Joining hands to ensure polio transmission remains at zero in Ethiopia

AWBARE, Somali region– Ermias Amare and Salah Kedir, health workers in Ethiopia’s Somali region, zip through the arid plains kicking up a trail of dust as they ride their motorcycle to the next settlement where they will be administering polio vaccines to children under the age of 5 years.

It is campaign time in Ethiopia’s Somali region, and the two health workers are on a mission that is critical for the well-being of Ethiopia’s children.

Ermias and Salah are taking part in the National Immunisation Days (NIDs) campaign, vaccinating children against polio with the oral polio vaccine (OPV) in the Somali region. Vaccination against polio is essential to prevention of this crippling, disabling and potentially fatal disease which, is easily contracted from person to person, and especially dangerous to individuals and populations when there is not sufficient immunity, or protection, against the virus. The consequences of polio disease are devastating, for a child, for a family, and for a community.

Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region, 9 February 2015. THe half-tick mark on the hut's opening flap indicates that not all the children who live their under the age of five have been vaccinated.Sophia's eldest daughter (five years old) is out wtending the families goats, and the vaccination team makes an appointment to return the next day to vaccinate her as well. ©UNICEF Ethiopia/2015/Getachew
Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region ©UNICEF Ethiopia/2015/Getachew

Most of the children in the village visited by Ermias and Salah have their finger marked with ink, indicating that they have already been vaccinated during this present campaign.

In August 2013, the Dollo zone of Somali region, in the southeastern corner of Ethiopia bordering Somalia, was hit by a polio outbreak. Tragically 10 children were paralysed as a result of wild poliovirus (WPV) infection. Since the beginning of the polio outbreak, 15 National and Sub-national Immunisation Days (NIDs/SNIDs), have been conducted to date to respond to the outbreak. The total number of WPV cases reported since the start of the outbreak remains at 10 – the last case confirmed 18 months ago. Maintaining the momentum of response efforts has been be critical to ensure no more polio cases are seen in Ethiopia.

Social Mobilisation  

Communication and social mobilisation efforts have been instrumental in the interruption of the WPV transmission in the Somali region. In Lafaisa kebele (sub-district) of Awbare (woreda) district, a town crier mobilizes the community through a megaphone to alert parents that children under the age of 5 years will be receiving polio vaccinations during the campaign.

Nearby, a village Sheikh, trained by the Somali Regional Health Bureau (SRHB) in partnership with UNICEF and the Islamic Affairs Supreme Council, gathers mothers and children for a discussion about the campaign where he explains the benefits of immunisation and urges them to have their children vaccinated. Among the strategies deployed by the SRHB and UNICEF to meet the need for information was to engage religious leaders to council the pastoralist communities, particularly women, about the importance of vaccinating their children, for every round. The eminent position that religious and clan leaders hold in pastoral Somali communities and their ability to mobilize the population, has become a key factor in the success of immunisation activities.

Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew
Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew

“In the past when we informed communities about upcoming campaigns, because they didn’t have an understanding about it, some would refuse to bring their children forward,” said Ermias. “There were many challenges. They would refuse to have their children vaccinated. But today, we vaccinated an infant who was born today. In the past, that would be unheard of.  Now, if they have a child out at their farm when we come for the vaccinations, they will tell us we missed one and to come back the next day.”

Cross Border Vaccination

The success of the polio eradication efforts hinges on successful cross-border collaboration between neighbouring countries, such as Somalia and Kenya. Immunisation activities in Ethiopia’s Somali region are therefore held in coordination with health institutions across the borders. Border vaccination points have been set up, and all children under 15 years of age crossing the border receive polio vaccination.

“All the children under 15 years of age who cross the border from Ethiopia to Somaliland or the other way are vaccinated,” said Nemo Alele, head of the Awbare Health Center, located near the border with Somaliland. “This is a border area and we explain to the mothers very carefully what harm can happen if there is transmission of the disease. We have good relations with our counterparts in Somaliland and have discussions on a monthly basis.

There is a similar vaccination centre on the other side of the border where they are doing similar work, and we are both committed that no child should cross without being vaccinated.” Sophia Ege Bulale lives with her three month old grandson Hamad Mukhtar Dayib, in Lafaissa kebele. Sophia has been caring for her grandson ever since her daughter-in-law left Hamad with her son, who lives in Hargeisa in Somaliland, to raise on his own. “I travel back and forth between Lafaissa and Hargeisa with Hamad,” said Sophia. “We didn’t have these vaccinations when I was young and I have seen children who grew up disabled as a result of polio. I am therefore happy that vaccinators come to our house to make sure that my grandson will be protected, whether he is here or in Hargeisa.”

