Eritrean refugee women and their Ethiopian hosts in the Afar region of Ethiopia ensure children attend school

By Amanda Westfall

Afar region, Ethiopia-On 21 September, in Asayita Woreda, Afar Region, Ethiopia, female community leaders who missed the opportunity for education when they were young, are now ensuring their children don’t follow that same path. Through the UNICEF-introduced and UK-Aid funded Accelerated Readiness Programme, children from both refugee and host communities in Afar Region, Ethiopia are participating in the summer programme to help prepare for primary school.

Zahara Halo, 28, a mother of three from Afar Region, Ethiopia, has never been to school. She was married, had a child at 13, and spent the latter half of her childhood raising her children and performing household chores expected of Afaari women: collecting water, cooking, building huts, tending cattle, and raising children.

Rokiya Mohammed, 35, is an Afaari woman from the Afar region of Eritrea. She also has never enjoyed the benefits of education, having spent much of her life doing household chores and caring for her seven children.
Approximately 13 years ago, Rokiya fled Eritrea to Ethiopia during the war between the two countries. She arrived with other Eritreans to Asayita Woreda where she has integrated into the host Ethiopian community and has received support ever since.

Zahar and Rokiya, although from two different countries, have many things in common. Both have learned to live in harsh desert climates, both are from pastoralist cultures, and both never had the opportunity for school. However, both are determined to change that pattern for their children.

They are part of the community’s Women’s Self Help Group, where they work to change the conditions for women and children in the community. Among other group activities, such as adult literacy classes and providing loans for small business, they are the delegated community leaders who ensure their children go to school.

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Eritrean refugee girls, Aysa, Musa, and Lali, attend UNICEF’s ASR programme at Sembile Primary School along with their fellow refugee and host community classmates. © UNICEF Ethiopia/2018/Tadesse

When these women heard that the new Accelerated School Readiness (ASR) programme was coming to Afar, they were determined to help. As Zahara explains:
“As the group leader (of the Women’s Group) we have difficulties in finding group members who can read and write, and we suffer a lot from this. That is why I am inspired to put my child in school. I do not want him to suffer as I have.”

Accelerated School Readiness(ASR) 

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Eritrean Refugee and Ethiopian host community children participating in ASR at Sembile Primary School © UNICEF Ethiopia/2018/Tadesse

ASR was designed for vulnerable children who never had early learning opportunities (like private or public pre-school) but are of age to begin primary school. It was developed through proven research on the importance of play-based activities (i.e. story-telling, art activities, literacy games) to help develop early literacy and communications skills. ASR gets children excited for school, ready for school, and keeps them in school.

In Ethiopia primary school dropout rates remain unfortunately high, with the highest rates found in Grade 1 (at 18 per cent), which is strongly linked to a lack of quality pre-primary opportunities. ASR is an innovative response to this challenge. In 2015, UNICEF introduced the initiative in rural areas of Ethiopia. Because it is relatively inexpensive (approximately US$13 per child), quick (two months over the summer), and effective, it has become a popular option for disadvantaged areas.

In 2016, ASR was offered to refugees and their host communities in an integrated and equitable approach. When they heard the news that ASR would be coming to refugees and host communities in Afar Region, the Women’s Group was ready and excited to support.

ASR is only possible through female community leaders

In Asayita Woreda, children are anywhere and everywhere – in condensed urban areas and expansive rural communities. In the vast deserts of the Afar Region where the climate is harsh and transportation services are minimal, it can be a major challenge to get children to school – a feat that is only possible by the determined female leaders of the community.

In less than one week, these women helped mobilize 258 children from urban and rural areas of Asayita Woreda, an area that spans almost 1,700 square kilometers.

Zahara explains how they were able to accomplish this: “We go from door-to-door and provide school materials for low income children … thereby giving the parents incentives to send children to school.”

Another Women’s Group member, Zahara Ali adds, “I know all of the mothers. I go knock on doors and say that you better send your children to school. I check up on each of them.”

