Since 1989 an evaluation study of the impact of a Primary Health Care (PHC) program is being carried out in Arsi region, Ethiopia. The principal aim of the study is to estimate the mortality rates in those villages mainly involved in PHC activities. A sample of 80 villages will be recruited to allow significant differences in mortality of 20 per thousand between less treated and best treated villages. Considering the absence of routine demographic data, a population census and demographic surveillance of the recruited villages have been carried out. All the activities related to the study are considered together with the principal logistic and methodologic problems.
PIP: The Arsi region in Ethiopia has a population of 2 million who are served by 2 hospitals, 7 health centers (HCs), and 82 health stations (HSs). In 1988, a primary health care program was launched to improve health care by restructuring the instrumentation of HCs, HSs, and health posts HPs, by strengthening maternal-child health (MCH) care with UNICEF support of an expanded program of immunization. In villages, community health agents (CHA) provide primary care for the sick as well as information on hygiene and sanitation in collaboration with traditional birth attendants (TBAs). The health indicators chosen for the study were: overall mortality, child mortality for ages 1-4, sudden illness, utilization of health care, and vaccination coverage. In the first year, child mortality was calculated indirectly by using the technique of Brass. The estimated annual birth rate was 43/1000, the mortality rate was 19/1000, and the child mortality rate was 149/1000. 80 villages with an average population of 1500 each had about 5000 births a year. It was hypothesized that child mortality was 130/1000 in those villages that received minor health care and that a reduction of 20/100 could be achieved if 40 villages were completely covered by health care. Data collection regarding health indicators, sanitation, and household economics was envisioned for late 1989 and 1990 by student interviewers and CHAs. A quarterly demographic bulletin was issued by the Regional Epidemiological Office that monitored field work and checked data for quality. Periodic meetings of CHAs were held for problem-solving. the large nonhomogeneous population and inaccessible terrain posed most of the problems and necessitated a large staff for data collection and continuous supervision.