24 October 2017, Addis Ababa: Today, as the world commemorates World Polio Day, we, the World Health Organization (WHO), UNICEF and Rotary International, reaffirm our commitment to building on the success of our joint polio eradication efforts and sustaining the polio free status of the country.
Today, we are looking back at nearly three decades of concerted global polio eradication efforts. The Global Polio Eradication Initiative was created in 1988 after the World Health Assembly resolved to eradicate poliomyelitis globally and has since made remarkable progress towards reaching the eradication target. As a result, polio cases globally decreased by over 99 per cent from an estimated 350,000 cases in 1988, to only 37 reported cases in 2016. Furthermore, the number of countries with polio endemic decreased from 125 to only three countries – Afghanistan, Nigeria and Pakistan. However, until the polio virus transmission is interrupted in these polio endemic countries, all countries remain at risk of polio importation.
Ethiopia maintained its polio-free status for almost four years (45 months) after the last wild polio case was reported in Somali region in January 2014. We recognize that this achievement is a result of the effective leadership of the Federal Ministry of Health and the great partnership of polio eradication initiative collaborators, donors and partners including:Rotary International; Bill and Melinda Gates Foundation; WHO; UNICEF; USAID; CDC; CORE Group; and many frontline health workers who have played a key role in the successful fight against polio.
We are committed to building on the recommendations which Ethiopia received from the Africa Regional Certification Commission (ARCC) in June 2017 when Ethiopia’s submission of a national polio free status report was accepted. As such, we will strive to strengthen and maintain routine immunization and surveillance with a particular focus on pastoralist communities, refugees, hard to reach and border areas as well as strengthening outbreak preparedness and coordination, cross-border surveillance with Somalia and others.
The theme for this year’s World Polio Day in Ethiopia is “Commending Ethiopia polio free status, sustaining the gain.” While we celebrate Ethiopia’s polio eradication success, we remain committed to continuing our joint polio eradication efforts in order to sustain this incredible achievement. In particular, we will build on the lessons learned as we strive to achieve regional certification.
The Polio Eradication and End Game Strategic Plan, developed by the Global Polio Eradication Initiative, envisages a polio free world by 2018. While we have come very close to achieving this goal, much remains to be done. We would like to call on all stakeholders to renew their commitment to a world which is free of polio.
What: The Ministry of Health will officially announce that Ethiopia will be hosting Acting on the Call conference of Ministers and high-level policy makers on maternal and child survival
When: Friday 18 August 2017, from 2:00 P.M – 3:30 P.M
Where: Ministry of Health, Addis Ababa Ethiopia
· H.E Prof. Yifru Berhan, Minister of Health, Federal Democratic Republic of Ethiopia
· Dr Ephrem Tekle, Director, Maternal Child Health and Nutrition Directorate, Minister of Health, Federal Democratic Republic of Ethiopia
Hosted by the governments of Ethiopia and India, 2017 Acting on the Call conference will gather around 500 participants across the world, including Ministers and high-level policy makers from both the public and private sectors from 24 countries. The organization of this conference has been supported by many partner organizations such as USAID, UNICEF, the Bill & Melinda Gates Foundation, NGOs as well as private sector actors. This conference has these objectives:
· Highlight successful approaches to increase the use of high-impact reproductive, maternal, newborn, child and adolescent health interventions (RMNCAH) with equity, quality and sustainability.
· Increase commitment from countries, private sector and NGOs to strengthen the system required to overcome the remaining key obstacles for maternal and child survival both within and outside the health sector.
· Demonstrate global commitment and continued the momentum to move forward towards the goal of ending preventable child and maternal deaths.
AYSAITA, AFAR, 18 May 2017 –Even with her sun-stricken skin and tired eyes, one can feel the vibrancy and strong personality of Zahara Ali. Zahara is a volunteer social worker who dedicates herself to helping her community without any compensation. With some broken Amharic mixed with a translated Afari language and a smile on her face, she starts to explain how she ended up serving her community.