Equal opportunities for refugees and host community children

Some Eritrean refugees, like Rokiya, have integrated into the local town, but some have decided to stay in the refugee camp just a few kilometers away. When Rokiya heard that ASR is also happening in the camp she was extremely grateful. “We are so happy our brothers and sisters also get this programme. We are grateful to see our children have equal opportunities like the host communities.”

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Zahara and her six-year-old son Zuruson
© UNICEF Ethiopia/2018/Tadesse

Because of determined women like Zahara and Rokiya, positive change is possible for the next generation in Asayita Woreda. As Women’s Group member Misre Ali explains, “We are in the darkness. We never had a chance to be educated and we don’t want this for our children. We want them to know many things.”

Since the introduction of ASR in Ethiopia, UNICEF has directly supported over 45,000 children in addition to the thousands more the Government has helped through their ASR interventions. As a result, hundreds of thousands of children have enjoyed its benefits in becoming well prepared for primary school.

Baby WASH: increasing communities’ awareness through health extension workers

by Hiwot Ghiday, Selamawit Yetemegn, Anina Stauffacher

Sekota Woreda, Northern Amhara region, 5 October 2018– Nigist lives 20km north of Sekota town in the mountainous and remote northern part of Ethiopia. Together with her husband and two children she lives in a one-room rock-built house in the centre of the village. The village is surrounded by rocky crop fields, where the men plough with the help of two oxen.

In early August, during the rainy season, everything looks not lush but pleasantly green. As Nigist takes a seat on a dusty plastic chair, the neighboring children come closer sitting and standing on the gravely dirt curious to hear and see what she is about to tell.

With the youngest child safely on her back, Nigist starts talking about how she cares for him. She explains how she washes the baby’s hands and face three times per day often with soap. “I would always like to wash my baby with soap, but we sometimes find it difficult to afford soap, then I wash him with water only”, she says. “I also wash his body every other day, for my older child it is less frequent”. Nigist’s understanding of the consequences of not properly washing her children’s hands and face with soap seems limited and leads her not to prioritize buying soap rather than other items.

UNICEF in collaboration with the BBC Media Action is currently piloting an EU-funded Baby WASH project in Zequalla and Sekota Woredas, Wag Himra Zone, northern Ethiopia. The aim of the Baby WASH project is to reduce the microbial burden encountered by young children in their play and feeding environments. In addition, the project aims to reduce trachoma and other disease exposure of children and therefore help reducing child stunting [1].

In August 2018, health extension workers were trained to work with the communities to change hygiene practices improving early childhood development. The focus lies on safe disposal of child feces, handwashing with soap, face hygiene, shoe wearing, protective play areas and food hygiene.

During the training, health extension workers learnt about Baby WASH activities and how to work with the communities to effectively change behavior. Listening groups and group discussions at community level using radio recordings are part of the methods the health extension workers use to raise Baby WASH issues in their own community. Additionally, during public discussion led by the local health office, key expectations were raised and discussed.

Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF2018Stauffacher
Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF/2018/Stauffacher

Debessa is one of the two health extension workers in the kebele where Nigist lives. Debessa says: “I know about safe sanitation and hygiene practices, but these interventions focusing on babies and young children are new for me. It is very interesting and I am learning a lot during the training.” Debessa is happy about attending the training together with other colleagues from Sekota Woreda.

She and her colleague working in the same kebele agree: “we are very motivated to go back home and work with the mothers on the Baby WASH, it is exciting. For the handwashing practices specifically focusing on babies and young children, we will connect it to previous handwashing promotion activities. To encourage families to properly dispose child feces, we expect that it will need some time for the change to be effective because this is a new concept for many in the community. And potties are expensive, it isn’t a priority for the families to spend money on potties particularly at this time of the year where families invest most of their money in farming”.

The key actions promoted during the training are summarized in form of pictures with both Amharic and Hemtegna language so training material can be used at community level.

Piloting the EU-funded Baby WASH project in collaboration with the government is a promising way forward to start triggering behavioral change with a focus on pregnant women, babies and children under 3. Shifting from a “have to” approach to a stronger focus of “how to”, Baby WASH requires close integration with existing interventions on maternal, new born and child health, early childhood development and nutrition.

A paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child feces. UNICEF Ethiopia WASH has included Baby WASH into its strategy for the new country program to contribute to the improvement of early childhood development.

[1] Stunting is a sign of ‘shortness’ and develops over a long period of time. In children and adults, it is measured through the height-for-age nutritional index. In Ethiopia approximately 40 per cent of children are stunted.

First Ever Civil Registration and Vital Statistics Day Observed in Ethiopia

Addis Ababa, Ethiopia, 21st August 2018: As Ethiopia enters the third year of rolling out a comprehensive civil and vital events registration system, which includes birth registration, the government and its partners gathered on 18th August to commemorate the first ever civil registration and vital statics day.

Beyond the usual fanfare that accompanies these events, the day was an opportune moment to reflect on the progress the country has made since the comprehensive vital events registration system was launched in 2016.

In his opening remarks, the President of Ethiopia Dr. Mulatu Teshome said the vital events registration system was important as it enabled citizens to demand their constitutional rights and obtain comprehensive social and economic services. It also enabled the government to design laws, policies and strategies with concrete evidence and ensure their enforcement.

Commemorated under the theme universal, permanent and continuous civil registration and vital statistics system for good governance and better lives, the event was held to raise public awareness about the importance of registering vital life events such as births, marriages, and deaths.

“As we embark on the third year, we can see that more than 18 per cent of children under one year of age are now registered with civil authorities, up from only 3 per cent in 2016,” said UNICEF Acting Representative Shalini Bahuguna.

Birth Registration Programme in Dodota woreda/district of Arsi zone, Oromia region
“Gemechu has a birth certificate” Gemechu’s parents, Bedaso Rago and his mother Ayati Kumbi, Awash Bishola Kebele, Oromia region. ©UNICEF Ethiopia /2017/Martha Tadesse

Ethiopia did not have a comprehensive vital events and civil registration system before 2016, as a result of which only three per cent of children under the age of five had their births registered with civil authorities and two in three of these children had a birth certificate. However, following the enactment of the Council of Ministers regulation to establish the Federal Vital Events Registration Agency (FVERA) and the national identity proclamation in 2012, a system for coordinating and supporting the registration of vital events registration was launched in July 2016.

Since then, 19,351 registration offices have been established across the country out of which 17,042 are providing vital events registration and certification services. Within this period, 965,457 births, 208,637 marriages, 8,089 divorces, 178,559 deaths, and 565 adoptions have been registered.

Key supporters of this programme who have channelled their support through UNICEF include the European Union via the Netherlands embassy (€4m) and Italian Agency for Development Cooperation (€1.5m). Other partners providing their support directly to FVERA include the World Bank (USD 15 million), UNHCR (computers, printers and laptops), Economic Commission for Africa and Plan International (technical support and capacity building), World Vision (media advocacy) and UNFPA and WHO (costing of the strategic plan).

Birth registration rates can be accelerated if bottlenecks such as the requirement that both mother and father should be present at the time the birth certificate is being issued are removed and if the first copy of the certificate is issued without a fee. Despite Ethiopia’s progress in expanding the system to cover 88 per cent of the country and improving rates of registration, most of the population, particularly in socially and economically disadvantaged areas, have neither heard about vital events registration nor understood its relevance. Thus, creating more awareness about the system and generating demand for its services remains a key focus of the programme.

 

Mass distribution of mosquito nets to South Sudanese refugees in Ethiopia

By Dorosella Bishanga and Bisrat Abiy

Kule Refugee Camp, Gambella, Ethiopia, 29 May 2018: Nyaluak Kun, 24, is a refugee at Kule Refugee Camp in Gambella, western Ethiopia. Originally from South Sudan, the mother of six has just received three long-lasting insecticide treated mosquito nets for her family. She says malaria has been a threat to her health and that of her family since the rainy season started.

“I am happy to receive these mosquito nets. I hope this is the right time that we have received the mosquito nets. Several times I have been sick with malaria. There was no solution for me. I get medicine, after a few weeks, I get sick again because of mosquito bites.”

