Menstrual Hygiene Management Programme Kicked off with a Training of Trainers in Oromia and Somali Regions

By Kalkidan Gugsa

OROMIA and SOMALI, February 2017 – Poor menstrual hygiene management (MHM) negatively impacts the education, health and empowerment of girls and women, as well as the environment. The impacts are compounded during emergencies, such as the protracted drought crises across Ethiopia. What fuels these negative effects of managing menstruation are cultural taboos and other societal barriers.

Girls across Ethiopia face social, cultural and economic barriers related to menstruation which not only prevents their right to dignity, but often prevents their right to education due to inadequate menstrual hygiene education, insufficient WASH facilities and poor access to sanitary materials.

With support from the Netherlands Government, UNICEF Ethiopia, in partnership with regional health and education bureaus (RHB, REB), is implementing an MHM programme to break the silence and bring change in beliefs and attitudes towards menstruation. The programme aims to support girls and women across the country to overcome the barriers that prohibit them from managing menstruation with dignity.

Why MHM?

Menstrual hygiene management is a complex and sensitive issue that requires a contextualized, multi-sectoral approach to adequately support girls and women across Ethiopia. A package of services that leads to improved MHM includes private, minimum-standard toilets, handwashing stations and adequate waste disposal in addition to allowing the safe space for discussion to increase awareness amongst men, boys and girls utilizing social and behavioural change communication (SBCC) methods. In addition, improvements in the supply chain for sanitary pad production complements the community- and school-based efforts in MHM.

In collaboration with UNICEF, the Ethiopia Ministry of Health developed a national MHM guide based on the package of services, which is designed to address the topic across the contexts of schools, communities and workplaces as well as in emergencies.

By working with both the RHB and the REB, and supporting the development of a sanitary supply chain, improved MHM facilities and services will keep girls in school where they can reach their full potential.

MHM social and behaviour change communication materials in Amharic and Oromiffa languages
MHM social and behaviour change communication materials in Amharic and Oromiffa languages

On 15 February 2017, UNICEF kicked off the community- and school-focused MHM training of trainers (ToT) workshops for a total of 120 staff of the RHB and the REB in Oromia and Somali regions. These were the first of such trainings made possible by support from the Netherlands Government.

The TOT workshop established coordination between the education and health sectors and equipped focal persons with global, national and regional menstruation facts. It also introduced participants to the MHM package of services: SBCC activities concerning menstruation, establishing safe spaces to enable girls to receive peer support, counselling and emergency kits as well as improved WASH facilities and sanitary pad production.

Throughout the training, participants highlighted the lack of discussion on this important topic, with one male participant explaining, “In our societies, the lack of information about menstrual hygiene creates a culture of taboos and misinformation about menstruation and therefore potential health problems. Now we know what to do from this training and how to react.”

The regional and woreda (district) focal persons who participated in the ToT, in turn will cascade the training to health extension workers (HEWs), school management committees and school club coordinators (teachers). The trained HEWs and teachers will then facilitate activities for the Health Development Army and the WASH, gender and girls’ club members in their respective areas.

The sanitary supply chain

The sanitary pad supply chain component of the programme establishes women’s groups to produce reusable sanitary pads and provides support to local manufacturers through partnerships to improve the production, packaging, distribution and use of sanitary pad products in target regions. On the manufacturing end, partner companies will engage in backward integration of the production of raw materials such as absorbents and liners. On the sales end, pharmaceutical and family planning outlets, such as pharmacies, drug stores and clinics, will be utilized at local and regional levels to bring the improved products to communities.

Additional MHM training and launch workshops are planned to kick off in March and April 2017 in Gambella, SNNP and Afar regions. Together with Government partners, UNICEF will support the positive change in the dynamics of MHM in Ethiopia and contribute to better futures of girls across the country.

Rehabilitation of Borehole Saves Thousands of Lives and Livestock during Drought

By Ayuko Matsuhashi

A signboard on the sight of rehabilitated borehole
A signboard on the sight of the rehabilitated borehole ©UNICEF/2017/Tsegaye

HARSHIM, SOMALI, 19 January 2017 – “For three months, the borehole was not functional and people suffered a lot. There was little rain, so most of the birkas[1] became empty. Additionally, water from birkas is usually contaminated so we suffered from diarrhoea,” Muse Hassan Ali, 45-years-old recalls the time that he and his neighbours did not have access to safe and sustainable water in his town. Birkas are underground water storage systems intended to collect rain water during the rainy season and store for use during the dry season. Birkas can also be used to store water transported by trucks during emergencies.