“My first daughter was lucky not to get mutilated,” explains Zahara, “I was sensitized about FGM/C at that time.” However, her second daughter was cut. “I was heavily pressured by family and neighbours.”
Zahara allowed the traditional cut to be done on her daughter at seven days old, not knowing that it would end up being the most ‘incorrect and terrible procedure’. Facing complications and enduring pain, her daughter had to be brought to Aysaita Primary Hospital for corrective surgery.
After that experience, Zahara became much stronger and committed to teach others about the harm of FGM/C. When a community FGM/C sensitization programme was started in her town, some volunteers were deterred due to the lack of compensation, but for Zahara, that did not matter. “After going through the pain with my second daughter, I decided to work as the hospital’s social worker. I am convinced that I have to help mothers with FGM/C complications and make a difference in people lives,” says Zahara.
“The hospital contacts Zahara to sensitize the community,” says Dr. Hatesy Abraha, the gynaecologist at Aysaita Primary Hospital who has been hired through UNICEF’s FGM/C programme. He adds, “It is sort of demand and supply. The hospital provides treatment while utilizing people like Zahara to sensitize and convince mothers. Otherwise, it is not common for mothers in the Afar region to go to the hospital.”
Zahara was trained on FGM/C by the community sensitization programme, which was launched by UNICEF and the Regional Health Bureau. She then goes into her community with volunteers like her to teach about the symptoms of FGM/C complications. That is when women with FGM/C complications and other gynaecological needs seek treatment from the hospital. Zahara brings in mothers who have medical cases such as fistula or urinary complications. She advices pregnant women to have antenatal care and institutional delivery.
While visiting the hospital with Dr. Hatesy, we met patients who had undergone such corrective procedures. One patient was Ebo Ahmed, a 60-year-old who has had many complications due to the type III FGM/C that was performed on her years earlier. Ebo has been stitched after every birth of her five children. Now, she has had vaginal prolapse, a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel or the vagina itself begin to fall out of their normal positions. In addition to repairing the prolapse, the medical team removed her uterus as well, all done in effort to ease complications from her FGM/C.
Ebo says, “I used to visit the hospital frequently as I was in severe and constant pain.” This constant pain was due to repeated urinary tract infections and other complications she had due to the FGM/C. Ebo is determined to advocate and teach her community by sharing her experience. “I will advise, if they give me their ears,” she declares. As she prepares for discharge, she expresses her gratitude for the medical procedure, which was nearly free of charge thanks to UNICEF and partners.
Aysaita Primary Hospital is one of the hospitals in Afar region that was upgraded from a health centre in 2014, providing services for a majority pastoralist population of approximately 100,000. Through UNICEF support, the hospital employed a gynaecologist in May 2016. Following his assignment, the hospital started providing inpatient and outpatient management for FGM/C complications and different gynaecologic and obstetric cases.
The hospital has five trained health providers on clinical management of FGM/C victims and has two admission wards with a total of 10 beds. In 2017, they treated 292 cases, up from zero in 2016. With efforts from community members such as Zahara and Ebo and treatment from medical staff such as Dr. Hatesy, the goal is that one day again, the cases will be at zero – this time as a sign of tremendous progress towards eradicating the FGM/C practice.
Erbeti, Sfar, 17 May 2017 – Muna*, like many other girls in Afar region, was subject to type III female genital mutilation and cutting (FGM/C), a removal of the clitoris and the labia minora as well as infibulation: the narrowing of the vaginal opening through the creation of a covering seal. In her first few days of life, she was irreversibly changed; the fate of 98 per cent of females in Afar according to the 2016 Demographic Health Survey.
Years later she began experiencing unending pain. “It is just not how I expected my life would be,” Muna explained. It began at the age of 13 when she had her first period, which quickly became her monthly nightmare. In fact, it was only the beginning of a brutal reality.
At the age of 15, Muna entered into an arranged marriage. Sexual intercourse is another painful experience. “I have never enjoyed sexual intercourse with my husband,” said Muna.
