1.

INTRODUCTION
1.1. BACKGROUND

Ethiopia is a Federal Democratic Republic country, having 11 regions with nine national regional
states and two city administration and further divided in to 805 districts. Ethiopia is the second
largest county among sub-Saharan Africa with the estimated population of around 82 million of
which more than 69 million (84 percent) live in rural areas. The proportion of male and female is
almost equal, and around 23.4 percent of women are at reproductive age and 45 percent of the
population is at younger age of less than 15 years .Primary health service coverage reached 92%
with 122 Public hospitals and 2660 health centers and 15,095 health posts and more than 4000
private for profit and not for profit clinics. The health sector has introduced a three tire system
that involves a primary Health Care Unit (PHCU), General hospitals and specialized hospitals.
PHCU consists of five satellite health posts, one health center and primary hospital to serve
5,000, 25,000 and 100,000 people respectively. The secondary level, General hospital, serves
for 1,000,000 population and the tertiary level, specialized hospital, serves for 5,000,000
people(1).

Jimma is located in southwest Ethiopia, 347 kilometers southwest of Addis Ababa, has a
population of 164,366 people (77,716 males and 86,650 females), known for its coffee
plantation. The town has an area of 14950 square Km, which comprises 3 Higher (Keftegnas),
and 21 Kebeles. The Kebeles are the smallest administrative units of the town whereas higher are
the middle, above the Kebeles but lower than the town Administration Counsel .According to the
1994 population and housing census of Ethiopia, the projected total population of the town in
2004 was 120,000. Different ethnic groups are living together in the town and the population
uses variety of languages of which Amharic, Oromiffa and Kulogna are spoken by 51%, 29%
and 6.5% of the people respectively. There are three governmental health institutions (2 Hospital,
3 Health center and Clinic) (2,3).

Jimma University is a public higher learning institution committed to advance teaching, research
and services through its innovative and cherished Community based education. Community
based Education (CBE) is a means of achieving educational relevance to community needs and
consists of learning activates that use the community -oriented education programmed. It
consists of learning activating that use the community extensively as a learning environment in
which not only students but also teacher members of the community and representatives of other
sectors are actively engaged throughout the educational experience. The programmer is of clear
benefit to both students and the community. Hence the core philosophy of the university is
Community based and problem oriented education, Multidisciplinary training, integrated training
service and research and uses strategies like CBTP, TTP, SRP and DTTP to bring a change in the
community(4).
 1.2. STATEMENT OF THE PROBLEM

Ethiopia experiences a heavy burden of disease with a growing prevalence of communicable

infections and non-communicable with low health service delivery. Many Ethiopians face high
disease morbidity and mortality largely attributable to potentially preventable infectious diseases
and nutritional deficiencies (5).

The federal democratic government of Ethiopia has established Health Sector Development
Program (HSDP), which is a 20-year health development strategy implemented through a series
of four consecutive 5-year investment programs (MOH, 2010). The first phase (HSDP I) was
initiated in 1996/97. The core elements of the HSDP include: democratization and
decentralization of the health care system; development of the preventive and curative
components of health care; ensuring accessibility of health care for all segments of the
population; and, promotion of private sector and NGO participation in the health sector. The
HSDP prioritizes maternal and newborn care, and child health, and aims to halt and reverse the
spread of major communicable disease such as HIV/AIDS, TB, and malaria. The Health
Extension Programme (HEP) serves as the primary vehicle for prevention, health promotion,
behavioral change communication, and basic curative care(6).

Communicable diseases account for about 60-80 % of the health problems in Ethiopia. The
national adult HIV prevalence is 2.2%. Data shows that relatively higher prevalence among
females (2.6%) than males (1.8%). Ethiopia ranks 7th out of the world’s 22 high burden
countries for TB. The prevalence of all forms of TB is 643/100,000 population with TB
mortality rate of 84 per 100,000 populations per year. In addition, malaria is one of the leading
causes of morbidity and mortality in Ethiopia. Leprosy, onchocerciasis,
leishmaniasis,schistosomiasis, soil-transmitted helminthiasis, lymphatic filariasis, and trachoma
are also prevalent in different parts of the country in various extents.(7)

Malaria, acute respiratory infections, nutritional deficiency diseases, tuberculosis, diarrheal

diseases, maternal and perinatal complications, and HIV infection are major public health
burdens in Ethiopia ranges from the lowest (17%) in Addis Ababa, to 38% in Benshanguz
Region. The 2001 national welfare monitoring assessment shows that 27.2% of the surveyed
population had health problems at least once over two months prior to the interview period.
Episode of illness are highest among the rural population than urban (8).