Campaign Support

Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew
Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew

In February, the polio NID aimed to reach nearly 14 million children under the age of 5 years with OPV. According to the national administrative coverage, 99.7 per cent of children were reached with the polio vaccine nation-wide; and over 98 per cent in the Somali region. This is a remarkable achievement, particularly within the context of the highly mobile pastoralist communities of Somali region.

Mobile health and nutrition teams (MHNTs) have helped to reach communities with polio and routine vaccination.  In the Somali region, 24 MHNTs operate to reach pastoralist and remote populations. The teams work 5-6 days a week in selected operational sites on a fixed schedule, and with the support of local social mobilizers who continuously inform the target community of the arrival of health teams. They reach over 1,000 clients per month, of whom, over 40 per cent are children under the age of 5 years.

Reaching all targeted children with the polio vaccine is neither an easy nor simple task. More than 90 million doses of the OPV were provided for all polio outbreak response campaigns to date. Much effort has been exerted by all stake holders to bring the polio vaccine from the manufacturer, to the vaccination teams, to the mouths of children, in a timely, safe and good condition to help protect every child against polio.

It is through the leadership of the Federal Ministry of Health and the generous support of polio donors such as the European Union, the Bill and Melinda Gates Foundation and Rotary International, and others that more children have been reached with the polio vaccine, and that interruption of the outbreak has been possible. In partnership, alongside health workers like Ermias and Salah, together, we can ensure polio transmission remains at zero in Ethiopia.

Rotarians visit to Ethiopia – a true demonstration of commitment

By Shalini Rozario

Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign
Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign ©UNICEF Ethiopia/2014/Tsegaye

36 Rotarians from Ethiopia, Canada and the United States visited East Shewa zone in the Oromia region of Ethiopia to deliver polio vaccinations to more than 600 children under the age of five.

The visit marked the launch of the first round of polio National Immunisation Days in the country and the group also visited the country office of UNICEF Ethiopia, which is a partner in the global polio eradication initiative.

The visit coincided with an intensified immunisation campaign in Ethiopia, in response to the polio outbreak which began in August 2013, triggered by the Horn of Africa outbreak in Somalia and Kenya.

As of November 2014, 10 cases of Wild Poliovirus Type 1 (WPV1) had been confirmed in the Somali region of Ethiopia.

At the UNICEF Ethiopia offices, members of the Rotary Polio Advocacy Group were shown a video and presentation on polio eradication efforts in the country, followed by a discussion.

Patrizia DiGiovanni, Acting Representative to UNICEF Ethiopia, welcomed the Rotarians and thanked them for their continued support in efforts to eradicate polio, which included a recent grant.

The grant is part of a larger announcement by Rotary International marking World Polio Day of a pledge of $44.7 million to fight polio in Africa, Asia and the Middle East.

To date, Rotary has donated more than $1.3 billion to global eradication efforts, allowing the mobilisation of resources at the grass-roots level through volunteer leaders.

Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunization campaign
Rotary International advocacy visit to Ethiopia to support the polio eradication efforts and participate in the National Polio Immunisation campaign ©UNICEF Ethiopia/2014/Tsegaye

During their visit to the Oromia region, the Rotarians attended a colourful ceremony at a primary school, alongside Dr Kebede Worku, State Minister at the Federal Ministry of Health and Dr Taye Tolera, Special Adviser to the State Minister of Health.

They were joined by the Federal Ministry of Health Expanded Programme on Immunisation (EPI) team, staff from the East Shewa Zone Health Office, UNICEF, WHO and other partners.

The group visited several kebeles within East Shewa Zone to visit people’s homes and carry out vaccinations, accompanied by kebele Health Extension Workers and Health Workers.

The Lume district health office and Shara Didandiba Health Post organised a kebele launching ceremony to mark the Rotarians’ visit. The Rotarians handed out t-shirts and caps to children and parents at the event.

The visiting Rotarians have a range of backgrounds, but share a common interest in supporting polio immunsation, child health and development programmes in Ethiopia. Some members of the group have visited Ethiopia several times.

