Ethiopia, 2012. A young girl in the arms of her caregiver - interacting with UNICEF's Sacha Westerbeek and Health Extension worker in Romey Village, North Shoa Zone, Amhara Region. Photo credit: UNICEF Ethiopia/2012/Getachew
Ethiopia, 2012. A young girl in the arms of her caregiver – interacting with UNICEF’s Sacha Westerbeek and Health Extension worker in Romey Village, North Shoa Zone, Amhara Region. Photo credit: UNICEF Ethiopia/2012/Getachew

Even before I joined UNICEF Ethiopia in June 2011, I had heard about its impressive health extension programme: health care is decentralised and over 30,000 health workers are deployed throughout the country and on Government payroll. A great story to tell!

By now, I’ve visited many health posts, run by these amazing women, generally in their early twenties from rural communities, dynamic and dedicated. Being educated and given the opportunity to work in their community, you can really see how this transforms their lives and status within the society in addition to the gains made in terms of health care. When one speaks about health in Ethiopia, I think about the health extension workers. To me, these young women represent the true heroes, or more precisely heroines, and one of the reasons why Ethiopia is doing so well in terms of its health indicators.

Foos Muhumed Gudaal is one of 35,000 rural health extension workers in Ethiopia. She practices at a post in the village of Walgo Yar in the eastern part of the country. The clinic is a simple, cement building with only two rooms: one for Gudaal to live in and one that serves as a consultation room. There is no electricity. There are no lights.

Gudaal’s role at the post is a bit like the old image of a small-town pediatrician. But she isn’t even a nurse. Instead, Gudaal, along with all of the other health extension workers, has gone through a special, one-year training program.

Her salary isn’t anywhere near that of a pediatrician, either. She earns roughly $35 each month. But Gudaal can still treat the diseases that often cut a child’s life short in Ethiopia. And she can make sure kids in the village are up to date on their vaccines.

Ethiopia, 2012. Health Extension Worker Haimanot Hailu and her partner walk through Romey Kebele (sub-district) North Shoa Zone, Amhara Region, for home visits carrying vaccine carriers. ©UNICEF Ethiopia/2012/Getachew
Ethiopia, 2012. Health Extension Worker Haimanot Hailu and her partner walk through Romey Kebele (sub-district) North Shoa Zone, Amhara Region, for home visits carrying vaccine carriers. ©UNICEF Ethiopia/2012/Getachew

“Ethiopia Achieves the Child Survival Millennium Development Goal (MDG), three years ahead of time.” If you don’t follow global health debates closely, you may have missed this news, which broke the news in September 2013 and seriously hit the roofs in this nick of the woods.

How did this happen in terms of policy choices? Around ten years ago, in order to address the increasing urban-rural gap in access to health services, the Government of Ethiopia launched the Health Extension Programme (HEP). This package of interventions was carefully tailored to the major causes of childhood mortality and morbidity – the epidemiology determined the priorities. The early years were not easy and, at several junctures, the system almost collapsed under the weight of expectations and the urgent imperative of delivering services to more than 80 million people in a vast and diverse country. And yet, every year, starting from a focus on basic prevention (insecticide treated nets, vaccination), the system has become stronger and stronger. Incrementally, best practice in curative-oriented, primary health care from around the world has been integrated into the HEP. So too has a multi-sectoral agenda that attempts to address root causes of childhood disease, such as food and nutrition security and water and sanitation. Community-based treatment of diarrhoea, pneumonia, malaria, severe acute malnutrition and, most recently, new-born sepsis and the inclusion of new vaccines, are all now central components.

Ethiopia, 2012. Health Extension Worker Haimanot Hailu discusses health and nutrition issues with Kokeb Negussie and her husband Teshome using the health extension booklet that is provided to all families in the village. These lessons include the importance of exclusive breastfeeding for six months and breastfeeding with complimentary feeding until two years old. ©UNICEF Ethiopia/2012/Getachew
Ethiopia, 2012. Health Extension Worker Haimanot Hailu discusses health and nutrition issues with Kokeb Negussie and her husband Teshome using the health extension booklet that is provided to all families in the village. These lessons include the importance of exclusive breastfeeding for six months and breastfeeding with complimentary feeding until two years old. ©UNICEF Ethiopia/2012/Getachew

Today, 38,000 health extension workers are deployed bringing health services to the doorstep of its rural people with real resources – becoming the cornerstone of the health system. Through my visits throughout this enormous country, I can see that the programme is sustainable and that the bilateral government donors, the World Bank and UN agencies, NGOs and civil society, philanthropic foundations, and the private sector, have all played a key role through their funding, their programmatic, operational and technical assistance, and their belief that Ethiopia could achieve the goals. Ethiopia could not have done this alone.

As the article mentions, in 1990, 1 in 5 Ethiopian children could be expected to die before reaching the age of 5. Today, the figure is closer to 1 in 15. The trend is compelling and consistent. Well over 1 million children have been saved during this period. Unfortunately, when I travel in the field, I still see too many children die and, still, there are major disparities between rich and poor, urban and rural, pastoralist and agricultural areas.

I’m proud working for UNICEF in Ethiopia, a country which makes enormous strides in terms of development, and somehow being part of its transformation. Ethiopia has shown that a poor country, once only associated with famine and conflict, can become a leader for global health and development. When you read the article, you will see: For Africa, there are no longer any excuses.

Alexandra (Sacha) Westerbeek
Chief Media and External Relation, UNICEF Ethiopia
awesterbeek(at)unicef.org

Read the full article here

See also:

Uganda scales up health care innovations to achieve MDGs

Backpack PLUS Toolkit created to help empower community health workers

Adapting child health innovations for the field of child protection

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