According to the Harshim woreda (district) administrator, Sied Abraham, this borehole in Harshim town is the only sustainable water source that survived the 2015 El-Niño drought. It was drilled by the Somali Regional Water Bureau (RWB) following a UNICEF groundwater mapping in 2009 to identify potential drilling sites. The depth of the borehole is 535 meters, one of the deepest in the Somali region. After this borehole became non-functional due to electromechanical failure last year, UNICEF, with generous financial contribution from European Commission’s humanitarian aid department (ECHO), supported the RWB to rehabilitate the borehole by replacing a submersible pump, generator and an electric cable.

An immediate rehabilitation of the only sustainable water source in the woreda was crucial not only for Harshim town, but a large part of the region. It typically benefits over 9,000 people in Harshim and neighbouring woredas as well as people who cross the border from Somalia. At the end of 2016, it also served people in far-reaching woredas when drought conditions worsened once again due to the negative Indian Ocean Dipole (IOD). The RWB and partners began providing emergency water trucking, using this borehole as their source. Thus, its well-functioning affects a high number of direct and indirect beneficiaries across the region.

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Roda Ahmed, 35 years old and Rahma Ahmed, 30 years old collecting clean water from the on-site water point ©UNICEF/2017/Tsegaye

Roda Ahmed, 35 years old, is with her five children collecting water. “This is a source of life. Now I can cook and feed my children,” she says. Another woman from Harshim town also with five children, Rahma Ahmed, explains, “Since this borehole has been working, we stopped drinking water from birkas.

In addition to people collecting water near the borehole, the on-site trough draws in many pastoralists and their livestock. It takes more than a day for Farah Aden, 60 years old, to walk to the Harshim borehole with his 10 camels. “We are grateful for this borehole. Water is always a great cost for livestock. The functionality of this borehole has impacted our life a lot.” Indeed, during drought periods such as this one, entire herds may be wiped out, as evidenced by dozens of dead carcasses along the roads across the region.

Pastoralists come to Harshim town from neighbouring woredas and Somalia looking for water
Hundreds of livestock come from all over the Harshim woreda and drink water at the on-site trough ©UNICEF/2017/Tsegaye

As he contemplates this grave issue in his region, Muse pauses before emphasizing, “Still, this is not enough. There is a great pressure on this borehole. The generator is working 22 hours every day.”

UNICEF and partners will continue efforts to support the Government of Ethiopia to increase water coverage and functional water schemes in the Somali region to save the lives of children, their families and their livestock and contribute to a better future for all.

[1] traditional water harvesting pond

Giving a village in the Amhara region its own water supply transforms lives

By Ayuko Matsuhashi

WOIRU DIKALA, Amhara region, 7 August 2016 – The women of Woiru Dikala kebele (sub-district) used to spend much of their day searching for water, a mission that grew even more difficult as drought ravaged Ethiopia’s Amhara Region over the past year.

Women and children often walked for more than six hours to get the water their community needed, searching for scarce rivers and ponds among the dry, rugged gorges of Raya Kobo woreda (district).

Local women at Raya Kobo woreda, Woiru Dikala Kebele -Amhara National Regional State enjoys the newly inaugurated water supply.
Women in Woiru Dikala kebele spend much of their time looking for water.   Now they can easily access clean water thanks to the multi-village water supply system built with UNICEF’s support.  ©UNICEF Ethiopia/2016/Mersha

This area, near the borders of Tigray and Afar regions, is full of migrants from these parts of the country also searching for water for their family and herds and fleeing the recurrent droughts.

So it was with great rejoicing that the people of Woiru Dikala welcomed a joint UNICEF and DFID project introducing a multi-village water supply system drawn from a deep well with a total of eight water points around the village – including one for the primary school.

Comments we received from community members included “We can avoid the risks of abuse of women and children as they travel to collect water from the gorges including at night time,” and “Our children and even adults have been frequently affected by diarrheal diseases and intestinal parasites. We feel happy that our life will be changed.”

The new water system will help 5,000 people over the next 20 years, including the 2,100 living in Woiru Dikala kebele.

The El Niño-driven drought has hit much of the country over the past year, but eastern Amhara has been especially hard hit, with over 1.5 million people suffering from a critical shortage of water.

The shortage also has severe health implications. The kebele has seen an outbreak of the itching menace of scabies because the lack of water means poor sanitation and personal hygiene.

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Boys and girls in Woiru Dikala kebele can grow healthily as they have unrestrained access to clean water. They can also attend school more regularly without worrying about fetching water. ©UNICEF Ethiopia/2016/Mersha

The condition breeds in cramped, dirty conditions and can move quickly through a population causing a great deal of distress among children, who make up half the population of the kebele.