The visit was intended to inform and promote polio advocacy work in Canada and the US through advocacy and fundraising, as well as engagement with US Congressional leaders.

Rotary International is spearheading the Global Polio Eradication Initiative, alongside the World Health Organisation, Bill & Melinda Gates Foundation, US Centers for Disease Control & Prevention and UNICEF. It has been at the forefront of the global fight against polio for the last three decades.

In Ethiopia, pneumonia is a leading single disease killing under-five children

Kokeb Negussie and her husband Teshome watch their two month old son Moges rest in Romey Village-Amhara Region
Kokeb Negussie and her husband Teshome watch their two month old son Moges rest in Romey Village-Amhara Region ©UNICEF Ethiopia/2012/Getachew

NEW YORK/Addis Ababa, 12 November 2014 – Significant declines in child deaths from pneumonia prove that strategies to defeat the disease are working, UNICEF said on the fifth World Pneumonia Day. But much more is needed to stop hundreds of thousands of children from succumbing to this preventable illness each year.

Pneumonia is still among the leading killers of children – accounting for 15 per cent of deaths, or approximately 940,000 children per year – but deaths from the disease have declined by 44 per cent since 2000, according to figures released recently by UNICEF.

“Pneumonia is still a very dangerous disease – it kills more children under five than HIV/AIDS, malaria, injuries and measles combined – and though the numbers are declining, with nearly 1 million deaths a year, there is no room for complacency,” said Dr. Mickey Chopra, head of UNICEF’s global health programmes. “Poverty is the biggest risk factor, and that means our efforts need to reach every child, no matter how marginalized.”

Deaths from pneumonia are highest in poor rural communities. Household air pollution is a major cause of pneumonia, so children from households which rely on solid fuels such as wood, dung or charcoal for cooking or heating, are at high risk. Overcrowded homes also contribute to higher pneumonia levels. In addition poor children are less likely to be immunized against measles and whooping cough, which are also among major causes of the disease.

Health Extension Worker Shewaye Berhanu administers the PCV vaccine
Health Extension Worker Shewaye Berhanu administers the PCV vaccine ©UNICEF Ethiopia/2011/Lemma

In Ethiopia, pneumonia is a leading single disease killing under-five children. It is estimated that 3,370,000 children encounter pneumonia annually which contributes to 20 per cent of all causes of deaths killing over 40,000 under-five children every year[1]. These deaths are easily preventable and treatable through simple and cost effective interventions. Immunization, good nutrition, exclusive breast feeding, appropriate complementary feeding and hand washing are among the preventive while administration of amoxicillin dispersible tablets and other antibiotics are among the curative methods which can save lives.

With the objective of increasing access to these lifesaving interventions, Ethiopia has made a policy breakthrough of introducing community based treatment of pneumonia through health extension workers in 2010[2]. Since then over 38,000 health extension workers from nearly 15,000 health posts are equipped with the skills and supplies to treat pneumonia at community level using the integrated community case management (iCCM) approach.[3]

Early diagnosis and treatment of pneumonia, and access to health care, will save lives, thus strategies must target low income communities.

The increased use of pneumonia vaccines, particularly in low income countries has led to progress against the disease, but inequities exist even in countries with wide coverage.

 “Closing the treatment gap between the poor and the better off is crucial to bringing down preventable deaths from pneumonia,” Dr Chopra said. “The more we focus on the causes and the known solutions, the faster we will bring this childhood scourge under control.”

UNICEF’s Supply Division has today put out a call to innovators for new, improved and more easily affordable respiratory rate timers to aid in the timely recognition and management of pneumonia.

One simple treatment has had great success: trained community health workers give sick children the antibiotic amoxicillin in a child-friendly tablet form, as part of an integrated case management programme at the community level. Scaling up the availability of similar inexpensive medicines will help to reduce the treatment gap especially among hard to reach populations.

Simple measures such as early and exclusive breastfeeding; handwashing with soap; vaccination; and provision of micronutrients will also reduce the incidence of pneumonia.

