpower shortage chronically facing EOS/ CHD campaigns.
•There should be better coordination among regional, zonal and woreda officials to avoid clashes of activities that are contributing to the delay and low performance in the EOS/CHD campaign coverage.
•There should be rigorous insistence on using only measurement techniques recommended by the official guideline rather than norms.
•The shortage of supplies essential for the screening process should be solved through advance planning, as the problem observed is not so much due to lack of materials but due to lack of advance preparation.  
• Special attention should be given to building the capacity of local personnel that could supervise the screening campaigns in a reliable and sustained manner


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