She soon became pregnant. Going to a health facility to give birth is considered taboo in her community; a woman showing her private parts to a man is ‘unacceptable’. Rather, women are to give birth at home. It was no different for Muna.
“I had a really horrible labour and birth experience; I was bleeding and was in dire pain. I felt I was dying,” Muna said. “I truly believe I would have died I had not been taken to the hospital,” she added. Health extension workers in the community came to her house and took her by ambulance to the hospital.
She recovered in the hospital, but that was not the end to her agony. Infections and bleeding continued for weeks. All this led Muna to make up her mind that she would never let her new born daughter go through life like her.
As accustomed in her community, when her daughter was less than one month old, her family started planning for her FGM/C. Muna strongly refused: “I do not want her to go through the same pain. My husband almost made me leave the house, but I was persistent,” said Muna.
Community efforts supported Muna’s tough decision. The Government of Ethiopia, together with UNICEF, implements a multi-sector FGM/C eradication programme, with prevention, protection and care components each respectively managed by the Bureau of Women and Children’s Affairs, the Bureau of Justice and the Regional Health Bureau. Communication committees are one of the interventions, comprised of local religious leaders, clan leaders, health extension workers and police officers. Each fully integrated into their communities, they keep alert for three types of situations: child marriage, instances of FGM/C or a woman whose husband is refusing her to give birth in a health facility. They are reported to the appropriate sector office for further action. The committee also organizes training, supported by UNICEF and the Bureau of Justice, for community members on harmful traditional practices, with an emphasis on FGM/C.
Asrat, a communication committee volunteer, is also a teacher who is passionate about improving the lives of girls and women. “If I were to work in a modern community, I would not be satisfied. Helping to rescue young girls [from FGM/C] is fulfilling,” she says with tears in her eyes, “This issue is often a matter of life and death for them.”
Muna is happy that she saved her daughter from FGM/C and grateful for the education her community is receiving through the FGM/C programme. “Because of the awareness and training, my husband accepted my decision. Otherwise, it would have been impossible,” she said.
Enhancing knowledge to bringing social norm change
Sheikh Mohammed Dersa, the president of the Afar Region Islamic Supreme Council, started to combat FGM/C 25 years ago. He believes that FGM/C is a harmful practice that risks the life of young girls and has no basis in Islamic law but rather is Pharaonic. “When it comes to protection of girls from harmful tradition practices such as FGM/C, our challenge is lack of knowledge,” Sheikh Mohammed said.
Years ago, Sheik Mohammed and other religious and clan leaders who were against FGM/C, were highly resisted by the community and some religious leaders; it was unimaginable to stop the practice. Hence, they started advising people who practice type III FGM/C to reduce the practice to type I, as type I is considered the less painful than the other FGM/C practices (where a girl’s clitoris is ‘only’ cut or removed). The FGM/C practice used to be celebrated with a feast, but nowadays it is done behind curtains, an indication of the progress made.
Through partner collaboration, UNICEF is sensitizing the community gate keepers such as religious and clan leaders to support the effort; engaging the community through regular community dialogue, involvement of adolescent girls in the change process and implementing various sensitization events. Thus, it is believed a critical mass across the community is being built to support the change of social norms and end the practice.
Another facet of eradicating FGM/C is the strengthening and enforcement of legal frameworks, as the Ethiopian Government has passed laws to deter the practice. To this end, consultations to endorse the draft family law, enhancing legal literacy of the community, building the capacity of law enforcement bodies and the establishment and strengthening of community surveillance mechanisms are among the key interventions.
Ending a practice which has been long engrained in a community cannot be done with a single, short-term intervention. With the support of international donors, UNICEF is undertaking this extensive, multisector approach alongside the Government of Ethiopia to ensure that progress continues until no girl and no women are subject to the brutal reality of FGM/C.