Poor water quality also led to an outbreak of Acute Watery Diarrhoea, which can be fatal for the young and infirm.

Regular access to clean water is key to combatting these diseases. There is no health facility in the kebele.

The inauguration of the new water supply for the area was attended by several regional officials as well as representatives of UNICEF.

“This water supply system provided from a deep well should support local resilience in times of climatic uncertainty,” said Jane Bevan, UNICEF’s manager for rural Water, Sanitation and Hygiene.

Ms. Gillian Mellsop, UNICEF Representative to Ethiopia visits and inaugurates the UNICEF/DIFID supported community emergency water supply scheme at Woiru Dikala Kebele, Raya Kobo woreda, Amhara region.
Attending the inauguration of the new water system were Ato Woldetnsae Mekonnen, head of the Water, Irrigation and Energy Department for North Wollo Zone, Jane Bevan, UNICEF’s Rural WASH Manager, Ato Ayenew Belay, head of Amhara’s Bureau of Finance, Ato Kedir Mustefa, administrator of Raya Kobo woreda, Gillian Mellsop, UNICEF representative to Ethiopia, Ato Yimer Habie, deputy head of Amhara’s Bureau of Water, Irrigation, and the Bureau of Energy. ©UNICEF Ethiopia/2016/Mersha

 

Volunteers Blast Hygiene Message to Halt Acute Watery Diarrhea

By Bethlehem Kiros

ADDIS ABABA, 30 September 2016 – Mickias Fikre, a taxi driver keeps soap in his car and makes sure to wash his hands thoroughly before he eats. According to him, it is a new habit he developed after he saw his friend suffer from Acute Watery Diarrhea (AWD). “He was so sick that I thought he would not recover,” he remembers. His friend got better after few days and Mickias learned from the local health centre how to protect himself from the disease. Mickias adds, “It is really helpful that volunteers are travelling throughout our community on trucks, spreading the message on how to stay safe.”

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
ERCS volunteers in Akaki/Kaliti sub-city perform a traditional dance to draw the attention of the community and raise awareness on AWD prevention. © UNICEF Ethiopia/2016/Ayene

Ayantu Dadi, 20, is one of the volunteers who is helping communities protect themselves from AWD. A recent college graduate and an Ethiopian Red Cross Society (ERCS) volunteer of over five years, she has been spending the last three months on the UNICEF and ERCS-supported audio truck that drives around the Nefasilk Lafto sub-city.   Since July 2016, UNICEF and ERCS have been conducting mass public awareness campaigns using 10 audio trucks deployed in each of the 10 sub-cities of Addis Ababa.

Ayantu and seven other volunteers meet early in the morning at the Nefasilk Lafto ERCS branch office, then visit the sub-city health office to obtain instructions on the exact locations they need to cover for the day. These locations are selected based on reported cases of AWD, as well as observed risk factors such as poor hygiene and sanitation practices. The volunteers spend about eight hours reaching out the public with awareness-raising messages on how to prevent AWD and recognize its symptoms. “We play music for few minutes to attract people’s attention and then we broadcast the Public Service Announcements on hygiene and sanitation,” she elaborates.

They also stop at designated priority locations, such as crowded locations where they can reach a large number of people, to distribute flyers, put up posters and have one-on-one talks with people who have questions about AWD. “We especially take time to talk with street food vendors and people in economically impoverished communities where the problem seems to be most prevalent,” she explains. According to Ayantu, the outreach helps prevent new cases of AWD as well as identify existing cases. “It is quite satisfying when you find out that your actions actually impact people’s lives. It is what encourages me to keep passing this message every day,” she says.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Ayantu Dadi, 20, an ERCS volunteer, teaches a street vendor about AWD. “I only graduated last month so this is what I do full time.” ©UNICEF Ethiopia/2016/Ayene

Since the AWD outbreak was reported in November last year, 7,769 cases have been identified in Addis Ababa alone.

The coordinated response by the Federal Ministry of Health (FMOH) and partners including UNICEF, cases have now continued to decline however, we should not let our guard down.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Sintayehu Tsegaye, who had AWD and has recovered, washes the hands of her son Michael, 3, before she gives him orange. “I always keep soap next to the tap so that I wash my hands when I come from outside or from the toilet. I also try my best to drink boiled water and make the rest of my family do the same.” ©UNICEF Ethiopia/2016/Ayene

Sintayehu Tsegaye 45, is among the thousands affected by AWD and was treated for a week in the local AWD case treatment centre (CTC). A mother of two, she has a small business selling potato chips, flowers and grass that is used in Ethiopian coffee ceremonies. “It is hard to be clean all the time when you touch grass all day, use community latrines and live with a big family that does not have the same hygiene practices as you,” she explains, adding that after her recovery from AWD, she has become more careful about practicing proper hygiene measures such as handwashing with soap.