The top ten causes of death, in all ages in Ethiopia in the year 2002 were: Lower respiratory
infections (12%), HIV/AIDS (12%), perinatal conditions (8%), Diarrheal diseases (6%),
Tuberculosis (4%), Measles (4%), cerebrovascular disease (3%), Ischemic heart disease (3%),
Malaria (3%), and Syphilis (2%). (9)

Although national data is not available, small-scale studies show that chronic non communicable
diseases are emerging as public health problems. The prevalence of non communicable diseases
including hypertension, cardiovascular diseases and diabetes mellitus is increasing due to
changes in lifestyles. Hypertension was the sixth leading cause of death among hospitalized
patients (10 ,11)

Infant mortality rate is estimated at 67/1,000 live births; under – five mortality estimated at
106/1,000 live births and maternal mortality ratio of 673/100,000 live births (FMoH, 2007/08).
The number of children dies every year from diseases related to sanitation and hygiene estimated
to be around 250,000. The burden of disease in relation to sanitation and hygiene accounts 60%
of the total. However, the proportion of budget allocated to the improvement of sanitation and
hygiene in comparison with the general health budget is less than 1% .(12)

Morbidity and mortality related to poor sanitation, hygiene and unsafe water supply remain a
major source of environment related deaths in the country. The population which have access to
improved drinking water have risen to 59.5% in 2007 (FMoH, 2007/08). Similarly, the
proportion of population which have access to sanitation in 2007/08 was 37% (FMoH, 2007/08).
Inadequate water and sanitation services affect women and girls more severely than other family
members as they are the once who spend much of their time fetching water for the whole family
and caring for ill family members.(12)

Contamination of water sources is the causal factor for all water-borne, water-washed and water-
related diseases. It is difficult to quantify morbidity and mortality related to contaminated water
because of the lack of an effective and sensitive monitoring and surveillance system for the
general population Violence against women and harmful traditional practices (female genital
mutilations, abductions, early marriage, etc.) are prevalent, and are among the main factors that
contribute to the high maternal mortality and disability. In recognition that the health sector has a
strong preventive role, the prevention of the various acts of violence against women has been
prioritized by the FMOH and receives WHO’s support. The same issues are also addressed in
partnership with other Government sectors, donors and NGOs. The challenges are the existing
gender inequality and the lack of awareness on the part of the general public including health
providers.(11)