[1] Fischer Walker, 2013

[2] National plan on Integrated Community Case management of common childhood illness, FMOH, 2010

[3] UNICEF, Ethiopia Central Data Base, October 2014

Safe water and sanitation services for South Sudanese mothers and children

By Demissew Bizuwerk

Fetching safe drinking water in Tirgol town
South Sudanese asylum seekers fetching safe drinking water in Tergol town, Gambella region of Ethiopia ©UNICEF Ethiopia/2014/Bizuwerk

TERGOL, AKOBO WOREDA (GAMBELLA REGION), 15 March, 2014- As the searing heat of the afternoon sun begins to ease, a group of women carrying jerry cans and plastic buckets start to descend into a small compound where they have access to clean water from two water points. The small compound is one of two sites where UNICEF has installed two emergency water treatment facilities (EMWAT kits) through its implementing partner, ZOA International, in Tergol town, in the Akobo district of the Gambella region, western Ethiopia.

Tergol is a small town by the Akobo River that marks the border between Ethiopia and South Sudan. Tergol has been under the spotlight since mid-December last year after thousands of South Sudanese asylum seekers crossed over into the town after being displaced by conflict in Africa’s youngest nation.

According to UNHCR, close to 66,000 asylum seekers crossed into Ethiopia by the beginning of March 2014. Akobo has received 34 per cent of this number, which is the second largest arrival rate after Pagak where 33,000 South Sudanese civilians displaced by conflict have entered. These asylum seekers are in a critical situation and need immediate humanitarian assistance including the provision of clean drinking water and sanitation services.

In Tergol, the host community has entirely depended on the Akobo River for its water needs as there has never been a facility to provide safe drinking water. However, this situation has been recently improved. With UNICEF’s support, EMWAT kits have been built and are now supplying clean drinking water to the Tergol community as well as to the thousands of South Sudanese asylum seekers. Water from the nearby river is purified and supplied by the first reservoir built by the emergency kit, the purified water is then transferred into a second reservoir where it is chemically treated before it is reticulated to the water access points. Each EMWAT kit has a capacity for providing 20,000 litres of clean water and the kits can be re-filled every two hours depending on the rate of demand.

Safe water for mothers and children

Nyathak Minyjang (with black dress), one of South Sudanese asylum seekers, comes to the water point at least three times a day.
Nyathak Minyjang (with black dress) comes to the water point at least three times a day. She fetches water for cooking, bathing and drinking. The emergency water treatment facility which is built with the support of UNICEF provide clean drinking water to South Sudanese asylum seekers and the host community in Tergol ©UNICEF Ethiopia/2014/Bizuwork.

While the women gather around the water points, they talk to each other as clean water fills their buckets and jerry cans. The women then help one another to balance the vessels on top of their heads.

When it is Nyathak Minyjang’s turn, a 25-year-old mother of four, she places her plastic bucket under the tap and holds the hose down to pour in the clean water. Prior to the response, Nyathak had lived on the South Sudan side of Akobo before coming to Tergol with her four children. Her only previous access to water was a river. She never imagined that she would have access to clean drinking water from a tap. “We used to drink water from a river. My children would regularly get sick and I would get sick too”, she says. “The quality of the water here is very nice.” Nyathak comes to the water point at least three times a day.  She fetches water for cooking, bathing and drinking. Most importantly, she applies the lessons she learnt about personal hygiene from community hygiene promoters. She is also keen to keep her children clean.

Nyarout Gazwech, a 21-year-old mother of two boys, is also very happy about the supply of clean water. She came from the South Sudan city of Malakal a month and a half ago, leaving her two brothers and her mother behind when the conflict intensified.  During her long trek to Tergol, she and her children had no option but to drink unsafe water. “My children were having diarrhoea after drinking the river water.  Here we have clean water and my boys will not get diarrhoea again,” she says.

Comprehensive WASH approach

UNICEF in partnership with UNHCR, the Government Administration for Refugee and Returnee Affairs (ARRA), the Gambella Region Water Bureau, and its implementing partner ZOA supports the provision of safe water to the host community and asylum seekers in Tergol. UNICEF’s response has followed its Water Sanitation Hygiene (WASH) strategy by increasing equitable and sustainable access to safe water and basic sanitation services, as well as promoting improved hygiene in Tergol.

“We are providing clean water to the asylum seekers and to the host community. Furthermore, we teach them about safe hygiene practices such as the importance of hand washing and using latrines,” says Nigussie Yisma of ZOA who is coordinating the WASH interventions in Tergol.

