ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.
While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.
In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.
The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.
Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.
The Italian Government funds UNICEF with Euro 500,000 to UNICEF to strengthen vital events registration system in Oromia and SNNP regions
ADDIS ABABA, 7 December 2016 – The Italian Agency for Development Cooperation funded UNICEF with a total contribution of €500,000 to strengthen the civil registration system for children’s rights to identify in two regions of Ethiopia: Oromia and SNNPR, in collaboration with the respective regional Vital Events Registration Agencies (VERAs).
The support is crucial as it represents the preliminary condition towards the creation of a fully functional civil and vital registration system of birth, death, marriage and divorce. The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and contribute to children’s right to identity to protect them from abuse and exploitation, as well as ensure their access to basic services.
The support comes at a critical time in light of Ethiopia’s creation of a fully functional nationwide civil and vital registration system of birth, death, marriage and divorce in August.
The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and help protect children from abuse and exploitation, as well as ensure their access to basic services.
In addition, vital events registration is an important pre-requisite for measuring equity, monitoring trends, and evaluating the impact and outcomes of broader development programmes, such as the Sustainable Development Goals (SDGs).
At the signing ceremony, the Ambassador of Italy to Ethiopia, H.E. Giuseppe Mistretta stated that “the registration of birth represents the first step towards the recognition of an individual within a society, allowing him or her to access to basic services and protect him or her from abuses and violence. Avoiding anonymity and invisibility, birth registration sets the basis for an efficient planning of the governmental policies and strategies of good governance”.
“All our current and upcoming projects of the Italian Agency for Development Cooperation in Ethiopia are aligned with the priorities and strategies set by the Government of Ethiopia. This initiative’s objectives are also expressed by the Proclamation on Vital Events Registration and National ID (Proclamation No. 760/2012), adopted in August 2012. Coherently with the government strategy, the initiative we are signing today aims at improving the institutional and technical capacity of Regional Vital Events Registration Agency (RVERA) in Oromia and SNNPR to effectively lead and coordinate the registration of vital events” said Ms. Ginevra Letizia, Head of the Addis Ababa Office of the Italian Agency for Development Cooperation.
Ethiopia has one of lowest levels of birth registration in the world at just 7 per cent. With the new system, however, registration of vital events in Ethiopia has been modernized. From regional up to federal and city level administration, UNICEF is supporting standardisation of registration and certification services, which has been officially launched nationwide.
“UNICEF appreciates the timely contribution from the Italian Government to count every child, and in the process, to make every child count. With proof of age and identity, we can protect every child from diverse child protection concerns including abuse, neglect and exploitation, early marriage, child labour and trafficking, and help them to access basic social services, including education and health,” said Gillian Mellsop, UNICEF Representative to Ethiopia.
ADDIS ABABA, Ethiopia. August 2016 – Ethiopia launched throughout the country on 4 August 2016 a permanent, compulsory and universal registration and certification of vital events such as birth, death, marriage and divorce.
The inauguration ceremony took place in the presence of the Ethiopian President Dr Mulatu Teshome, UNICEF Representative Gillian Mellsop as well as representatives of other ministries and development partners.
“The Government of Ethiopia has given great emphasis to vital events registration across the country by putting the appropriate policies in place, establishing a system up to the lowest administrative level and deploying massive resources in this endeavor,” said Teshome at the ceremony. “I am confident that, with the collaboration and commitment of all stakeholders, we will succeed in the operationalization of the system, just like we have succeeded in other development sectors in the country.”
Mellsop underscored in her address the importance of the registry in protecting children and combatting child trafficking.
‘’With no proof of age and identity, Ethiopian children become a more attractive ‘commodity’ to a child trafficker, and will not even have the minimal protection that a birth certificate provides against early marriage, child labour, or detention and prosecution of the child as an adult.”
Ethiopia ranks among the lowest in sub-Saharan countries on birth registration with less than 10 per cent of children under the age of 5 with their births registered.
The issue is especially urgent because 48 per cent of the 92 million-strong population is under the age of 18 – 90 per cent of whom are unregistered. The Government has committed itself to reaching at least 50 per cent of children with registration and certification services over the next two years.
UNICEF’s support to Ethiopia’s national civil registration is based on a recognition that birth registration is an important element of ensuring the rights and protection of children.
