UNDSG’s – Jan Eliasson Calls for Action on sanitation at Ethiopian school

By Sacha Westerbeek

SEBETA DISTRICT, 1 February 2014 –  “Wash your hands before you eat; wash your hands after visiting the toilet; wash your body… clean your environment ….” The song in the Oromiffa language continues with further messages on hygiene.

When the UN Deputy Secretary-General, Mr Jan Eliasson walks toward the latrines at DimaPrimary School in Sebeta, Oromia Region, he is welcomed by students from the Hygiene and Sanitation club, singing proudly about personal and environmental hygiene.

Hayat Hachallu, is 13 years old and a member of the Dima Primary school Hygiene and Sanitation Club. This 7th grader is certainly not shy. She takes the DSG by the hand and shows him the school latrine, hand washing facilities and the water point.

“Here are the latrines for girls,” she explains to the special visitor, while opening the door carefully. “For us, girls, it is very important to have private facilities. A place where we feel safe and have the privacy we need. The toilets here are not great: they are too dark, the doors don’t close very well and it really smells badly,” she says. “Now, let me show you our newly built latrines,” and she pulls Mr. Eliasson away from the rickety iron sheet structure toward a stone construction.

Hayat Machala, 13, a member of Hygiene Club, explains the role of the club and one of the latrines to DSG Jan Eliasson
Hayat Machala, 13, a member of Hygiene Club, explains the role of the club and show one of latrines in school to Jan Eliasson, Deputy Secretary-General of the United Nations, at Dima Guranda Primary School in Sebeta District in Oromia Region of Ethiopia ©UNICEF Ethiopia/2014/Ose

There are 30,634 primary schools in Ethiopia[1], of which 5,000 are directly supported by UNICEF.  Primary schools are encouraged to address key Water, Sanitation and Hygiene (WASH) issues such as installation of water supply, construction of gender-segregated toilets and hand-washing facilities.  Hayat and the other girls are benefiting from UNICEF funding for the newly built girls latrine.

“Look Mister look”, Hayat points proudly. “Look, here are our new toilets. They are much better don’t you think,” she asks cheekily.  Hayat clarifies that the school Hygiene and Sanitation activities are managed by the Environmental Protection and Sanitation Club which is composed of 105 students of which 57 are girls and 5 are teachers.

Mr Mesfin Tessema, the school director further elaborates: “The sanitation club is established to engage children in various hygiene and sanitation activities as part of learning and behavioural change.”

When Mr Jan Eliasson asks about the clubs activities, Hayat goes into detail: We are involved in the clearing and cleaning of the school compound; cleaning of the latrines; we encourage students to wash their hands after they use latrines; we conduct environmental sanitation campaigns in the school and within the community; and we have established relationships with the nearby Health Post for the promotion of hygiene activities. And we are also involved with the beautification and environmental protection of the school compound with tree planting.”

Children are agents of change

Hayat Machala, 13, a member of Hygiene Club, shows a newly built toilet for girls to DSG Jan Eliasson
Hayat Machala, 13, a member of Hygiene Club, shows a newly built toilet for girls to Jan Eliasson, Deputy Secretary- General of the United Nations, at Dima Guranda Primary School in Sebeta District in Oromia Region of Ethiopia. ©UNICEF Ethiopia/2014/Ose

By focusing on school aged children and providing them with the necessary tools and knowledge to change behaviours at school and home, children play a crucial role in sharing information and knowledge with their parents and family members to achieve better health, environmental, sanitation and hygiene practices.

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 for sanitation.

Since 1990, the country has made substantial progress in improving access to water supply and sanitation coverage. However, millions of people still remain without access to safe water and sanitation services. 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.[2] 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.

Although good progress is underway, still some challenges remain. Nationally, only around 31 per cent of school have water supply facilities in their premises and 33 per cent have improved latrine facilities. On average, the toilet/student ratio is 1:120.[3] In Oromia Region, where the Dima Primary School is situated, only 52 per cent of its total population has access to safe drinking water and the sanitation and hygiene coverage is also 52 per cent.[4]

It is up to ALL of us

The Deputy Secretary-General talks with the school children to hear about their experiences. While they explain the importance of the school club in educating the community on hygiene practices, and the challenges they are facing, the DSG appeals to each and every one of them. “It is up to ALL of us,” he underlines while speaking to the students and the bystanders. With passion and conviction he adds: “Nobody can do everything, but everybody can do something”.

