The Clinton Health Access Initiative (CHAI), Ethiopia has been implementing the Child Survival Program (CSP) since October 2015. It is a multiyear project that is funded by the Bill Melinda Gates Foundation (BMGF) to support the national child survival strategy with a focus on pneumonia and diarrhea. The program is operational in four big agrarian regions of Ethiopia, namely Amhara, Oromia, SNNPR and Tigray intended to serve 1600 Health facilities in 400 Woredas. But oxygen support extends to all hospitals in all regions across the country. Although the program was initially started in 2015 with a specific focus on diarrhea and pneumonia, the work has focused on approaches that would support the broader supply chain as a whole, including the improvement of Integrated Pharmaceuticals and Logistics Systems (IPLS), Drug and Therapeutic Committee (DTC), Quantification, Distribution and procurement as well as access to oxygen therapy (which is a cross cutting service). Apart from on-site technical support provided to facility staff, the following major findings were identified by the SS teams. 80% and 65% of pharmacy heads and health facility heads were trained on Drug and Therapeutic Committee (DTC), respectively. The baseline for the same training of pharmacy heads and health facility heads were 13% and 7% respectively. DTC functionality improved from 19% (baseline) to 69% The SS revealed that there is significant improvement in IPLS/LMIS implementation and availability of CHCs compared with the baseline. In terms of commodity availability, 90%, 98% and 96% of HCs had Amox DT 250mg, ORS, and Zinc, respectively, on the day of visit. Application of IPLS formats for CHCs was also improved from the previous SS. About 89%, 80% and 77% of HCs included ORS, zinc and Amox DT in their last RRF sent respectively. Improved adherence to the new IMNCI guidelines in terms of diarrhea and pneumonia treatment observed in the 4th round SS. About 88% of diarrhea cases were treated with ORS and Zinc. Similarly among children seen with pneumonia, 90% were treated with any Amoxicillin, but prescription of Amox is still low (29%). Yet, 6% were treated with other antibiotics (typically cotrimoxazole) . gaps observed during this time Limitations in updating bin cards for some CHCs including ORS, which is popular for years ,Adapting and utilization of facility specific medicine list (FSML) is limited,There are some HCs yet they do not use Amox DT for HC patients ,The practice of prescribing of Amox DT for pneumonia cases needs improvement ,Utilization of IFRR and regular reporting is poor; some facilities are using IFRR, but many of them report for items that are needed to be refilled and There is a shortage of preprinted updated LMIS format, specially IFRR and HPMRR. The program will continue to provide focused technical supports on major gaps identified during the fourth round SS, such as:DTC functionality based on the criteria, Bin card updating for child health commodities,Availability and proper distribution of CHCs, particularly Co-Pack and Amox DT, Prescription of Amox DT for under five children with pneumonia cases, and providing co-pack for all diarrhea cases & Consistently incorporation of CHCs into RRF.

• • Availability of Child Health Commodities pneumonia and diarrhea • children under-5 • progress of LMIS and DTC status • IPLS training • Ethiopia

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       This meta data shows  data of joint Supportive Supervision Reported in  February 2018  by  Clinton Health Access Initiative -Ethiopia on Child Survival Program in Collaboration with PFSA and Regional Health Bureaus    This report investigate the  progress of % of HCs has Amox DT 250mg in-stock on day of visit 90%, % of HCs experiencing stock outs in the last 6m for Amox DT 250mg 27%, % of HCs has ORS in-stock on day of visit 98%, % of HCs experiencing stock outs in the last 6m for ORS 28%, % of HCs has Zinc DT 20mg in-stock on day of visit 96% , % of HCs experiencing stock outs in the last 6m for Zinc DT 20mg 13% is the report of 4th round  gaps observed during this time Limitations in updating bin cards for some CHCs including ORS, which is popular for years ,Adapting and utilization of facility specific medicine list (FSML) is limited,There are some HCs yet they do not use Amox DT for HC patients ,The practice of prescribing of Amox DT for pneumonia cases needs improvement ,Utilization of IFRR and regular reporting is poor; some facilities are using IFRR, but many of them report for items that are needed to be refilled and There is a shortage of preprinted updated LMIS format, specially IFRR and HPMRR. The program will continue to provide focused technical supports on major gaps identified during the fourth round SS, such as:DTC functionality based on the criteria, Bin card updating for child health commodities,Availability and proper distribution of CHCs, particularly Co-Pack and Amox DT, Prescription of Amox DT for under five children with pneumonia cases, and providing co-pack for all diarrhea cases & Consistently incorporation of CHCs into RRF.the data was available by excel.

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