For children, being registered at birth is key to other rights such as access to basic social services, protection, nationality and later the full rights of citizenship, including the right to vote. Moreover, not only is vital events registration essential for compiling statistics that are required to develop policies and implement social services, it is also, as Mellsop points out, “a pre-requisite in measuring equity; for monitoring trends such as child mortality, maternal health and gender equality.”
UNICEF has supported the Government in putting in place a decentralized registration and certification system, which is informed by a legislative framework promulgated in August 2012.
UNICEF is a catalyst in creating this new system with support that includes the reform of the legislative framework, the development of a national strategy and its implementation across the country.
An important element of the Civil Registration and Vital Statistics (CRVS) system is its interoperability with the health sector. On this aspect, UNICEF has worked in collaboration with the Ministry of Justice and Ministry of Health in its efforts to formalize the interoperability, culminating in the signing of Memorandum of Understanding (MoU) between the two ministries.
The important of involving the Health Ministry is because it already has its own well organized and decentralized network stretching across the country. This arrangement allows the health facilities found in nearly every community to manage notifications of births and deaths.
The actual registration and certification of all vital events started on 6 August 2016 at the lowest administrative level of the kebele (sub-district).
With Ethiopia’s new conventional vital events registration system in place, there are better opportunities for accelerating vital events registration in Ethiopia, and realizing one of the fundamental rights of children – the right to be registered upon birth.
Ethiopia is a country showing strong progress in achieving global and national goals for WASH services. It has achieved the MDG target 7c for water supply. Although still behind for sanitation targets, considerable progress is made. As of 2012, 37 per cent of communities practiced open defecation, as compared to 92 per cent in 1990
The progress on sanitation is mainly achieved through the national Health Extension Programme (HEP) and the community led total sanitation and hygiene (CLTSH) approach. CLTSH is an approach that helps to mainly rural communities to understand undesirable effects of poor sanitation, and through a process of “triggering” – igniting a change in behaviour – achieve sustained behaviour change leading to spontaneous and long term abandonment of Open Defecation (OD) practices. Since its introduction in 2006/7, CLTSH has remained the only instrument in Ethiopia to induce behaviour change of communities to consider construction of latrines and use them – discouraging the practice of open defecation. Although the achievements in the past decade are significant, the success of the approach varied significantly from place to place.
For example, the Oromia regional state, the largest in the country, consists 265 rural and 39 urban districts or woredas. Out of 6,531 kebeles (sub-districts each with an average population of 5,000) in rural areas, about 16 per cent are open-defecation free (ODF) – meaning no-one, including visitors and passing pedestrians, are openly defecating and all have access to basic latrines with handwashing facilities.
UNICEF supports 24 woredas in Oromia state between 2011 and 2015. Of the supported woredas, 24 per cent (116 of 477 kebeles) have achieved ODF status. Compared to regional average of 16 per cent, this is a huge achievement. Sire, one of the supported woredas, has recently been graduated in 2015 with 100 per cent performance, declaring all 18 rural kebeles ODF. Other woredas are at various stages. 11 woredas are between 20-50 per cent progresses, while the rest 12 woredas are of 0-10 per cent progress. Compared to these, Sire Woreda shows an outstanding performance.
Such exceptional achievement requires successfully overcoming a number of challenges. A key challenge is lack of thorough understanding of the steps involved in CLTSH and their importance. Usually CLTSH is about training facilitators and triggering communities. However, many practitioners agree that this is the easiest part. Rendering adequate supervision after the triggering stage and providing support that is necessary to sustain the momentum is the difficult part. Other challenges include diffusion of information to neighbouring communities that make the approach ineffective, lack of trainers with actual field experience, high staff turnover, poor coordination among stakeholders, weak commitment of staff and trained people and application of CLTSH without adequate or proper organisation and preparation.
Growing over all these challenges and as a result of four years of effort, Sire Woreda celebrated 100 per cent ODF achievement in April 2015, with all rural villages and kebeles free from open defecation.
Even though, some of these kebeles were declared ODF two or more years ago, , they continued to sustain their status despite the usual trend of falling-back to OD practice noticed as time elapses. This demonstrates an effective post-triggering activity by the Woreda that effectively complimented the planning and triggering activity.
How was this achieved? The Woreda administration leveraged existing structures to sensitize the leadership ladder down to village level on CLTSH and built it in to the regular reporting and evaluation process. This has helped to mobilize the largest possible support to the effort of Health Extension Workers (HEWs) and CLTSH facilitators, including teachers and students under the guidance and support of the Woreda Health Office. It has also avoided diversions of focus (including manpower, logistics, and resources) as CLTSH has become an official woreda priority.
