By Sacha Westerbeek
HAROJILA FULASO, OROMIA REGION, 1 February 2014 – “The health extension worker told us to wash our hands with soap and if we don’t have soap, we can use ashes. So, when I have not been able to buy soap, this is what we use to disinfect our hands”.
Ms Shure Gore takes the can of ashes and hands it to United Nations Deputy Secretary-General Mr Jan Eliasson. He gently takes out some of the greyish substance and rubs it before rinsing it off with the water from the jerry can attached to the tree, next to the family’s’ latrine. “My hands are clean,” he exclaims while the family is observing his actions closely.
In Ethiopia’s Oromia region, the hygiene and environmental sanitation activities are the main focus for household and community level interventions. The woreda (district) latrine coverage is about 70 per cent. In Harojila Fulaso, however, 80 per cent of the households have reached the status of becoming a “model household.”
The model family is the approach adapted by the Health Extension Programme to improve household practices. After 96 hours of training and adopting 12 of the 16 packages, a family graduates to become a so-called model family. The health extension package is categorised under three major areas and one cross cutting area: namely Hygiene and environmental sanitation; family health services; disease prevention and control; and health education and communication.
The Lemma-Buchule family, in which Ms Shure Gore is the driving force, has a latrine with hand washing facilities and dry and liquid waste disposal pits. In addition, the household has adequate aeration and light and the animals are kept separate from the living area – to name a few requirements of becoming a model household.
The family lives a couple of minutes walk away from the health post. Ms Abebech Desalegn is one of the two health extension workers running the facility. The health post provides services to 736 households and 3,532 inhabitants – ensuring that health care is delivered at the doorstep. “I know Shure and her family very well,” says Ababech. “The family consists of 10 members, including eight children between the ages of 3 and 22 years old. They come here when they need vaccine, a new mosquito net or when they are ill.” She has assisted the household in reaching the status of “model household”. “They now inspire others to do just like them, they are an example to the community,” Ababech explains.
Health extension workers deliver health care at the doorstep
Ababech is a government salaried and trained health worker, under the Health Extension Programme, an innovative community based programme which started in 2003. To date, 38,000 health extension workers have been deployed in nearly all rural villages. The programme aims to create a healthy environment and healthy living by delivering essential health services to communities.
UNICEF supports the Health Extension Programme in different dimensions. Training of HEWs to improve their technical competencies in delivering health and nutrition services, procuring and distributing of vaccines, medicines and supplies, ensuring availability of job aids at health posts, have all led to increased coverage of health and nutrition services at community level.
In addition to prevention and health promotion services, health extension workers are also now involved in case management of pneumonia, diarrhoea and severe acute malnutrition in more than 90 percent of health posts.
The Deputy Secretary-General, Mr Jan Eliasson studies the charts on the wall of the small health post. “You are doing an excellent job here,” he says while impressed with the statistics and service delivery provided by this health extension post.
Abebech explains that she is required to split her time between the health post and the community. Community outreach activities include working with model families, community groups or households. “Every day I’m very busy she continues. When I’m at the health post I provide basic services such as: immunisation; health education; antenatal care; family planning; delivery and postnatal care; growth monitoring and community treatment of severe acute malnutrition; diagnosis and treatment of malaria, pneumonia and diarrhoea; treatment of eye infections; treatment of selected skin problems; Vitamin A supplementation; first aid and referral of difficult cases… just to name a few of my daily activities.”
In addition, this young health worker, who has worked at this health post for the last seven years, has done thirty deliveries and many more postnatal checks. “I’m happy UNICEF provided delivery beds, but I also need clean water. Every single day I walk to the nearest water point, because I need clean water for the latrine and health interventions.”
WASH interventions at Health Post level
To date, UNICEF has provided a total of 160 health posts with a complete WASH package. This includes: providing capacity in the design of WASH facilities, construction of water supply and sanitation facilities and hygiene promotion to health institutions through construction and disseminating information on hygiene and environmental sanitation. In addition, WASH interventions at the health post level include: the provision of a hand-washing stand; a septic tank; incinerator; placenta pits; general solid waste and sharp pits.
“I’m lucky having clean water nearby,” says Ababech. “But too many of my colleagues really struggle, especially those who work in remote and dry areas.”
Ethiopia has been an active participant in the Sanitation and Water for All Partnership. In 2013, the Ethiopian Government, with support from UNICEF, was able to establish a Sector-wide Approach termed the ONE WASH National Programme with a dedicated budget line for sanitation in the Government of Ethiopia’s treasury.
Although good progress is underway in the area of water, sanitation and hygiene, still some challenges remain. In 2010, out of a population of over 80 million, about 46 million were without access to improved water supply and sanitation and Ethiopia had the highest number of people (38 million) practicing open defecation among African countries. The lack of access to adequate clean drinking water and sanitation services has a dramatic impact on the lives of people, especially women and girls, and undermines efforts to improve health, nutrition and education outcomes.
Mr Jan Eliasson underlines the need for clean water and sanitation. “We really must act now. We have to talk about sanitation and improving access to toilets and clean water. We also must change attitudes and behaviours,” he emphasises with passion.
Ms Gore fully agrees. “Since I have a latrine and we wash our hands at critical times, I see less disease in my family. The children go to school and we work on the land – for this, we need to be healthy.”