1.1. Rationale of the Investigation

Ethiopia as one of the developing country in which health and health related problems are
contributes a lot of impact on the efforts made by the community on the reduction of poverty
and development of the nations. So this document is intended to identify major health and health
related problems in the study area and helps to prioritize problems and for further developing
intervention strategies in the selected community.
Literature Review
The WHO 2008 report on the global burden of disease based on data for 2004, assesses that,
worldwide, infectious and parasitic diseases account for 9.5 million deaths a year (16.2% of all
deaths). The report shows that, of the top 10 leading causes of death worldwide, lower
respiratory tract and diarrhoeal infections rank 3 rd and 5th respectively, accounting for 7.1% and
2.2% of all deaths. Of the 10.4 million deaths among children under 5 years old, diarrhoeal
diseases and neonatal infections (mainly sepsis) account for 17% and 9% of deaths.
Ambient air pollution and in door air pollution: the health of 400-700 million people in the
world is endangering due to indoor air pollution; Ozone depletion has raised the risk of skin
cancer; Loss of biodiversity has raised the need of basified in many developing countries; Global
climate change has become a concern in the world: Deforestation, draught, earthquakes,
hurricanes etc. are wiping out the lives many people from infectious and parasitic diseases. Poor
people, women, children, and the elderly are the most vulnerable. Infectious diseases continue to
be the world’s leading killer of young adults and children. Worldwide, 1.8 million people die
annually from diarrheal disease, 90 % of whom are children. WHO found that risk increased as
fewer had access to services, without piped water, without sanitation services, and little
management of the water supply every year; quarter of all irrigated land suffers from soil
salination
The global burden of these diseases is staggering. It is particularly tragic due to its preventable
nature given that 80 percent of diarrheal disease is attributed to unsafe water supply, inadequate
sanitation, and lack of hygiene. Including diarrheal disease; schistosomiasis, trachoma, scariasis,
trichariosis, and hookworm diseases, the burden of disease from water, sanitation, and hygiene,
accounts for 4% of worldwide deaths and 5.7% of worldwide disability adjusted life years
(DALYs) per year.
Every year, unsafe water, coupled with a lack of basic sanitation, kills at least 1.6 million
children under the age of five years more than eight times the number of people who died in the
Asian tsunami of 2004
Water supply, sanitation and hygiene, given their direct impact on infectious disease, especially
diarrhea, are important for preventing malnutrition. Both malnutrition and inadequate water
supply and sanitation are linked to poverty. The impact of repeated or persistent diarrhea on
nutrition-related poverty and the effect of malnutrition on susceptibility to infectious diarrhea are
reinforcing elements of the same vicious circle, especially amongst children in developing
countries Repeated episodes of diarrhoeal disease makes children more vulnerable to other
diseases and malnutrition. The simple act of washing hands with soap and water can cut
diarrhoeal disease by one-third. Next to providing adequate sanitation facilities, it is the key to
preventing waterborne diseases
In Ethiopia many studies and reports indicate that communicable diseases account for more than
85% of the diseases seen in the health institutions those problems are mostly caused by poor
sanitation and malnutrition
A recent WHO/UNICEF report in Ethiopia diarrhoeal disease currently takes the lives of 1.8
million people each year, most of them children under five. There are low levels of hygiene
awareness, which compound the health risks associated with low water and sanitation coverage.
Women and children often spend several hours every day fetching water. For girls, the task of
carrying water, combined with a lack of sanitary facilities in schools, often stands in the way of
their education, squandering their intellectual and economic potential
In Ethiopia 42% of population using improved drinking-water sources, 96% of population using
improved drinking-water sources urban, 31% of population using improved drinking-water
sources, rural, and 11% of population using improved sanitation facilities. 27% of population
using improved sanitation facilities urban and 8% of population using improved sanitation
facilities in rural
Malaria is ranked as the leading communicable disease in Ethiopia. Malaria is reported to cause
70,000 deaths each year. According to Ethiopia’s Federal Ministry of Health (FMOH), in
2008/2009, malaria was the first cause of outpatient visits, health facility admissions and
inpatient deaths, accounting for 12% of out-patient visits and 9.9% of admissions. However, as
36% of the population does not have access to health care services, these figures probably under
represent the true burden of malaria in the country according to EDHS 2011 Just 34% of
Ethiopian women receive some antenatal care (ANC) from a skilled provider, most commonly
from a nurse or trained midwife (28%). Only 11% of women had an antenatal care visit before
their fourth month of pregnancy, as recommended and 19% Seventeen percent of women took
iron supplements during pregnancy; 6% took intestinal parasite drugs. One in five women was
informed of signs of pregnancy complications during an ANC visit. Less than half (48%) of
women’s most recent births were protected against neonatal tetanus. Ten percent of Ethiopian
births occur in health facilities, primarily in public sector facilities. Home births are almost twice
as common in rural areas (95%) as in urban areas (50%).

One in ten births are assisted by a skilled provider (doctor, nurse, or midwife). Another 28% are
assisted by a traditional birth attendant and 57% by untrained relatives or friends.
Postnatal care helps prevent complications after childbirth. Just 7% of women received a
postnatal checkup within two days of delivery. The vast majority (92%) of women did not have a
postnatal
Knowledge and attitude to communicable disease related to WASH
Study done in South Australia on KAP of diarrheal disease; its prevention; and ways of
intervening. 93.1% of the respondents did not answer the question "What is a normal bowel
movement?". Perhaps due to the characteristic reticence and shyness of Aborigines. 89.7%
believed alcohol and eating partially cooked food were the leading dietary causes of diarrhea
with 51.7% believing that wombat meat causes diarrhea. Nearly everyone agreed that water
causes diarrhea, especially very cold or very hot water (96.6%) and dirty water (93.1%). In terms
of poor hygiene, most participants (96.6%) attributed diarrhea to poor environmental hygiene,
e.g. sick dogs (37.9%) and overflowing septic tank (17%), and improperly washed dishes, rather
than poor personal (17.2%) and domestic hygiene (3.4%).
A 1987 nationwide study in Uganda found that children suffer an average of 6 diarrheal
episodes/year. More than 55% of mothers acknowledge that poor hygiene is the most important
cause of childhood diarrhea. Even so, sanitation is generally poor and inadequate. Steps must be
taken to increase the supply and availability of safe water as well as the efficiency of human
waste disposal. Finally, radio holds potential as an effective tool for health education and all
health workers should be given continuing education on the management of diarrhea.
UNICEF in collaboration with the Ministry of Health of Ethiopia had conducted studies in 1997
on knowledge, attitudes, and practices on water supply, environmental sanitation, and hygiene
education in selected “Woredas” involved under its Woreda Integrated Basic Services (WIBS)
project since 1990. Findings of the study indicate that the respondents’ status was very poor
regarding KAP. More specifically, more than 60% of respondents in most of the rural “Woredas”
did not know that diseases could be transmitted through human excreta; 30-75% of respondents
in different Woredas did not know that diseases could result from drinking water; and 23 to 87%
of respondents did not know any method of treatment for drinking water (31).