Two notable practices can be praised in the woreda for this success. (a) the technique of triggering one full kebele at a time in contrast to the usual practice of village by village, and (b) use of different post-triggering follow-up technique suited to context. The advantage of the first technique was twofold. It helped to avoid diffusion of information in to neighbouring communities. Since, focusing in one kebele at a time required more trained people, the coordinators called upon trained and experienced facilitators from adjacent woredas to support, which worked really well. On the other hand, the woreda experts consciously applied different post-triggering follow-up methods. In highland areas, they applied the ‘flag system’, where by communities themselves awarded white flags to households who have constructed basic latrines, and red flags to those who did not. In low land areas, students were organized to alert the community when they see any one defecating in the open, who will then ensure the person buries the excreta.
Currently, the Woreda continues to strengthen the community platforms for monitoring progress and pro-actively works with local leaders to provide the necessary guidance and technical support to sustain the achievement. As a result of this, they are expecting at least two kebeles to achieve secondary ODF, which includes upgrading of basic latrines to improved latrines (with washable slab, vent pipe, hole-cover) with hand washing facility by the whole community. The commitment of leaders, and subsequent effective coordination in the Woreda has benefited the wider community to keep children, women and the society at large healthy.
Editor’s note: UNICEF‘s Deputy Executive Director for Programmes, Ms. Geeta Rao Gupta, visited UNICEF-supported maternal and child health programmes in Ethiopia ahead of the Ministerial Conference on Immunization in Africa in Addis Ababa. At the conference, African leaders–including health and finance ministers –came together to commit to expanding access to vaccines for children across the continent.
My recent visit to a health post in Ethiopia’s Bassona Worena district allowed me to see routine immunization activities, community case management and child and newborn health care programmes in action. The visit also highlighted one crucial element that characterizes successful child health programmes: community engagement.
I spoke with several community health workers, including Ms. Demem Demeke, 29, who described the full range of services she provides in her one-room, neatly organized health post: “We provide promotive, preventive and basic curative health services including immunization, community case management of diarrhoea, malaria, pneumonia and sepsis, antenatal care, post-natal care and other services to our community.” With handwritten charts plastered across the walls, Ms. Demeke was able to tell me exactly which households in her area had children in need of immunization, and with folders organized by the day of the week, she knew which children were due for a vaccination on that day. I watched as she expertly vaccinated a baby boy and then comforted him and instructed his mother on his care – quality, personalized care provided right there in a remote village in rural Ethiopia.
I also visited the home of Ms. Etenesh Deksiosa, a leader in the Health Development Army, a band of community members who support the work of the community health workers by educating neighbours and encouraging them to use maternal, newborn and child health services. Demonstrating the various tools she uses to educate her neighbours, she proudly told me: “I am always inspired to teach communities about the importance of vaccination and other child health-related issues.”
I was very impressed by professionalism and strong sense of responsibility of the community health workers. By engaging the communities they serve and working in partnership with the leaders in the Health Development Army they create a high level of ownership and a conducive environment to address traditional practices, cultural beliefs and social norms that contribute to hesitancy or even resistance to vaccination. The trust they build also helps to identify and reach children who are the most vulnerable — children who might otherwise never benefit from health services.
Ethiopia’s 38,000 health workers are mainly women selected from local communities who are paid by the government as part of the country’s flagship health extension programme. With the help of these committed women Ethiopia has expanded access to and demand for essential health services like immunization, making significant gains in reducing child mortality in less than a generation. By leveraging community engagement for child health Ethiopia reduced under-five mortality by two-thirds between 1990 and 2012 meeting Millennium Development Goal (MDG) 4 ahead of schedule.
Community involvement is a common success factor among countries that are reducing the prevalence of childhood diseases, particularly those that can be prevented with vaccines. Engaging and involving communities directly through community health workers and champions within communities is among the most effective means of promoting immunization in rural or marginalized populations and contributing to broader health goals.
At UNICEF, we have learned that lesson well over the years, most recently through our efforts to eradicate polio in Africa and elsewhere. Involvement and engagement of community leaders by community health extension workers transformed those efforts leading to increased success in reaching vulnerable children previously missed in polio vaccination campaigns.