ADDIS ABABA, 30 June 2017- UNICEF Ethiopia signed the Ethiopian Fiscal Year 2010 annual work plans with the Federal and Regional Government under the umbrella of the United Nations Development Assistance Framework (UNDAF 2016-2020). The signing ceremony, held at the Ethiopian Ministry of Finance and Economic Commission’s office, was attended by Heads of United Nations agencies including UNDP, UNFPA and UNICEF and the implementing Federal and Regional Government offices as signatories of the annual work plans.
Mr Admasu Nebebe, State Minister for Ministry of Finance and Economic Cooperation, speaking after signing the work plans, said “Implementation of the signed work plans will contribute to the achievement of Ethiopia’s current Growth and Transformation Plan [GTP II]. The results and activities are linked to the Government’s priorities at all levels.” UNICEF Representative to Ethiopia, Officer-in-Charge, Ms. Shalini Bahuguna, applauded the Government of Ethiopia’s leadership in implementing the annual work plans, saying “A recent review conducted by UNICEF’s global team has identified the annual work planning process of Ethiopia as a model for other country offices, demonstrating principle of alignment with government policy and ownership by stakeholders.”
The work plans were prepared under the logic that the accomplishment of activities will contribute to the achievement of UNICEF’s and UNDAF’s intermediate and higher level results, which are in support of GTP II. A consultative process was followed during the preparation of the work plans at the Regional and Federal level. This year, UNICEF Ethiopia signed 143 work plans with more than 140 Regional and Federal Government implementing partners. The work plans cover fifteen programme areas including:
Early Warning and Disaster Preparedness
Sanitation and Hygiene
Child Friendly Social Welfare
Adolescents and HIV/AIDS
Violence against Children
Ending Child Marriage and FGM
Justice for Children
Public Finance for Children
Evidence and Coordination
The total budget equals US$ 74,867,075. Implementation of the work plans will start on the 1st of July 2017 and will close on the 30th of June 2018, following the Ethiopian Fiscal Year.
Addis Ababa, 30 June 2017: “Maternal and Neonatal Tetanus Elimination in Ethiopia is hereby validated!” That was the conclusion of the joint mission from UNICEF and WHO today at its debriefing sessions with: the Ethiopian Ministry of Health; the WHO Representative to Ethiopia; and the UNICEF Representative to Ethiopia. The Federal Democratic Republic of Ethiopia has thus become 42nd country in the world to have validated the elimination of Maternal and Neonatal tetanus.
Ethiopia began accelerated Maternal and Neonatal Tetanus Elimination (MNTE) efforts in 1999. In 2011, all the regions in the country except the Somali Region were validated for MNTE. The 2011 validation mission made recommendations that would see the Somali Region progress to MNTE over time. The recommendations were implemented especially corrective vaccination campaigns against tetanus in 2016. The administrative, as well as post-campaign survey data, revealed more than 85% coverage in each of the 9 zones of Ethiopia Somali Region. The Joint validation mission reviewed these and other related data during the period, 28-30 June 2017, and concluded that maternal and neonatal tetanus elimination had been achieved in the Somali Region and, by extension, in the whole of Ethiopia.
Receiving the good news of the validation of MNTE in Ethiopia, the State Minister of Health, His Excellency Dr. Kebede Worku exclaimed that “The country had worked hard on improving Maternal and Child Health services delivery with tangible results including the record attainment of MDG 4 three years ahead of the target year of 2015. Along with this, MNTE was given emphasis and hence between 1999 and 2009, over 15 million women of reproductive age (WRA) in 59 high-risk zones were immunized during three rounds of Tetanus Toxoid (TT) Supplementary Immunization Activities (SIA). Thus in April 2011, the validation survey concluded that the whole country except Somali region had been validated for MNTE, and now the whole country including Somali region has achieved MNT elimination. This was possible through the efforts and investments made to improve maternal and child health care. The ministry of health will continue to sustain this gain by integrating maternal and child health care services with other public health priorities”.