Hayat and her peers nod in agreement. Although they had never previously heard of the DSG’s Call to Action on Sanitation, they know the importance of sanitation. They know their individual and club efforts will bring change. They know its up to them to make their school and community a better place. In the end, this is also their call to action. 


[3] Source: WASH Inventory 2012

[4] Source: WASH Inventory 2011

Sudan and its partners learn how Ethiopia brings nutrition and health to doorstep of its people

By Sylvie Chamois

Team of visitors from Sudan getting a briefing on the Health & Nutrition programme
Salwa Abdelrahim Surkati Hassan, FMOH nutrition director, Nada Yahya Omer Hamza, WHO IMCI coordinator and Naglaa Osman Khidir Babikir, UNICEF nutrition officer visiting Tula health post in Babile woreda, East Hararghe zone of Oromia region ©UNICEF Ethiopia/2014/Gemeda

From the 24th to the 28th of March 2014, the Ethiopian Federal Ministry of Health (FMOH) and UNICEF Country Office had the pleasure to host a team from Khartoum composed of the Sudanese FMOH (planning, nutrition and IMCI[1] departments), WHO, WFP and UNICEF.

The objective of the visit was to learn how Nutrition has been integrated in the Health system and how the Government of Ethiopia managed to bring Health & Nutrition services to the doorstep of its people.

Following an opening meeting with the State Minister of Health, H. E. Dr Kedede Worku, the team proceeded directly to the domestic airport heading to East Hararghe zone of Oromia region. They were introduced to the programme by the Zonal Health Department’s head, Ato Ali Abdulai, before visiting Babile and Gursum woredas.

In the two districts, they were able to visit and discuss with the one-to-five network, a team of Health Development Women; female Health Extension Workers working in health posts; Health Workers in health centres and finally, nurses and doctors in Bessidimo hospital.

Team of visitors from Sudan getting a briefing on the Health & Nutrition programme
Team of visitors from Sudan getting a briefing on the Health & Nutrition programme in Babile health centre, Babile woreda, East Hararghe zone of Oromia region on March 25, 2014
©UNICEF Ethiopia/2014/Gemeda

In Harare, Frehiwot Mesfin presented a project managed by Haromaya University, with the support of UNICEF and FAO, to produce complementary food for children under two years of age using exclusively locally available ingredients.

Back in Addis Ababa, the team had the opportunity to visit the local producing factory for Ready-to-Use Therapeutic Food[2], Hilina PLC.

On the last day, during the debriefing meeting at the FMOH with Ato Birara Melese, head of the Nutrition unit, the visitors appreciated having been able to see all levels of the Health system, from the Federal Ministry down to the households with the one-to-five network. They said that they were impressed by the very well organised and functional system and confident that they can adapt the Ethiopian experience to integrate child and maternal Health & Nutrition to the lowest level. Sudan is working hard to accelerate the achievement of the Millennium Development Goal 4 – to halve child mortality by 2015.

UNDSG Jan Eliasson washes hands with ashes in Ethiopia

By Sacha Westerbeek

DSG Jan Eliasson wash his hands with ash with the help of Lemma Buchule
Jan Eliasson, UN Deputy Secretary-General, washes his hands with ash with the help of Lemma Buchule at her home in Sebeta District in Oromia Region of Ethiopia,. ©UNICEF Ethioia/2014/Ose

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.

DSG visit to Ethiopia
Jan Eliasson, Deputy Secretary General of the United Nations, discusses the importance of hygiene to Lemma Buchule, right, and Abebech Desalegn, Health Extension Worker, at Buchule’s home in Sebeta District in Oromia Region of Ethiopia, 1 February, 2014. © UNICEF Ethiopia/2014/Ose

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[1] 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 Desalegn, Health Extension Worker explaining her role in the community to  DSG Jan Eliasson
Abebech Desalegn, Health Extension Worker, explains her role in the community to Jan Eliasson, UN Deputy Secretary-General at Haro Jila Folaso Health Post in Sebeta District in Oromia Region of Ethiopia, ©UNICEF Ethioia/2014/Ose

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[2]. 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.”

In South Omo, Education- a gateway for children but a competition for parents

By Zerihun Sewunet

Students attend class at Alkatekach primary school

DAASANACH, Southern Nations, Nationalities, and People’s Region (SNNPR), 18 December 2013 – Omorate village in South Omo Zone of the SNNPR is a semi-arid area where the Daasanach tribes live. Their houses are dome-shaped made from a frame of branches, covered with hides and patch works. These houses are scattered along the site where the Omo River delta enters Lake Turkana of Kenya. Most tribes in South Omo are pastoralists. In Omorate too, the people’s lives are bound to the fate of their herds of cattle, sheep and goats that they raise.

