Physicians take to the field.
A joint project on the Ministry of Health, Addis Ababa University, the Jimma Institute of Health Services, the Gondar College of Health Sciences, and McGill University in Montreal, Canada is involved with working to improve the health care system in Ethiopia. The Ethiopian government has established postgraduate degrees in public health for district health managers, and overseas fellowships for students in order to train health professionals to work in 359 districts (awrajas). The emphasis is on district managers because of their link to the people, to stimulating community participation, and to coordinating activities. Training programs are available for physicians who have worked in rural areas for 2 years; completion of the program usually means placement as district health managers. One student was able to reduce respiratory illness among textile mill workers because of the success of his research thesis on byssinosis. 40% of Ethiopia has district health centers which provide primary health care and coordinate health resources. A 1st priority is convincing local leaders to construct latrines and provide safe sources of drinking water. The example of the functioning of the Suluta health district is provided. Of the 129,000 inhabitants, the health personnel and facilities provide for only 25% of the villages in the district. The district director is completing his thesis on field trials of oral rehydration therapy. Student research is supervised by physicians based at Addis Ababa University. An example is given of one such visit to a student studying adolescent sexual behavior and illegal abortion increases. Student work involved research, an action plan which identifies priorities for the area, and a health profile. Students learn how to compile data and plot graphs in a country where rural birth and death records are not kept. Record keeping, reference books and materials were also needed for the organization; technical resources were provided to this end. Computers and CD-ROMS have expended the resource base. Standards have improved since the initiation of the program, and the importance of the training was evident in the ability to handle the meningitis epidemic in 1989 and the coup in 1991. Economic conditions need to improve and be directed to health personnel, drugs, books and supplies.