WHO Representative, Dr. Akpaka A. Kalu, congratulated the country and said that “WHO is grateful for this remarkable result. He added that WHO will continue to support the Ministry to sustain this achievement by prioritizing risk areas for public health interventions that need more support and interventions through specifically targeted strategies with active community involvement to achieve the desired results.” Dr. Kalu also revealed that the integration of vaccine preventable disease with other health programs will be also incorporated in the WHO response strategy.
“I would like to extend my warm congratulations to the Ministry of Health and its partners for this excellent achievement, which benefits the health of women and children,” said Ms. Shalini Bahuguna, Officer in Charge of UNICEF Representative to Ethiopia. “UNICEF will continue to support the government of Ethiopia to sustain this achievement and deliver results for every child” she added.
Zones were selected following an in-depth review of the risk factors for maternal and neonatal tetanus (MNT) using the high-risk approach. Clean delivery and cord care practices, reaching all women of reproductive age in high-risk districts through TT SIAs and immunization of pregnant women during routine immunization and conducting neonatal surveillance as it is a hidden disease, are some of the interventions that helped to achieve this remarkable result.
It is acknowledged that the validation of MNTE in Ethiopia is not an end in itself but the beginning of a new phase of interventions focused on sustaining the attainment of Maternal and Neonatal Tetanus elimination status, an endeavour that is possible only through: maintaining tetanus protection level at above 80 percent in every zone especially in the zones that achieved elimination through Supplementary Immunization Activities (SIAs); strengthening partnerships for improving Maternal, Newborn and Child Health (MNCH) activities; and implementing the sustainability plan of action-2014 which incorporates a switch from Tetanus Toxoid (TT) to Tetanus-diphtheria (Td) vaccine, and annual joint review of national MNT risk status to guide the interventions.
On 03 April 2017, UNICEF, WFP, and UN-OCHA went on a joint one-day field visit with the German Minister for Development Cooperation (BMZ) to Kebri Dahar and Waaf Duug Temporary Resettlement Site in Doolo Zone, Somali Region, Ethiopia. The Minister was accompanied by 16 German journalists, BMZ officials, German Embassy partners, GiZ and KfW. The Somali Regional President and key regional government counterparts have also joined the field visit. The visit was part of the German Minister’s visit to Ethiopia to discuss the Marshall Plan for Africa with Ethiopian Government and AU Officials.
The Minister and his delegation visited the Urban WASH programme (borehole and water trucking) in Kebri Dahar town, as well as UNICEF’s emergency Health, Nutrition and WASH programmes in the Waaf Dhuug Resettlement Site for drought displaced people. More specifically, the Minister was able to see a Mobile Health and Nutrition Team operating with the German funded vehicles, a stabilization centre for severely malnourished children that utilizes German funded Ready to Use Therapeutic Food (RUTF) and a water point. The Minister also visited WFP’s school feeding programme at the Waaf Dhuug primary school and a WFP food distribution.
Waaf Dhuug Temporary Resettlement Site (TRS) hosts 4,500 host community and 3,882 drought displaced people, of which more than 85 per cent are women and children from surrounding grassing areas. The site was established in January 2017 and is one of the 58 Temporary Resettlement Site established by the Somali Regional Government in response to the drought emergency. Majority of the pastoralist community have moved into the TRS due to extensive loss of livestock as a result of the drought. They have left their villages in search of water and health and nutrition services for themselves and their children. Discussing with the Minister, Kadar Kaydsane, 35 years old and a mother of 10 said, “We walked for five hours to get to Waaf Dhuug and we lost all our livestock on the way. We came here to find water and other services provided by the Government.”
The Minister and German development partners recognized the importance of investing in building resilience, for instance through funding water schemes and strengthening Government systems, such as the Health Extension Programme. The Minister further appreciated the German Government’s strong partnership with UNICEF and was impressed by the integrated drought emergency response at the resettlement site, but recognized that the challenges are very complex and the required funding remains significant. As a response to the dire need of the people affected by the drought, the Minister announced that German funds for the Horn of Africa drought response will be increased from 100 million Euro to 300 million Euro.