The efforts of health extension workers in Ethiopia have contributed to a sharp reduction in child mortality rates over the last decade.
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By Sarah Crowe
The 2013 Progress Report on Committing to Child Survival: A Promise Renewed shows that major progress has been made in lowering child mortality in all regions of the world and at all levels of national income. Nonetheless, even bigger gains are needed if the world is to meet Millennium Development Goal 4 – reducing under-5 mortality by two thirds by 2015. UNICEF’s Web series on A Promise Renewed focuses on some of the successful and innovative programmes that have helped save the lives of millions of children around the world.
In Ethiopia, the effort to deploy health workers to even the most remote parts of the country has helped bring about a steep reduction in child mortality.
UPDATE: The Ministry of Health of the Federal Democratic Republic of Ethiopia and UNICEF announced today that Ethiopia reduced its under-5 mortality by two thirds between 1990 and 2012 – the required reduction for meeting the target of Millennium Development Goal 4. In 1990, the under-5 mortality rate was one of the highest in the world at 204/1,000 live births; by 2012, this rate had been slashed to 68/1,000 live births.
Even in remote parts of the country, more children are thriving beyond their fifth birthday.
GAMBELLA, Ethiopia, 13 September 2013 – For a country that once made headlines for famine, poverty and war, Ethiopia is gaining a reputation as a development leader on the African continent. In just over 10 years, the country has slashed child mortality rates by half, rising in global rank from 146 in 2000 to 68 in 2012. More money is being spent on health care, poverty levels and fertility rates are down, and twice as many children are in school.
Even in remote parts of the country, such as the Gambella region near the border with South Sudan, more children are thriving beyond their fifth birthday, and their parents are having fewer children.
It all means that Ethiopia appears set to achieve the Millennium Development Goals.
The steep decline in child mortality and increase in smaller, healthier families may come as a surprise to some, but not to Ethiopia’s Minister of Health, Dr. Kesetebirhan Admasu. He credits the turnaround to a mixture of targeted policies and the 38,000 health extension workers the Government has deployed throughout the country, trained, equipped and supported by UNICEF.
“Our government has a policy of reaching the hard-to-reach parts of the country and focusing on prevention of disease, health promotion and transferring responsibility to individual families,” he says. “To do that, we designed a community health extension programme, our flagship programme.”
Dr. Kesete believes the community health workers have led the way to achieving major reductions in child and maternal mortality. And he adds that Ethiopia’s advances demonstrate that even poor countries can deliver for children. “With commitments of governments and the community, it is really possible to make a difference and to save the lives of millions of children and mothers across Africa,” he says.
On the ground, the results are evident. The village of Okura lies on the Baro River in southwestern Ethiopia. During the rainy season, the village is largely cut off, accessible only by river transport. But now people get help from one of their own, a community health extension worker whose job is to check immunization records, test for diarrhoea, pneumonia and malaria, and monitor hygiene in homes. There are also certificates awarded for ‘model homes’ – households that adhere to good health habits like washing with soap and using insecticide-treated bed nets.
The family in one model home has seen the benefits since the programme started. Ariet Nyignio, a 22-year-old mother, explains, “The reason why the sons of my father died is because at the time there was no health facility, but now there is a health centre, health post, and health extension workers are more caring, so for each person who goes there, they will get attention, they will get medicine.”
“Before, a lot of under-5 children used to die because of the lack of knowledge about health,” says Getachew Wako, a UNICEF Immunization Officer. “Now I need to educate and change this community to reduce the deaths and sickness of children under 5 years.” “Ten years ago, we used to see five under-5 children per household. Now a lot of people are using family planning,” Dr. Wako says. “I never thought this change would come five years ago. The reason why this happened was because of massive involvement by the community.”
With Ethiopia leading the pack, African leaders made a strong commitment earlier this year to prevent child deaths, putting child survival at the forefront of social development agendas across the continent and renewing the focus of African leaders to head their own countries’ efforts. Sub-Saharan Africa still accounts for the majority of child deaths, however, and high rates of preventable child disease and death persist, despite simple, affordable and high-impact interventions.
The pledge in Addis Ababa was to develop and implement country-led roadmaps that integrate efforts to end preventable deaths among children under 5 by 2035, and reduce the mortality rate for children under 5 to below 20 per 1,000 live births in all African nations.
A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. The movement seeks to advance Every Woman Every Child — a strategy launched by United Nations Secretary-General Ban Ki-moon to improve the health of women and children — through action and advocacy to accelerate reductions in preventable maternal, newborn and child deaths.
Since its launch, 176 governments have signed the Committing to Child Survival: A Promise Renewed pledge, and thousands of civil society groups and private individuals have mobilized actions and resources in support of the goal. A diverse array of governments are setting bold new targets for maternal, newborn and child survival, while, around the world, civil society is increasingly holding governments accountable for their promises, facilitated by new communication technologies and tools.
A Promise Renewed recognizes that leadership, commitment and accountability are vital if we are to end preventable child deaths. And because child survival is increasingly recognized as a shared responsibility, everyone has a role to play.