Water and sanitation

At the World Summit on Sustainable Development at Johannesburg in September 2002 the World

Community committed itself to "halve by 2015 the proportion of people without access to safe sanitation".

Since 1990 an estimated 747 million people have gained access to sanitation facilities (equivalent to 205,000

people every day). Despite this huge achievement, a further 1,089 million rural and 1,085 million urban

dwellers will need to gain access in the coming 15 years if the 2015 target is to be realized. Today, sixty

percent of people living in developing countries, amounting to some 2.4 billion people, have no access to

hygienic means of personal sanitation. (Sanitation and Hygiene Promotion, WHO program guidance

2005)
Recently, the ministry of health targeted in accomplishing the MDG goals by launching various

strategies. The health policy of the government focuses primarily on prevention. Hence the

policy aims at the protection of the environment, the prevention of disease, promotion of health

and prolongation of life with the application of science and technology. Institutions are asked to

ensure the installation of appropriate latrines with urinals and hand washing facilities at schools,

health posts, markets and public places. Where space is limited in peri-urban/urban slum areas,

appropriate communal latrines are to be made available under community (or private sector)

management. For effective liquid waste management, re-use and recycle principles are to be

promoted – particularly organic matter, by exploring and promoting biogas/ecological sanitation

options. (Global sanitation fund water supply and sanitation collaborative council, sanitation

sector status and gap analysis, Ethiopia September 2009)

Ghana, Although ranks 152 out of 182 on the Human Development Index, has the 4th lowest
rate of sanitation coverage worldwide. While the WHO and UNICEF Joint Monitoring
Programme reports gradual improvements, over the last 20 years, in access to improved
sanitation in Ghana, huge challenges remain with providing rural sanitation. In January 2011, it
was observed that many rural communities with populations ranging from several hundred to
several thousand have been donated pit latrines. According to the WHO/UNICEF Joint
Monitoring Programme’s metrics, these latrines would represent “improved sanitation” in that
area. We must remember that in reality, there is little correlation between health improvements
and the provision of sanitation unless there is adequate provision. Even if 10 percent of a
neighborhood defecates in the open, the health of the whole community may suffer
In Ethiopia, according to the recent census conducted in 2011, has a projected population of
77.6 million People in 2011. Its economy is based on agriculture, accounting for over 40% of
GDP. About 84% of the population is rural with about 76 % agrarian and 8 % pastoralist
communities, while the remaining 16% are urbanites. Despite a relatively long history of
environmental health activities in the country, their service provisions in the field are so far not
up to expectations. Environmental sanitation became a component of PHC in the 1970 - 80’s.
(Kumie A, and Ali A. An overview of environmental health status in Ethiopia with particular
emphasis to its organization, drinking water and sanitation: A literature survey. Ethiop.J.Health
Dev. 2005; 19(2):89-103.)
Objective

General objective

• To explore health and health related problems in Hirmata Mentina kebele, Jimma Town,
November, 2012
Specific objectives

• To explore perceived health and health related problems from community key informats
point of view in Hirmata Mentina kebele, Jimma Town, November 2012
• To identify common causes of health and health related problems from health
professionals perspective point of view in Hirmata Mentina kebele, Jimma Town,
November 2012
• To identify priority community health problems in Hirmata Mentina kebele, Jimma
Town, November 2012
Methods and Materials

Study area and period

Jimma town is located at 354 Kms Southwest of Addis Ababa. The study will be conducted in
HirmataMentina kebele, which is one of the 13 kebeles in Jimma town. The total population of
the town is 174, 396 from which _______ found in this kebele. There are 5 public health
institutions (3 health centers& 2 hospitals) and 19 private health institutions (6 higher and 13
medium clinics) in the town. Also there are 13 urban kebeles at which health extension
professionals provide health services. Assessment will be conducted on November 14, 2012.

