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.
Moges dashes across the grass with a herding whip in hand. At three years old he can’t make it crack like his father or the other men in Romey Kebele (sub-district), a pastoralist area a few hours outside Addis Ababa where his family lives. But he smiles proudly as he loops it in wide circles around his head.
Muluemebet Balcha, one of the Health Extension Workers (HEW) that helped save Moges’ life, remembers how distraught his mother was. Ms. Muluemebet had contacted her to offer postnatal care for Moges through the Ethiopian government’s Health Extension Programme (HEP). “She was desperate. She thought the child would have died,” she said.
“I gave him treatment and on the second day he got well. I was very happy to see him survive,” she remembers.
Prior to becoming this kebele’s first HEW, Ms. Muluemebet says not all new-borns in the area were as lucky as Moges. “Before that training was given so many children who encountered the same problem died,” she said. The HEP has done wonders for families in hard-to-reach rural areas like Moges’ ever since it was established in 2003.
With help from UN agencies like UNICEF, it continues to grow. As of 2015 there were more than 38,000 HEWs like Ms. Muluemebet working in over 16,000 health posts across the country. Each health post serves around 5,000 people, meaning the vast majority of Ethiopia’s population of 99 million are within reach of free, basic health care.
Teshome Alemu, Moges’ father, says he owes his child’s life to the HEWs. “To go to [the nearest hospital] you may not even afford the transportation cost,” he said. “If you don’t have money, you can suffer a lot. The children will also suffer.”
“The provision of this service in our Kebele is very beneficial,” he added.
In September 2013 Ethiopia turned heads around the world by announcing it had achieved Millennium Development Goal 4, which pushed for a reduction of child mortality rates by 67 percent, three years ahead of its 2015 deadline. What started as 205 deaths for every 1,000 children in 1990 tapered off to 59 deaths per 1,000 in 2015. While developments in technology and new levels of political support are partially responsible for this drop, the HEP was a key driver in making this improvement a reality.
Meeting MDG 4 was a milestone in the country’s history, but HEWs aren’t claiming “mission accomplished” quite yet.
“The size of kebeles and their population means they cannot be covered by one HEW. I am the only health worker serving this community so it is very tough to reach all the households,” says Ms. Muluemebet, outlining challenges she and the program at large still faces.
Because she balances so many patients, she’s not always able to put in the time to make sure health education sticks. “Given the awareness of the community, it takes a long time to implement some of the activities. Families are getting the education needed, but sometimes it takes them a while to put it into practice,” she says.
Moges’ mother, Kokeb Nigusse, admits that while the community is grateful for the free services they provide, not everyone follows their advice to the fullest.
“They give the children medicinal drops, injections and syrup when they are sick,” she said. “They check up on the children. They also follow up and give injections to pregnant women. More significantly they advise us to deliver in health institutions and not at home.” Despite this last suggestion, she says, house deliveries still occur.
With more support from Ethiopia and UNICEF, that is beginning to change. “Before I started work, most mothers delivered at home. But now, if you take this year’s data, out of 171 pregnant mothers only 20 delivered at home,” said Ms. Muluemebet. The rest delivered at the local HEP health centre.
There have also been gains in building confidence in mothers like Ms. Kokeb, who are reluctant to vaccinate their children. “Vaccination of children was very low previously but now almost all children get vaccinated,” says Ms. Muluemebet. “I informed her that if the child gets sick he should get treatment even before baptism, because the community believes they shouldn’t get anything before baptism.”
Pneumonia, diarrhoea and malaria are three of the five most common life-threatening conditions that new-borns face in Ethiopia. These threats have curtailed with the debut of the integrated community case-based management of common childhood illnesses (ICCM) regime. So far, more than 28,000 HEWs like have been trained in ICCM.
With help from the financial support of its donors, UNICEF has guided development of the ICCM and HEP programs, given technical assistance to Ethiopia’s Ministry of Health, and delivered 10,000 health kits to HEP health posts throughout the country. Ms. Muluemebet says the change from this support has been enormous.
“I am a witness to seeing mothers die while giving birth,” she says. “But with the HEP we can easily detect mothers who need help, or who need to get service at health centres, and if it is beyond their capacity they call the ambulance and they take the mother to health centre and they can be easily saved.”
Moges and Ms Kokeb were saved from having to travel great lengths to get basic care. Today they walk hand-in-hand across the bright green plains that surround their vast plot of land, happy, at ease and part of a complete family. As the HEP continues to grow, success stories like theirs will become a shared experience for millions more Ethiopians.
Korea International Cooperation Agency (KOICA) announces US$ 9 million support to UNICEF for “Community Based Newborn Care” today in the UNICEF Ethiopia office. This financial support will be implemented in five zones of SNNP, Oromia and Benishangul Gumuz regions of Ethiopia.
The agreement was signed by KOICA Country Director, Doh Young Ah and UNICEF representative to Ethiopia, Gillian Mellsop.
KOICA’s support aims to strengthen Ethiopian government’s efforts to improve maternal and newborn health in hard to reach areas building mainly on the Health Extension Program and the Primary Health Care platform. Over 150,000 pregnant women and their newborns will benefit from this generous support per year, reaching over 300,000 mother-baby pairs in the coming years.