Distribution of mosquito nets - Gambella
Nyaluak Kun and her child at Kule Refugee Camp in Gambella, Ethiopia. ©UNICEF Ethiopia/2018/Dorosella Bishanga

For Nyaluak, the mosquito nets will not only keep the family safe from mosquito bites but also from other poisonous insects that enter homes during the rainy season.

Malaria is endemic to the Gambella Region and is one of the top three causes of sickness and death across all the refugee camps.  The epidemic occurs mostly from April to June and September to November every year. Mosquito nets, in-door and out-door residual spraying, and environmental management are the most recommended malaria prevention and control interventions.

The standardized expanded nutrition survey of 2017 indicates that the proportion of households with access to at least one mosquito net is below 50 per cent in all the refugee camps, except for Kule at 54 per cent and Pugnido II at 60 per cent. With inadequate mosquito nets, malaria is rampant: last year alone, 128,520 cases and 33 deaths were recorded, 25 of them children under the age of five.

Distribution of mosquito nets to vulnerable groups, such as under five and malnourished children, pregnant and lactating women, and newly arrived refugees, is ongoing in all the refugee camps of Kule, Tierkidi, Nguenyyiel, Jewi, Pugnido I, Pugnido II, and Okugo.

However, the 2018 blanket distribution, targeting 386,000 refugees, started on 29th May in Kule Refugee Camp. It was combined with general food distribution using lists obtained from UNHCR population and household databases. With the overall coordination of the Administration for Refugee and Returnee Affairs (ARRA), UNHCR and UNICEF, refugees received mosquito nets at distribution centres managed by MSF-Holland, an implementing partner. Upon presentation of a mosquito net coupon obtained at the food registration centre showing the family size, the refugees would receive a mosquito net free of charge based on the UNICEF standard of one mosquito net for every two individuals.

UNICEF monitored the distribution exercise and conducted awareness and demonstration on slinging the mosquito nets. The awareness was done by Community Outreach Agents. Special messages with visuals were developed for under five children and pregnant and lactating women. The monitoring team also conducted interviews with refugees to ascertain their knowledge levels on utilisation of mosquito nets.

Distribution of mosquito nets - Gambella
Nyaluak Kun after demonstrating how to hang the mosquito net. ©UNICEF Ethiopia/2018/Dorosella Bishanga

Nyaluak says the demonstrations were important although the refugees faced difficulties in fixing the nets because of the type of housing and beddings they had.

In all, 163,000 mosquito nets were distributed. They were procured by UNICEF with funds from the European Commission (ECHO) under a project to provide lifesaving and resilience-building health and nutrition interventions for South Sudanese refugees and host communities in Gambella.

In Ethiopia, Community-Based Approaches Help to Improve Nutrition among Women and Children

By Victor Chinyama and Tiguaded Fentahun

South Gondar Zone, Ethiopia: Enalem Asnakew (40) had no idea why her one-year-old son Misganaw Asmare would not stop vomiting. His arms, legs, and abdomen were swollen and his appetite was failing. After about a month, she had had enough and decided to bring him to the local hospital.

“He was put on blood transfusion for three days,” she says in a barely audible voice.Then, they administered [therapeutic] milk through his nostrils in addition to [intravenous] medicine. The nurses frequently visited my child and now, after nine days, the swelling has disappeared, the vomiting is almost gone, and my child takes therapeutic milk orally.”

Misganaw was diagnosed with severe acute malnutrition, a serious but entirely preventable and treatable condition which the WHO estimates accounts for 35 per cent of deaths among children under five globally. Typically, severe acute malnutrition is treated in a hospital but the advent of ready-to-use therapeutic foods has enabled children like Misganaw to be treated at home if they have no underlying medical complication requiring hospitalization.

In general, Ethiopia has made strides in reducing undernutrition in children, with stunting in particular dropping from 58 per cent in 2000 to 38 per cent in 2016. However, the number of children with severe acute malnutrition spikes up during the ‘lean’ season between June and August, the period when most households will have exhausted their food stocks as they await the next harvest beginning September. Prolonged and chronic humanitarian crises, such as droughts and floods, also contribute to increased malnutrition in children.