Study design

• Explorative study will be used.

Population

Source population

• All Community key informants of Hirmata Mentina kebele

Study population

Selected Community key informants of Hirmata Mentina kebele

Sampling technique

• Purposively we will select community key informants in order to get over all common causes
of health and health related problems.
Data collection Methods

• Interview of Key informants

• Record review (Review of annual plan, monthly reports, weekly disease surveillance reports)
• Observation of the environmental risk factors
Data quality control

• Data will be collected by the investigators themselves which increases the quality of
information gathered. The principal investigators have exchanged the information and
discussed over information gathered.
Data analysis

• The qualitative data will be analyzed manually using thematic analysis method
Ethical consideration

• Formal letter of permission will be obtained from JU to communicate with local

administrative bodies in the area. Permission letters will be obtained from administrative
bodies of the area to communicate with relevant bodies at the kebele level. Finally verbal
consent obtained from the subjects included in the study immediately before proposal
development.
Operational definition

Community key informants:

• Kebele chairman
• head of health facilities
• head of health office
• administration bodies(water and energy office, education office , child and women
affairs, municipality
• Religious leader
• Edir leaders
• NGO representatives
Principal investigators:

These are all students who will conduct DTTP program at Hirmata Mentina
 2. References (Introduction)
1. Federal Democratic Republic of Ethiopia Ministry Of Health. Health and Related Indicators,
2010/2011.
2. Resource mobilization for health action in crises Ethiopia saving lives and reducing
suffering,2009.
3. Cherinethailu, Assessment of Knowledge, Attitude, & Practice among Mothers about VCT
and Feeding of Infants Born to HIV Positive Women in Jimma Town, Ethiopia,2005.

4. http://www.ju.edu.et/?q=philosophy-jimma-university-community-based-education.

5. Federal Democratic Republic of Ethiopia Ministry Of Health. Health and Related Indicators,
2006/207.
6. Ethiopian Heath and demographic survey ,2011.

7. http://www.who.int/countryfocus/cooperation_strategy/
8. The participation of NGOs/CSOs in the Health Sector Development Program of Ethiopia
9. Death and DALY Estimates by Cause, 2002
http://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls
10. Health and health-related indicators of FMOH 2005 –2006)
11. World Health Organization: WHO country cooperation strategy 2008–2011.Ethiopia
12. Federal Government of Ethiopia: situation analysis and needs assessment on the Libreville
declaration on health and environment interlinkage country report, April 2010
Reference (literature)

1. WHO 2008. The global Burden of Disease: 2004 update. Available

from:http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.
2. World bank, World development report, 1992)
3. Water-Borne Disease: A Worldwide Epidemic, 2009. http://www.nap.edu/openbook.php?
record_id=12597&page=78.
4. Prüss et al. WATER AND HEALTH: THE GLOBAL PICTURE OF RISK OF
WATERBORNE DISEASE AND CHRONIC DISEASE, 2002.
5. NGE OF THE DECADE: WHO UNICEF M E E T I N G T H E M D G D R I N K I N G
WATER AND SANITATION 2004.
http://www.who.int/water_sanitation_health/monitoring/jmpfinal.pdf

6. WHO, FAO Water-related diseases: Malnutrition, 2000.

http://www.who.int/water_sanitation_health/diseases/malnutrition/en/

7. unicef. Water, Sanitation and Hygiene: Common water and sanitation-related diseases,
http://www.unicef.org/wash/index_wes_related.html

8 . Prüss et al. WATER AND HEALTH: THE GLOBAL PICTURE OF RISK OF

WATERBORNE
DISEASE AND CHRONIC DISEASE, 2002

9. SERVE Ethiopia, Philip J Tuso, MD, FACP.

http://xnet.kp.org/permanentejournal/sum09/ethiopia.html
10.UNICEF. ETHIOPIA’S WATER AND SANITATION (WES) PROGRAMME

11. WHO 2008. The global Burden of Disease: 2004 update. Available
from:http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index
.html.