In collaboration with the Federal Ministry of Health, Regional Health Bureaus, the Ethiopia Midwifery and Paediatric associations, NGOs, donors and academic institutions, the programme aims to scale up maternal and newborn care in 5 zones covering a total population of 4 million between 2015 and 2018. This programme will contribute to the national scaling up of evidence based high impact interventions to improve maternal and newborn health at community and health facilities levels.
The combination of innovative, evidence-based strategies and the government’s long legacy of leadership on maternal, newborn and child survival is yielding impressive results. Ethiopia achieved MDG 4 three years ahead of schedule by cutting under-five mortality from 205 per 1,000 live births in 1990 to 68 per 1,000 in 2012. Ethiopia’s progress illustrates that countries can achieve dramatic declines in child mortality, despite constrained resources.
Canada mobilizes support for innovation, integrated action for youngest children
Toronto/Addis Ababa, 29 May 2014 – Every minute, 10 babies die or are stillborn across the world, a staggering 5.5 million lives ended every year just as they start. The majority of those deaths are from preventable causes, including prematurity, childbirth complications and newborn infections.
While child death rates have been reduced by almost half since 1990, newborn mortality has increased as a proportion of overall of child mortality, as highlighted by papers published in The Lancet earlier this month.
“We are succeeding in rapidly reducing child mortality because we have made it a global priority, with a commitment to innovation, partnership, and equity,” said UNICEF Executive Director Anthony Lake. “We need the same global commitment, and the same political will, to reduce newborn mortality — working together to find new ways of reaching every family.”
Poorer families bear the greatest burden of newborn deaths. If current trends continue, it will take over a century before a baby in the Central African Republic has the same chances of survival as a baby born in Canada.
Lake hailed Canada’s leadership in galvanizing global support to reduce maternal, newborn and child mortality. The Toronto Summit will explore the most effective ways to speed up progress on newborn, child and health.
“The fact that not all children and young people around the world have access to critical health care is unacceptable. It must change,” said UNICEF Ethiopia National Ambassador, Hannah Godefa, who was the only young person to speak at the Summit. “I hope we can redouble our efforts and be catalysts for change. I urge all of you today to renew your promise to the women and children of the world and commit to taking concrete action to ending the preventable deaths of women and children. Because I don’t want a world where all children are healthy, happy and safe to be just a dream. I want it to be reality.” she added.
Improving newborn and child health also depends on better accountability — and more thorough accounting.
In 2012 alone, around two out of five births worldwide were not registered. Around the world, nearly 230 million children under age five have never been recorded – meaning they do not have the legal identity they need to access health, education and other services. And the numbers will rise unless action is taken.
But increasing the number of children registered at birth enables governments to improve the planning and budgeting of life-saving interventions, and to summon the political will and civil society support that is needed to meet targets.
“This year we will celebrate the 25th anniversary of the Convention on the Rights of the Child. Millions of children are still being deprived of the most precious right — the right to survive,” said UNICEF Executive Director Anthony Lake. “We must reach every family, every woman, every child, and every newborn.”
Five United Nations agencies, known as UNH4+ (UNAIDS, UNFPA, UNICEF, UN Women and WHO) and the Federal Ministry of Health signed an agreement with the Government of Sweden (through the Swedish International Development Agency – Sida) on the work plan for a joint project on reproductive, maternal, newborn and child health in Ethiopia, 2013-2015. The signing ceremony took place in the presence of Hon Dr Kesetebirhan Admasu, Ethiopian Minister of Health, at the African Union Conference Center during the historic International Conference on Family Planning.
Speaking at the signing ceremony, Dr Kesetebirhan appreciated the support of development partners in the Government’s efforts to reduce maternal and newborn mortality. He further expressed his satisfaction at how the partnership is supporting the Government’s initiative, with the Government in the driving seat. “With such country ownership and continued support of partners, the achievement of MDG 5 is not out of reach,” he underscored.
Also speaking at the event, WHO Representative, Dr Pierre M’pele recalled that Ethiopia has already achieved MDG 4 two years ahead of schedule by reducing child mortality rates, and affirmed that the joint program comes “At the right time to strengthen the partnership of the UN agencies delivering as one and Sida with the Federal Ministry of Health to work together to achieve MDG 5.”
In its endeavor to maximize the impact of its support to the Government of Ethiopia, the United Nations Country Team (UNCT) is working with the principle of Delivering as One and strengthening joint efforts of the UN agencies in advancing priority areas within the development agenda. Both the Government of Ethiopia and the UNCT recognize maternal and newborn health as one of the top priority areas that require the concerted efforts of all stakeholders in the few years remaining of the MDGs. This work plan for the Sida/H4+ grant contributes to filling gaps in the current joint efforts by UN agencies in supporting the FMOH for implementation of the National Road Map for Accelerating Reduction of Maternal and Newborn Mortality and Morbidity, and thereby pave the way for Ethiopia to meet MDG 5 of by 2015, reducing maternal mortality ratio and increasing access to reproductive health.
This blog post is extracted from World Health Organization Ethiopia Country Office media release.