Children play a critical role in the pastoralist lifestyle. Boys as young as 6 years old start to herd their family’s sheep and goats, while girls marry very young so parents get additional livestock through dowry. Therefore, parents do not send their children to school. In the Daasanach tribe, education is considered as a luxury. For teachers of Alkatekach Primary School this is their biggest challenge. They use the Alternative Basic Education (ABE) system to cater for the need of the children. The Alternative Basic Education system responds to the urgent need for an education that suits the special needs and constraints of pastoral life. It provides flexible school hours, allowing pastoral children fulfil their household responsibilities of herding cattle to find water and pastures while still finding time for school.

Meseret Chanyalew, Director of the school, explains there is an increase in the number of children from last year because of the continuous effort to enroll and retain students. “We enroll students throughout the year to encourage children to come to school. We also discuss with the community to create awareness on education by going house to house to convince parents to send their children to school.”

Located five kilometers from Omorate town of Kuraz district, the Alkatekach Primary school has only 79 registered students for the 2013/2014 academic year and the highest grade these students can reach is fourth grade. This is because there are no classes set up above the fourth grade.

The Lucky ones in the family go to school

Temesgen Qoshme, 14,  attends a class in Alkatekach primary school14 years old Temesegen Koshme is a third grade student in Alkatekach Primary School. He is sitting in a class exercising the conversion formula for different measurements. His favorite subjects are mathematics and social science. Unlike Temesgen, children his age are taking care of family cattle or are married off. “I prefer coming to school than looking after my parents’ cattle. Alkatekach is where I grasp knowledge,” says Temesgen, “When I go to school in the morning my brother and sister look after the cattle. After school, I go straight to the field to take over”.

Temesgen’s parents told him that his younger sister is waiting to be married off, “I tried to explain that she has to come to school, but they did not listen to me” says Temesgen concerned about his sister’s future. Temesgen is one of the lucky ones to be enrolled this year. For him school is his happiest place.

Agure Amite, a father of twelve, living in Omorate village, sends two of his children to Alkatekach Primary School. When asked why the others do not go to school he says, “Some of them have to look after my cattle and others are not ready for school because they are below 10 years old.” Some parents in the Daasanach tribe send their children to school when they reach age 10. However, nationally children start school at age 7.

Alternative Basic Education (ABE) accommodates the pastoral children

Children, not students, play at Alkatekach Primary SchoolThe 2012 study on situation of out of school children in Ethiopia shows that SNNPR has 46.5% of out of school children making it the third highest region after Oromia (49.2%) and Amhara (48.7%).

With the support of UNICEF and the generous donation of US$240, 000 received from ING the Daasanach tribe now has ABE centers close to in their area. In addition to the construction of ABE centers, ING’s support also helped to provide furniture, training for ABE facilitators and education materials to pastoralist and economically disadvantaged children. For Meseret and her colleagues at the Alkatekach Primary School, this means increasing the schools capacity up to sixth grade means that children like Temesgen will be able to receive education within their community for the next two years.

In Ethiopia, DFATD support improves community based child and maternal care

By Frehiwot Yilma

Paul Rochon thanks Misa Wondimagen, 25, Health Extension WorkerDERA DISTRICT: AMHARA REGION, 30 October, 2013 – It is early Thursday morning and Gibtsawit Health Post, found in a rural village of Gibtsawit Mariam located 42 kilometres from Bahirdar, is busy with patients. The small room is crowded with mothers who are there to check their babies’ growth; pregnant women having their antenatal care and men and women of the community who are receiving malaria treatment.  Today is a special day, because the health extension workers of the health post are welcoming Mr Paul Rochon, Deputy Minister of International Development, Foreign Affairs, Trade and Development Canada (DFATD) and Dr Peter Salama, UNICEF Representative to Ethiopia.

Misa Wondimagegn, a 25 year old health extension worker, supports the community in Gibtsawit village of Dera district with curative and preventative health and nutrition services.  Misa and her colleagues Meseret and Hagere are supported by the health development army (a network of one volunteer to five Households) attend the 13,366 population of the kebele.

Misa has been working at Gibtsawit Health Post for seven years. “It was just when I finished tenth grade that I had the opportunity to join the training for health extension workers. It was hard convincing people to allow me to monitor the growth of their baby and take my advice about what to feed their children,” she says.  “We travelled long distances to reach as many households in the village as possible.  In each of our visit we tried to improve the health seeking behaviour of the community and eventually encouraged them to go to the health post.”