Apart from Tergol, UNICEF also supports WASH interventions at the entry point in Pagag and in the Lietchor refugee camp. One EMWAT kit has been installed at the Pagag entry point and is providing clean drinking water to the asylum seekers and the host community.  Similarly, five shallow water wells have been drilled in the Lietchor refugee camp to increase access to a sustainable source of clean water for the refugees.  Moreover, water purification chemicals and emergency sanitation facilities are being distributed while hygiene promoters continue teaching the community and asylum seekers about safe personal and environmental hygiene practices.

Local capacity building

A women in Tergol town, Akobo Woreda, carries water to her home.
South Sudanese asylum seeker in Tergol town, Akobo Woreda, carries water back from a water point built with the support of UNICEF ©UNICEF Ethiopia/2014/Bizuwerk

When the emergency response was launched in January 2014, community hygiene promoters were trained and they taught the community and asylum seekers about the benefits of safe hygiene practices. Furthermore, 40 communal latrines have been built in close proximity to the host community as well as where asylum seekers are staying.

“We have been taught about personal hygiene and the importance of hand washing before cooking and after using the toilet,” says Nyathak “They [hygiene promoters] also told us this can prevent our children from getting diarrhoea.”

In order to keep the facilities running smoothly, local water technicians have been trained on the management and maintenance of the water facilities to safeguard smooth operation. The water technicians are responsible for regularly monitoring the water levels and the quality of the drinking water.

Water purification chemicals and accessories are also readily available to the community.

Clean and safe drinking water is essential for life and is also bringing renewed hope for people like Nyathak and Nyarout after being displaced by the conflict in South Sudan.

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

By Sacha Westerbeek

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

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

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

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

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

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

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

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

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

Children are agents of change

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

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

Ethiopia has been an active participant in the Sanitation and Water for All Partnership. In 2013, the Ethiopian Government, with support from UNICEF, was able to establish a Sector-wide Approach termed the ONE WASH National Programme with a dedicated budget line for sanitation in the Government of Ethiopia’s treasury for sanitation.

Since 1990, the country has made substantial progress in improving access to water supply and sanitation coverage. However, millions of people still remain without access to safe water and sanitation services. In 2010, out of a population of over 80 million, about 46 million were without access to improved water supply and sanitation and Ethiopia had the highest number of people (38 million) practicing open defecation  among African countries.[2] The lack of access to adequate clean drinking water and sanitation services has a dramatic impact on the lives of people, especially women and girls, and undermines efforts to improve health, nutrition and education outcomes.

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

It is up to ALL of us

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

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


[3] Source: WASH Inventory 2012

[4] Source: WASH Inventory 2011

UNDSG Jan Eliasson washes hands with ashes in Ethiopia

By Sacha Westerbeek

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

HAROJILA FULASO, OROMIA REGION, 1 February 2014 – “The health extension worker told us to wash our hands with soap and if we don’t have soap, we can use ashes. So, when I have not been able to buy soap, this is what we use to disinfect our hands”.

Ms Shure Gore takes the can of ashes and hands it to United Nations Deputy Secretary-General Mr Jan Eliasson. He gently takes out some of the greyish substance and rubs it before rinsing it off with the water from the jerry can attached to the tree, next to the family’s’ latrine. “My hands are clean,” he exclaims while the family is observing his actions closely.

In Ethiopia’s Oromia region, the hygiene and environmental sanitation activities are the main focus for household and community level interventions. The woreda (district) latrine coverage is about 70 per cent. In Harojila Fulaso, however, 80 per cent of the households have reached the status of becoming a “model household.”

The model family is the approach adapted by the Health Extension Programme to improve household practices. After 96 hours of training and adopting 12 of the 16 packages, a family graduates to become a so-called model family. The health extension package is categorised under three major areas and one cross cutting area: namely Hygiene and environmental sanitation; family health services; disease prevention and control; and health education and communication.

The Lemma-Buchule family, in which Ms Shure Gore is the driving force, has a latrine with hand washing facilities and dry and liquid waste disposal pits. In addition, the household has adequate aeration and light and the animals are kept separate from the living area – to name a few requirements of becoming a model household.