“People in the community don’t always take the information seriously unless they are personally affected by it, but with repeated teaching, I believe many will listen,” says Sintayehu. “Is especially important to spread the message in communities like mine that use shared latrines.”

In addition to public outreach, UNICEF is also supporting the Government of Ethiopia’s efforts to contain and prevent the spread of AWD  by providing supplies for case treatment centres, technical support for case management and infection prevention, and water treatment supplies to safeguard drinking water for households and communities.

UNICEF and WFP Regional Directors visit El Niño driven drought response in Ethiopia

Afar Region – Ethiopia Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa, have visited the ongoing government-led drought response where UNICEF-WFP are closely collaborating. The drought is affecting six regions in Ethiopia, and 9.7 million people are in need of urgent food relief assistance including approximately 5.7 million children who are at risk from hunger, disease and lack of water as a result of the current El Niño driven drought.

In Afar Region, where an estimated 1.7 million people are affected by the drought, including 234,000 under-five children, the Regional Directors visited UNICEF/WFP/Government of Ethiopia supported programmes. These included the targeted supplementary feeding programme (TSFP) and an outreach site where one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs) provides preventive and curative health, nutrition and WASH services to a hard-to-reach community in Lubakda kebele.

Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa in Ethiopia visit

The Mobile Health and Nutrition Team provides Outpatient Therapeutic Programme (OTP) and targeted supplementary feeding programme (TSFP) services to remote communities. The TSFP is integrated with MHNT services that address under five children and pregnant and lactating women with moderate acute malnutrition, and link them to TSFP when they are discharged from OTP. This solves the challenge in addressing the SAM–MAM continuum of care and preventing moderate acute malnourished children deteriorating into severe acute malnutrition.

The Directors also visited a multi-village water scheme for Afar pastoralist communities in Musle Kebele, Kore Woreda (district) which suffers from chronic water insecurity.

“Valerie and I are hugely impressed by the work of the WFP and UNICEF teams in Afar,” said UNICEF’s Pakkala.  “The quality of the work being done in such difficult circumstances – from the mobile health and nutrition teams, to WASH, protection, education and advocacy – is remarkable. We were also immensely impressed with the national level partnership between UNICEF and WFP, and our credibility with government and donors. The relationship and collaboration is a model for other countries to learn from and emulate.”

“Ethiopia is showing us that drought does not have to equal disaster,” said Valerie Guarnieri of WFP.  “We can clearly see the evidence here that a robust, government-led humanitarian response – supported by the international community – can and does save lives in a time of crisis.”

UNICEF and WFP continue to support the Government in responding to the current drought with a focus on the most vulnerable and hard to reach communities by using proven context specific solutions and approaches.

ONEWASH  – UNICEF Ethiopia’s pivotal role 

By Dr Samuel Godfrey

Two months ago, I asked five friends of mine two critical questions; one where does the water that flows out of your tap come from and second where does the waste that is flushed down your toilet go to? Answers like, from a river or “my toilet waste is flushed down a sewer pipe…where it goes, I don’t know?” These answers are symptomatic of many educated peoples understanding.  Last month, I asked five inhabitants of the northern Ethiopian town of Wukro the same question. All five respondents gave me an articulate description of borehole water as well as the exact location of all the septic tanks.

Water and Sanitation are a daily priority for most of the world and the Sustainable Development Goal (SDG) number 6 has been designed to ensure that everyone, everywhere has access to water and sanitation by 2030.

In Ethiopia, UNICEF was ahead of the SDG curve and in 2013 developed a programme called the ONEWASH which was designed to pull all financial resources from the government, aid agencies, development banks and the UN around ONEPLAN.

To develop the ONEWASH programme, UNICEF Ethiopia was delegated by the Government of Ethiopia to design the strategy for a 10 year plan to ensure that the 50 million people gain access to water and 70 million people gain access to sanitation in every house in every town, city and village across Ethiopia. The ONEWASH is the biggest water and sanitation initiative in Africa and requires an estimated investment of US$2.4 billion. See http://www.unicef.org/ethiopia/OWNP_LEAFLET.pdf.

