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In Ethiopia, a young boy holds the promise of a healthy nation

By Johnny Magdaleno

The expansion of health services to rural areas of Ethiopia through the Health Extension Worker programme has brought a dramatic reduction in child mortality.

ROMEY, Ethiopia, 20 October 2015 – Moges dashes across the grass with a herding whip in hand. At 2 years old, he can’t make it crack like his father or the other men in Romey kebele (sub-district), a pastoralist area a few hours outside Addis Ababa where his family lives. But he smiles proudly as he loops it in wide circles around his head.

While Moges is beaming with vitality today, two years ago pneumonia and diarrhoea nearly robbed him of his life within months of his birth.

Muluemebet Balcha, one of the Health Extension Workers (HEW) who helped save Moges, remembers how distraught his mother was. Ms. Muluemebet had contacted her to offer postnatal care for Moges through the Ethiopian government’s Health Extension Programme (HEP).

“She was desperate,” she says. “She thought the child would have died.”

“I gave him treatment and on the second day he got well. I was very happy to see him survive,” she remembers.

Ms. Muluemebet says not all newborns in the area were as lucky as Moges. “Before that [HEW] training was given, so many children who encountered the same problem died,” she says. The HEP has done wonders for families in hard-to-reach rural areas like Moges’ since it was established in 2003.

With help from agencies like UNICEF, the programme continues to grow. As of 2015, there were more than 38,000 HEWs like Ms. Muluemebet working in more than 16,000 health posts across the country. Each post serves around 5,000 people, meaning the vast majority of Ethiopia’s population of 99 million are within reach of free, basic health care.

Teshome Alemu, Moges’ father, says he owes his child’s life to the HEWs. “To go to [the nearest hospital], you may not even afford the transportation cost,” he says. “If you don’t have money, you can suffer a lot. The children will also suffer.”

“The provision of this service in our kebele is very beneficial,” he adds.

Achieving a milestone

In September 2013, Ethiopia gained notice around the world by announcing it had achieved Millennium Development Goal 4, which pushed for a reduction of child mortality rates by 67 percent, three years ahead of its 2015 deadline. What started as 205 deaths for every 1,000 children in 1990 tapered off to 59 deaths per 1,000 by 2015. While developments in technology and new levels of political support have been partially responsible for this drop, the HEP was a key driver in making this improvement a reality.

Meeting MDG 4 was a milestone in the country’s history, but HEWs aren’t claiming “mission accomplished” quite yet.

“The size of kebeles and their population means they cannot be covered by one HEW. I am the only health worker serving this community, so it is very tough to reach all the households,” says Ms. Muluemebet.

Because she balances so many patients, she’s not always able to put in the time to make sure her advice sticks. “Given the awareness of the community, it takes a long time to implement some of the activities. Families are getting the education needed, but sometimes it takes them a while to put it into practice,” she says.

Moges’ mother, Kokeb Nigusse, admits that while the community is grateful for the free services they provide, not everyone follows their advice to the fullest.

“They give the children medicinal drops, injections and syrup when they are sick,” she says. “They check up on the children. They also follow up and give injections to pregnant women. More significantly, they advise us to deliver in health institutions and not at home.”

Despite this last suggestion, she says, home births do still occur.

With more support from the Government and UNICEF, that is beginning to change. “Before I started work, most mothers delivered at home. But now, if you take this year’s data, out of 171 pregnant mothers, only 20 delivered at home,” says Ms. Muluemebet. The rest delivered at the local HEP health centre.

There have also been gains among mothers like Ms. Kokeb, who are reluctant to vaccinate their children. “Vaccination of children was very low previously, but now almost all children get vaccinated,” says Ms. Muluemebet. “I informed her that if the child gets sick, he should get treatment even before baptism, because the community believes they shouldn’t get anything before baptism.”

Pneumonia, diarrhoea and malaria are among the five most common life-threatening conditions that newborns face in Ethiopia. These threats have curtailed with the debut of the integrated community case-based management of common childhood illnesses (ICCM) regime. So far, more than 28,000 HEWs like have been trained in ICCM.

Strong support

With help from the financial support of its donors, UNICEF has guided development of the ICCM and HEP programs, given technical assistance to Ethiopia’s Ministry of Health, and delivered 10,000 health kits to HEP health posts throughout the country. Ms. Muluemebet says the change from this support has been enormous.

“I am a witness to seeing mothers die while giving birth,” she says. “But with the HEP we can easily detect mothers who need help, or who need to get service at health centres, and if it is beyond their capacity, they call the ambulance and they take the mother to health centre and they can be easily saved.”

Moges and Ms. Kokeb were saved from having to travel great lengths to get basic care. Today they walk hand-in-hand across the bright green plains that surround their large plot of land, happy, at ease and part of a complete family. As the HEP continues to grow, success stories like theirs will become a shared experience for millions more Ethiopians.



UNICEF Photography: Committing to child survival

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