Inadequate food however is not the only cause of malnutrition. Multiple factors, such as the child’s size at birth and the mother’s weight, predispose a child to malnutrition. Acute illnesses and poor feeding practices are other contributing factors. The key to preventing malnutrition therefore lies in improving the nutritional status of the mother, ensuring the child has access to an improved and diverse diet, providing safe water and sanitation, improving hygiene, and building a strong and supportive system at community level.

In 2011, with a US$ 50 million grant from the Government of Canada, UNICEF embarked on a project to improve nutrition in children and women in 100 food insecure districts in the Amhara, Oromia, and SNNP regions of Ethiopia. The six-year project, later extended for another year, was to improve the use of health and nutrition services by children, adolescent girls, and breastfeeding mothers, and increase the availability of water and sanitation services. The project focused on the community level, where efforts were made to increase the scope and coverage of nutrition activities. These included multi-media campaigns, education of mothers and caregivers on nutrition, promotion of breastfeeding, and increasing production of local complementary foods. Wells were drilled to supply safe water to communities and households were encouraged to construct their own improved latrines.

To improve service delivery, 2,000 community-based health extension workers responsible for mobilizing people and agriculture development agents were trained in nutrition. Water was supplied to health posts and committees to oversee water, sanitation, and hygiene activities were established at kebele level (smallest administrative unit in Ethiopia).

Students line up to receive deworming tablets at Gurumu Koysha Primary and Secondary School in the SNNP Region of Ethiopia. Deworming of adolescents became a national programme after being introduced through the Canada-funded project.
© UNICEF Ethiopia/ 2016/ Meklit Mersha

In total, the number of community-based nutrition activities doubled and 24 per cent more households cultivated a garden (the largest increase was observed among the poorest households). Nutrition knowledge among health workers and health extension workers increased from 51 to 80 per cent while exclusive breastfeeding increased from 71 to 80 per cent. The proportion of mothers stating that water should not be given to babies under six months of age increased from 61 to 78 per cent.

The project also marked a milestone as the first ever in Ethiopia to target nutrition for adolescents (children aged between 10-18 years). Deworming of adolescents was first introduced under the project as a pilot but was subsequently scaled up to national school deworming campaigns, reaching 3.9 million school children.

These results were achieved against a backdrop of unforeseen challenges, such as the civil unrest of 2016 which limited travel and access and the El Nino drought in 2016 which shifted attention and resources.  Notwithstanding, a survey at the end of the project showed that stunting among children had declined from 40 per cent to 35 per cent and the prevalence of underweight children from 22 per cent to 17 per cent. Put differently, the odds of children in the 100 districts being stunted or underweight had been reduced by 19 per cent and 20 per cent respectively.

The education, mobilization, and support given to the 100 districts in Amhara and the other two regions will ensure that mothers like Enalem will never have to wonder again why their children are vomiting, or why their abdomen and limbs are swollen. They will also ensure that children like Misganaw can grow up healthy and strong, free from dangerous yet preventable conditions like malnutrition.

Ethiopia inaugurates model water supply and waste management project

26 May 2018, WUKRO, Tigray region – Today marks another major milestone in the Water Supply, Sanitation and Hygiene (WASH) sector in Ethiopia with the inauguration of a model water supply, sanitation and waste management system in Wukro Town, Tigray Region. Part of the One WASH Plus programme, the system integrates innovative and resilient solutions to provide WASH services to 73,000 people, including 35,000 children under the age of 15, residing in the town and its satellite villages.

Attending the inauguration were His Excellency Dr. Negash Wagasho, State Minister of Water Irrigation and Electricity, Dr Christian Rogg, Head of the UK’s Department for International Development (DFID) in Ethiopia, Ms. Gillian Mellsop, UNICEF Representative in Ethiopia, officials from the Tigray Regional Government and Wukro Town administration officials.

“Ethiopia’s rapid urbanization and population growth has resulted in increased water stress,” said Dr. Negash Wagasho. “The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of rapidly growing towns. Thus, what we are seeing today is what can be achieved when we put our concerted efforts together.”