Growth Monitoring and Promotion is the cornerstone in the Community Based Nutrition Programme.  It creates a platform for the health extension workers to contact the caregivers and check the nutritional status of children, detect growth faltering at early stage and provide counselling on Infant and Young Child Feeding practices (IYCF).

“Now, the situation has changed a lot: we have mothers who bring their children for check-up and pregnant women who come for antenatal care. The support we get from UNICEF and the Canadian Government has increased the variety of treatments we provide for the community. We have outpatient treatment for children diagnosed with severe acute malnutrition and for pregnant women we give antenatal care and supply iron –folate. We promote good Hygiene and sanitation and we also give treatment for common childhood illnesses like pneumonia malaria and diarrhoea for the community,” Misa explains with smile on her face.

Support in Action

Haimanot Andarge, 20, and her daughter Azeb Abraru, 23 month, relax at home in Dera Woreda in Amhara region of Ethiopia

Since 2007, the Canadian Government has been supporting UNICEF Ethiopia’s interventions in Child Survival with Vitamin A and Zinc Supplementation and Integrated Health System Strengthening as well as routine immunization. Dera is one of the 100 UNICEF supported districts implementing the preventive and curative nutrition interventions. It is implementing Community Based Nutrition (CBN), integrated with other Community Maternal New-born and Child Health Interventions (CMNCH) to prevent child malnutrition, focusing on the first 1000 days: the time between conception and when a child turns two years of age.

In August 2013, 1,247 children attended the monthly Growth Monitoring and Promotion session in Dera enabling Misa and the other 78 health extension workers in the district to identify nutritional status of the children, detect early growth faltering, help the caregivers visualize the status and counsel them on appropriate age specific feeding messages using the Family Health Card as a counselling aid and refer children for further care in a timely manner whenever needed.

Haimanot Andarge, a 20 year old mother of baby girl Azeb, is one of the many mothers in the district who got follow ups from Misa and her colleagues during their pregnancy. “Misa used to come to my house regularly ever since she knew I was pregnant. She gave me vaccines and other supplements which was important for my baby. And when my labour began my husband took me to the health post. Misa encouraged me to deliver at Hamusit Health Centre which referred me to Bahirdar Hospital in time as my delivery was complicated. My baby was delivered safely because the health post was in our village to identify my condition,” Haimanot remembered. Her eyes reflect her fear of what might have happened. “ Azeb, is going to be two this year and  Misa still follows up on her  regularly and gives me advice on what to feed her,” adds Haimanot.

Integrating approaches to combat malnutrition

Holding Plumpy'Nut produced in Ethiopia, Misa Wondimagen, 25, Health Extension WorkerOne of the challenges to the health extension workers was what kind of advice to give to families with low income, regarding additional food for their children. “Health Extension Workers usually explain to families to use variety of cereals, animal protein and vegetables. Those who have money would buy and others barter with what they have produced,” explains Ato Worku Endale, Head of the Dera District Health Office. “Recently we have been integrating the health extension programme with the agriculture extension programme to support farmers on what to produce and how they can support their children and family with variety of food items. In addition, the safety net programme that has been implemented in this particular community allows families with low income to be involved in the income generating activities.”

With the integrated multisectoral approach of the government of Ethiopia and the support of UNICEF and partners such as DFATD, the hard work of health extension workers like Misa and colleagues is paying off.

Revolutionizing treatment of Severe Acute Malnutrition (SAM)

The support from UNICEF and the Canada Government that started the preventive nutrition programme of Community Based Nutrition linked with provision of WASH facilities has helped reduce the number of children who are malnourished.  According to Dr. Peter Salama, the collaborative work of all stake holders, the availability of treating health posts within the community have made saving a child easier than ever before.

At the end of the visit the team eagerly waits to hear from Misa and her colleagues on their response to the fundamental question of how many children were lost to malnutrition recently.  “There were 27 children diagnosed with Severe Acute malnutrition in July 2012- August 2013. They were treated with the Out-patient Therapeutic Programme (OTP) and 20 have been cured and seven are still on follow up with good prognosis but we have not lost a single child,” Misa explained boastfully.
Group Photo: Joint visit of UNICEF and DFTAD

“It was not easy to change the attitude of the community. When we started, there was no one before us working with the community reaching every  household door to door. We started from nothing. But with the support of donors like  UNICEF and the Canadian Government, I cannot even remember the last time a child died in the community for the last four years,” Misa reminisces.

“It makes me realise that it was not for nothing that I worked so hard at the beginning. I have brought change in my community.” Misa concludes.