"We seek simple, well-focused, understandable information, in small quantities, in a local context/language, and on a regular basis."
-- Community-level healthcare provider (and K4Health Needs Assessment/Net-Map participant)
Outside the Saadamoo Health Post in Holeta, in the Oromia Region of Ethiopia.
As shown in our Knowledge for Health (K4Health) needs assessment and network mapping study in Ethiopia, family planning (FP) providers at the local level need tailored, contextual information to use in their daily work (Harlan et al, 2013). They may be bombarded with information about FP policy, research results, and clinical practice—or, on the flipside, they may lack these materials completely. Finding the right balance is a key element of what some refer to as “social knowledge management” (SKM). SKM puts people at the center of knowledge exchange, and focuses on a systematic approach to continual learning that improves health outcomes. SKM can help not only with national-level systems—such as web portals and other tools to connect those who have access to this technology—but it can rely on social exchange and networks to encourage learning and sharing at the community level.
Last week, I attended the International Conference on Family Planning in Addis Ababa, Ethiopia. Before the conference began, I was able to visit the Holeta Health Center and the Saadamoo Health Post, in the Oromia Region of Ethiopia. Each kebele (neighborhood) in Ethiopia has a health post that serves the community in family planning, HIV/AIDS, child health, sanitation, and more. Each health post employs two female Health Extension Workers (HEWs), who spend part of their time at the health post seeing patients, and the remainder visiting community members in their homes. The Health Extension Program—launched in 2003 by the government—has been instrumental in helping Ethiopia achieve phenomenal improvements in infant health and contraceptive prevalence over the past decade. Use of modern contraception has risen dramatically from 6% in 2000 to 27% in 2011. However, more remains to be done: The total fertility rate remains high at 4.8 children per woman (and is even higher in rural areas), and 25% of women have an unmet need for contraception (source: Central Statistical Agency and ICF International 2012).
After visiting the main Holeta Health Center—which includes a number of mid-level providers offering antenatal care, family planning, maternity care, infant care, immunizations, HIV testing and treatment, pharmaceuticals, and a host of other services—we visited the Saadamoo Health Post, which serves a rural community, and is located just a few kilometers from the main health center. When we arrived, the two HEWs described the care they provide at the community level. As they were demonstrating some of the materials that they use for counseling women and couples about their FP options, I asked them both the same question: “When a client asks you something you don’t know, where do you go to find the answer?”