“The UK is the largest bilateral donor in the Ethiopian WASH sector and we are proud to fund the excellent work taking place in Wukro, which is supplying vital water and sanitation services to the town and its surroundings,” said Dr Rogg. “I hope the progress in Wukro can serve as an example to be emulated on a national scale.”

UNICEF Representative Gillian Mellsop said the project was one of the greatest achievements of the One WaSH Plus programme and stands as a testament to the tremendous good that can be achieved when everyone pools their resources together towards one common purpose.

“Investments of this nature, both in Wukro and elsewhere in Ethiopia, are not just improving access to essential services but are changing entire lives,” said Dr. Samuel Godfrey, Chief of WASH at UNICEF. “Women and girls no longer have to walk long distances and spend many hours fetching water. Girls can go to school and attend to their schoolwork while mothers have enough time to spend with their children and engage in other productive activities. For communities, a safe and clean environment means fewer disease outbreaks.”

The Wukro project involved expanding the capacity of the town’s existing system to supply water to the town and five satellite villages, integrating it with a “full chain” system for managing liquid sludge and waste (from containment to recycling), improving water and sanitation in institutions such as schools and health facilities, and establishing a business model for managing the facility comprising the local administration and private operators. The low-cost technology deployed in treating domestic liquid waste in selected social housing developments in the town was sourced through a partnership with the Government of Brazil.

The One WASH Plus programme, fully funded by DFID, is implemented by UNICEF in collaboration with the Ministry of Water, Irrigation and Electricity, regional sector bureaus, and the Water Resource Development Fund. The programme also works with the Ministry of Health, the Ministry of Urban Development and Construction, and respective Sector Regional Bureaus, as well as town administrations and town water supply and sewerage utilities.

The programme, which began in 2013, will benefit 250,000 people in eight small towns and surrounding rural villages in Amhara, Oromia, Somali and Tigray regions with a total investment of some US $36 million by targeting communities living in towns and in peri-urban areas. Models such as the one in Wukro, some large and others medium sized, are now a key component of the One WaSH programme across more than 1,000 towns in the four regions in Ethiopia.

Ethiopia’s rapid urbanization and urban development has resulted in increased water stress and high potential for disease outbreaks. The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of the rapidly growing towns to meet the targets set in the SDGs.

Sweden contributes US$ 3 million to UNICEF’s 2018 humanitarian appeal for children in Ethiopia

30 April 2018, Addis Ababa: The Government of Sweden has provided US$3 million to UNICEF Ethiopia’s 2018 Humanitarian Action for Children. The funds will be used to meet the needs of internally displaced populations in the Oromia and Somali regions of Ethiopia.

“We are grateful to the Government of Sweden for this contribution, which confirms Sweden’s continued commitment to supporting populations affected by humanitarian emergencies,” said UNICEF Representative Gillian Mellsop. “This is the first such significant contribution to our funding appeal in 2018. It will enable us to alleviate the hardships currently faced by populations living in IDP sites where access to basic services remains low and where conditions, especially for children, are simply unbearable.”

Current estimates place the number of persons internally displaced by climatic and conflict factors at around 1.7 million. The displaced are settled in 916 sites across the country.

The contribution from Sweden will enable UNICEF to provide critical and much-needed water and sanitation, nutrition, and health services to displaced populations in the two regions. Other services will include education and child protection.

Specifically, Sweden’s support will go towards:

  • Trucking of water to IDP sites and construction or expansion of water supply systems;
  • Diarrhoea treatment, vaccination of children against measles, and distribution of mosquito nets;
  • Treatment of children with acute malnutrition and provision of high protein biscuits to prevent malnutrition in children and pregnant and lactating women;
  • Provision of emergency education, including early childhood development;
  • Reunification of separated and unaccompanied children with their families and preventing and mitigating risks faced by children, especially girls.

While the Government continues to prioritize the return and resettlement of the IDPs, thousands of displaced people are still in need of urgent life-saving assistance. UNICEF’s US$ 112 million humanitarian appeal for children targets 3.1 million people with support, out of which 1.5 million are children. Presently, the appeal has a shortfall of US$ 86 million, with nutrition, health, and education having the most significant gaps.