12. WHO, Communicable disease prevention, control and eradication,

http://www.who.int/countries/eth/areas/cds/en/index.html

13. EDHS 2011 report

14. Ratnaike RN, Collings MT, Ratnaike SK, Brogan RM, Gibbs A. Diarrhoeal disease:
knowledge, attitudes and practices in an aboriginal community, Department of Medicine,
Queen Elizabeth Hospital, Woodville, Australia.1988 Dec;4(4):451-5.

15. Konde-Lule JK, Elasu S, Musonge Knowledge, attitudes, and practices and their policy
implications in childhood diarrhea in Uganda, Institute of Public Health, Makerere
University, Kampala, Uganda. 1992 Mar;10(1):25-30
 Jimma University
College of Public Health and Medical Sciences
Community Based Education (CBTP and DTTP) for Postgraduate Students

Situational Analysis Tool

Health and Health Related Situational Analysis Tool for Hermata Mentina kebeles, Jimma
Town, November 14, 2012.

Situations to be Assessed

1. Populations characteristics
1.1. Total population size__________
1.2. Gender distribution Male ____________ Female______________
1.3. Age distribution: Children < 1 year______________ Children < 5 years_________
Children < 14years______________Women of child bearing age_______________
1.4. Ethnicity : Oromo____________ Amhara____________ Kefa_____ _____
Gurage____________Tigre_______________ Dawro_____ Others______________
1.5. Religion Muslim ________________Orthodox________________
Protestant _____________Others_____________________
1.6. Educational Status Illiterate_________ Read and Write Only____________
Elementary (grade 1-8) ________ Grade 9-10__________ Grade 11-12_________
1.1. Public and private health sectors

Hospital_____ Heath centers_______ Governmental Clinics __________ Health post_________

Private clinics________ Drug venders ________ Pharmacy _________Health related
NGOs_______ Diagnostic laboratory ___________

1.2. Infrastructures

Telecommunication__________ Electricity_____________ Transportation system__________

Roads types in the town ______________
Check lists for qualitative survey

In-depth interview designed for community leaders, nongovernmental organizations, edir

leaders and others

 What major health and health related problems are there in the Kebele?

___________________________________________________________________________
___________________________________________________________________________

 What are Contributing factors for the problems?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

 How do you rate them?

______________________________________________________________________________
______________________________________________________________________________

 Are there Interventions to the above problems?

______________________________________________________________________________
______________________________________________________________________________

 If yes, what were done and what are the limitations?

______________________________________________________________________________
______________________________________________________________________________

 If no, why not?

______________________________________________________________________________
______________________________________________________________________________

 As a leader, what was your role?

___________________________________________________________________________
___________________________________________________________________________

 Do you have a plan to improve the kebele health service access?

______________________________________________________________________________
______________________________________________________________________________
In-depth interview guide line for religious leaders

 What are major health and health related problems in the Kebele?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

 Contributing factors?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________

 Is there Intervention to the above problems?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

 If yes, what were done and what are the limitations?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

 If no, why not?

______________________________________________________________________________
______________________________________________________________________________

 What role the church or the mosque can play?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 In-depth interview designed for key informants in the community
1. In your perception what are the common problems in the community? Why is that so?
What are the perceived causes?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. How do you rate them? (arrange them according to their magnitude)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. What would you like to learn to improve the communities’ health? (Why?)
(Women’s health, First aid, Nutrition …)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. Which organizations and/or community association do you know that help your community?
(What support they provided? and providing currently?)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5. Do you know that urban health extension professionals are providing services in your kebele?
(If yes, what services are they providing, what the community benefited from the service/
program?)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Key informants in-depth interview guide line for health institutions: health office
/HEPs/Health centers/NGOs
1. How do you see the community health service utilization in Hermata mentina kebele?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. What are the major health problems observed in Hermata mentina Kebele? Why is that so?
What intervention measures your organization conducted?)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. Is urban health extension professionals’ service available in Hermata mentina kebele? What
services are they providing?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. Do you have a plan to improve the kebele health service access?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

In depth interview for schools

 1. What are the common health problems of your students in your school?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. Do your students miss classes? If Yes, What do you think the reason of absenteeism of
students in your school? Observe sick leave?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. What intervention measures your organization conducted?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. In your perception, what do youu think the main problems of the community/ Hermata
mentina kebele?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________