The ONEWASH programme has: ONE plan, ONE Budget, ONE Procurement system, ONE monitoring system and ONE report. Led by the ONEWASH Coordination office in the Government of Ethiopia  Ministry of Water, Irrigation and Electricity  and with financial and technical collaboration with the Ministry of Finance, Education and Health, the ONEWASH was a “showcase” at the 2016 Sanitation and Water for All High Level Meeting.

UNICEF Ethiopia also teamed up with the key financiers in the WASH sector in Ethiopia such as the World Bank, African Development Bank, DFID, Government of Finland and others to set up a Sector Wide Approach (SWAp) pool fund called the Consolidated WASH Account where funds are blended together. To ensure all UNICEFs financial rule and regulations were respected, UNICEF Ethiopia developed a Fiduciary Risk Assessment tool. This is now been worked into a Programme Operational Manual and is used to guide the sector investments.

The SDGs present an opportunity and challenge for UNICEF Ethiopia. If ONEWASH is successful it will improve sanitation and hygiene facilities in hospitals, schools and health centres and will provide essential water supply for areas affected by climate change and drought. It will ultimately result in reducing undernutrition in children and improving the cognitive performance of school goers.

We are working in the WASH sector to complement and partner with other sector financiers to ensure that all children and all women, everywhere: rural and urban – development and emergency -have the right to water, sanitation and hygiene in communities, health centres and schools…..ONEWASH for all…

Dr Samuel Godfrey is Water Supply, Sanitation and Hygiene (WASH) Section Chief at UNICEF Ethiopia

South-South Cooperation as a new approach for WASH sector development in Ethiopia

By Samuel Godfrey and Michele Paba 

South – South Consultative Meeting Addis Ababa, Ethiopia
(LR) Ms.Gillian Mellsop, UNICEF Representative to Ethiopia, Ato Kebede Gerba State Minister MOWIE, Octavio Henrique Cortes Brazilian Ambassador to Ethiopia. Signed a trilateral program document to cooperate on WASH under South-South initiative. ©UNICEF Ethiopia/2016/Tesfaye

In the effort to improve delivery of essential services to women and children, South-South cooperation provides a platform for lower income countries to learn from middle income countries that have recently addressed developmental challenges similar to their own. Ethiopia’s aspiration to reach middle income status by 2020 means that its five-year Growth and Transformation Plan II is heavily reliant on exploring the economic and social development models of China, Brazil, Cuba and other Latin American Nations.

The need to address rapidly urbanizing small and medium sized towns is central to Ethiopia’s growth. UNICEF in its new Country Programme (2016-2020) has identified urbanization as one of the key challenges being faced by women and children. How do lower income households get access to equitable and affordable services such as health care, education, water supply and sanitation? How will the rights of out-of-school children in urban areas be protected?

To answer some of these questions, UNICEF Ethiopia has supported the South-South partnerships between the Government of Ethiopia and the Governments of Brazil and Cuba in two strategic areas, Urban Water, Sanitation and Hygiene (WASH) and Integrated Water Resource Management.

The cooperation initiative with Brazil was initiated in 2014 with the support of UNICEF Ethiopia and Brazil Country Offices and the UK Government, under the ONEWASH Plus Programme, with the aim of supporting the water and sanitation sector in Ethiopia in two key pillars, namely, the development of the sanitation sector in towns, with particular focus on technology transfer for the treatment of waste water generated by densely populated housing facilities such as condominiums, and the establishment of an independent regulatory framework for WASH services at all levels.

Given the extensive experience of the Cuban Government in river basin and water resource management, the recently established collaboration with the Ethiopian authorities, supported by UNICEF and the US Government, will definitively generate great impacts on the watershed management plans and riverine resources conservation initiatives across the country.

The two South-South initiatives were reviewed, through a consultative workshop held in Addis Ababa on 26 May 2016, by high level officials from the Ministry of Water Irrigation and Electricity, the Embassies of Brazil and Cuba, UNICEF as well as other sector institutions and development partners including  the UK and US Governments. The workshop culminated in the signing of the three-year project document between Ethiopia and Brazil. Together, the partnerships with Brazil and Cuba will help Ethiopia strengthen the WASH sector to be able to better deliver services for children and communities.

During the event, the State Minister of Water Irrigation and Energy, H.E. Ato Kebede Gerba, underlined the importance of the integration of different forms of cooperation, both North-South and South-South, in order for the sector in Ethiopia to get the required exposure and learning from different experiences and practices.

Dr. Samuel Godfrey is Chief of WASH and Michele Paba a WASH Specialist at UNICEF Ethiopia