Despite this experience and evidence, in far too many African countries today, consistent, nation-wide investments in community health programmes are still the exception – not the rule.
To maximize the return on investment in immunization programmes and to strengthen overall health systems, Ministries of Health should allocate adequate resources to support community-based health workers working hand-in-hand with community networks. By educating communities and generating demand, community health workers are key to expanding coverage and sustaining demand. And when community health workers involve community members in planning and monitoring the quality of services, it boosts community ownership, acceptance and accountability – cornerstones of effective health programmes.
During my visit to the health post in Bassona Worena, I was privileged to personally witness what the power of a partnership between a government health system and communities can achieve. With communities by their side, governments can succeed in reducing child mortality through quality and equitable health programmes, allowing children everywhere to reach their full potential. Community health programmes characterized by the full engagement and involvement of communities must become the norm across the African continent. UNICEF stands ready to assist. It is one of the most effective ways to make the right to health a reality for all children.
Geeta Rao Gupta is UNICEF‘s Deputy Executive Director for Programmes.
For the community in Lode Lemofo Kebele, Sire Woreda in the Arsi Zone of the Great Rift Valley of Ethiopia, access to water was an ongoing problem. During the annual dry seasons in this hot, low-land area, community members had to walk for hours under a blazing sun just to get water.
In January 2016, the communities of Lode Lemofo and neighbouring Chenge Kebeles have seen a marked improvement in their day-to-day lives, thanks to a water supply project that was commissioned and constructed with UNICEF support. About 6,500 people in two Kebeles, particularly the 3,250 women and girls who are usually charged with collecting water for household use, are reaping the benefits of improved access to clean and safe water, including increased school attendance among children.
Lode Lemofo community member Yesunesh, mother of 10-year-old Genet and two-year-old Samuel, says, “Fetching water used to be the most demanding task we had to endure on a daily basis. Sometimes we had to do it twice a day. It is very tiring and takes up to three hours to and from the river. At times it is also dangerous, because sometimes hyenas try to attack us or our donkeys.”
The lack of access to water also affected health centres and schools. Communities had to support the provision of water in these facilities themselves. Visiting patients and members of neighbouring households carried water to health centres while school girls and boys carried water to school on a daily basis.
All this has changed when the new water supply scheme became operational. The scheme draws its source from a 265-metre deep well and includes 16 kilometres of pipe network, 11 water distribution points and a 100,000-litre reservoir. One primary school and one health centre have also been connected to the water distribution system.
Yesunesh underscores the difference the scheme has made, saying, “All that suffering is now gone. My girl Genet – as you have seen – can get the water we need for cooking and other household use in less than ten minutes.”
Health centres can now provide better care to community members, particularly pregnant women, while boys and girls are better able to learn at school.
In total, 24 other Woredas in Oromia Regional State are benefitting from UNICEF’s water and sanitation programme. This is part of the overall progress in water and sanitation in Ethiopia, where 57 per cent of the population now relies on improved water supply sources such as water taps or hand pumps, rather than unprotected and risky sources such as rivers and streams. This increased access to clean and safe water has benefitted the children of Ethiopia tremendously, contributing to the reduction of under-five child mortality by two-thirds and the significant reduction of child stunting.
By Efa Workineh, CBNC Project Officer, Save the Children, Ethiopia; Tadesse Bekele, Regional Programme Manager, Save the Children, Ethiopia; Hailemariam Legesse, Health Specialist, UNICEF Ethiopia; Asheber Gaym, Health Specialist, UNICEF Ethiopia
Abuna Gindeberet Woreda is one of the eighteen woredas (districts) found in West Shoa Zone, Oromia Regional State, 182 km west of Addis Ababa, Ethiopia’s capital.
Baby Elias Suyum Belacho was born in Guro Furto health centre in Gartoke Kebele (sub district) of Abuna Gindeberet Woreda on September 20 2015. His mother, Shure Negasa and father, Suyum Belacho took good care of Elias, the fourth born in the family, even prior to his birth. During her pregnancy, Shure attended three Ante Natal Care (ANC) visits at the Guro Furto health centre. Unfortunately, she had not received the required post-natal visit schedule following her delivery.
When Elias was three weeks old, he attended the routine community based new-born care assessment provided as part of the community based new-born care programme of the national Health Extension Programme (HEP) package. (The HEP is a community health programme covering the whole of Ethiopia provided by two female community health workers (health extension workers) working at rural health posts, at present over 38,000 health extension workers are providing services in over 16,000 health posts across Ethiopia. The community based new-born care programme (CBNC) is one of the key public health interventions provided by HEP through extensive partner support. UNICEF is the major supporter of CBNC scale up in Ethiopia). Emushe Abebe, the health extension worker providing CBNC noted that Elias’ respiration rate was found to be 72 breaths per minutes in two counts; much higher than the upper limit of 60 expected at his age. During the assessment, Emushe asked Shure if she has noted any other symptoms that Elias has been showing recently. Shure explained that Elias had been coughing for the last two days. Thanks to her Community Based New-born Care (CBNC) training, the health extension worker correctly diagnosed Elias’ condition as new-born sepsis; a potentially lethal advanced infection in new-borns. In addition, she found out that Elias was underweight, which was caused by not enough breastfeeding. As per her CBNC training, she classified Elias’s condition to be very severe. Shure was not aware that she had to breastfeed at least eight times per day and because she did not realise that Elias was seriously sick, she never reached out for medical assistance.
After counselling by the health extension worker, Shure agreed to start the treatment at home immediately and to continue taking Elias to the health post. 48 hours after initiating the standardised (Chart Booklet) treatment with gentamicin and amoxicillin antibiotics, the HEW assessed the status of the child and found that he was rapidly improving. By now he was physically stable: he showed a lower breathing rate of 48/minute and he was breastfed more than 10 times a day. Following the seven days’ full course treatment, Elias completely recovered from his illness.
Elias’ mother Shure Negasa, who was not aware of her child being in life threatening condition, has promised to seriously take care for her new-born child and other children. From now onwards she will seek health care when ever needed and she will teach her neighbour’s what she experienced.
When Ethiopia along with 196 other countries signed the Millennium Declaration in New York in 2000, maternal and child health situation was bad for the majority of the population. Under five mortality rate – number of children dying before their fifth birthday from 1000 born alive- in 1990 (the beginning of measurements for the MDGs) was 222; one of the highest in the world. Many were sceptical that the country would achieve the targeted reduction of two thirds of the 1990 levels by 2015. Against all odds, the country has achieved child health target of the millennium development goals MDG 4 three years ahead of 2015 by reducing the 1990 child mortality rate to less than 68 child deaths per 1000 live births.
Clear health policy and strong implementation supported by coordinated international partnership; a large scale community health programme targeting rural villages through the health extension programme; sustained investments in health and sustained economic growth are among the reasons for this success story.
Highly appreciable as the improvements in child health are, an under five mortality rate of 68 translates to the unacceptable number of over 200,000 child deaths annually. More than 43 per cent of these child deaths occur during the first 28 days following child birth (the neonatal period) the majority occurring in the few days following birth. Breathing difficulties; premature birth and new-born infections/sepsis are responsible for the majority of neonatal deaths and most are preventable or easily treatable with currently available medical care. Access to health care is nevertheless essential to obtain the benefits of these lifesaving interventions. For the tens of thousands of new-borns born at home and far from health facilities, accessing these lifesaving interventions have been largely impossible.
To overcome this formidable challenge to access key new-born health interventions, Ethiopia in collaboration with its major child health partners including UNICEF has adopted novel public health interventions of ICCM/CBNC (Integrated community case management of childhood illnesses/ community based new-born care). ICCM/CBNC interventions rely on task shifting of key child health interventions responsible for majority of child deaths to community health workers who receive training on detection and treatment of key childhood illnesses at home or at village clinics (health posts). They also timely refer new-borns and older children with severe illnesses to higher level care.
The EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project, allocated Euro 42 million for a three-year support to maternal and new-born health to Ethiopia from 2014-2016. The EU is one of the major partners for the national scale up of ICCM/CBNC programme in Ethiopia. Since its inception in 2013, the ICCM/CBNC programme has rapidly scaled up to increase availability of CBNC services in 75 per cent of the total health posts in the country. Key interventions of the programme include training and mentoring of health extension workers on key skills of detections of new-borns and infants with illness through clear symptoms and signs and provision of essential interventions including provision of antibiotics to sick new-borns.
Emushe Abebe, the HEW who provided the critical intervention that saved the life of Elias is one of the 2500 health extension workers who received training through EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project support. She is saving lives of many children like Elias, and teaches mothers like Shure the importance of seeking health care.