The family lives a couple of minutes walk away from the health post. Ms Abebech Desalegn is one of the two health extension workers running the facility. The health post provides services to 736 households and 3,532 inhabitants – ensuring that health care is delivered at the doorstep. “I know Shure and her family very well,” says Ababech. “The family consists of 10 members, including eight children between the ages of 3 and 22 years old. They come here when they need vaccine, a new mosquito net or when they are ill.” She has assisted the household in reaching the status of “model household”. “They now inspire others to do just like them, they are an example to the community,” Ababech explains.

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

Health extension workers deliver health care at the doorstep

Ababech is a government salaried and trained health worker, under the Health Extension Programme, an innovative community based programme which started in 2003. To date, 38,000[1] health extension workers have been deployed in nearly all rural villages. The programme aims to create a healthy environment and healthy living by delivering essential health services to communities.

UNICEF supports the Health Extension Programme in different dimensions. Training of HEWs to improve their technical competencies in delivering health and nutrition services, procuring and distributing of vaccines, medicines and supplies, ensuring availability of job aids at health posts, have all led to increased coverage of health and nutrition services at community level.

In addition to prevention and health promotion services, health extension workers are also now involved in case management of pneumonia, diarrhoea and severe acute malnutrition in more than 90 percent of health posts.

The Deputy Secretary-General, Mr Jan Eliasson studies the charts on the wall of the small health post. “You are doing an excellent job here,” he says while impressed with the statistics and service delivery provided by this health extension post.

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

Abebech explains that she is required to split her time between the health post and the community. Community outreach activities include working with model families, community groups or households. “Every day I’m very busy she continues. When I’m at the health post I provide basic services such as: immunisation; health education; antenatal care; family planning; delivery and postnatal care; growth monitoring and community treatment of severe acute malnutrition; diagnosis and treatment of malaria, pneumonia and diarrhoea; treatment of eye infections; treatment of selected skin problems; Vitamin A supplementation; first aid and referral of difficult cases… just to name a few of my daily activities.”

In addition, this young health worker, who has worked at this health post for the last seven years, has done thirty deliveries and many more postnatal checks. “I’m happy UNICEF provided delivery beds, but I also need clean water. Every single day I walk to the nearest water point, because I need clean water for the latrine and health interventions.”

WASH interventions at Health Post level

To date, UNICEF has provided a total of 160 health posts with a complete WASH package.  This includes: providing capacity in the design of WASH facilities, construction of water supply and sanitation facilities and hygiene promotion to health institutions through construction and disseminating information on hygiene and environmental sanitation. In addition, WASH interventions at the health post level include: the provision of a hand-washing stand; a septic tank; incinerator; placenta pits; general solid waste and sharp pits.

“I’m lucky having clean water nearby,” says Ababech. “But too many of my colleagues really struggle, especially those who work in remote and dry areas.”

Ethiopia has been an active participant in the Sanitation and Water for All Partnership. In 2013, the Ethiopian Government, with support from UNICEF, was able to establish a Sector-wide Approach termed the ONE WASH National Programme with a dedicated budget line for sanitation in the Government of Ethiopia’s treasury.

Although good progress is underway in the area of water, sanitation and hygiene, still some challenges remain. In 2010, out of a population of over 80 million, about 46 million were without access to improved water supply and sanitation and Ethiopia had the highest number of people (38 million) practicing open defecation among African countries[2]. The lack of access to adequate clean drinking water and sanitation services has a dramatic impact on the lives of people, especially women and girls, and undermines efforts to improve health, nutrition and education outcomes.

Mr Jan Eliasson underlines the need for clean water and sanitation. “We really must act now. We have to talk about sanitation and improving access to toilets and clean water. We also must change attitudes and behaviours,” he emphasises with passion.

Ms Gore fully agrees. “Since I have a latrine and we wash our hands at critical times, I see less disease in my family. The children go to school and we work on the land – for this, we need to be healthy.”

Ethiopia: Ending newborn deaths

This is a re-blog from girlsglobe.org

By Haile Gebrselassie, Save the Children Child Ambassador, two-time Olympic Champion and four-time World Champion.

Credit: Jiro Ose/Save the Children

Credit: Jiro Ose/Save the Children

Ethiopia, my country, is the cradle of humanity. The first stone tools were found here and Lucy, a 3 million year old skeleton and the first Homo sapiens, was found in the village of Hadar, on the southern edge of the Afar triangle.

Our history is ancient and continuous. We are fiercely proud of the fact that we are the only African nation never to have been colonised. But like every nation our history is chequered and we have suffered.

In 1983, when I was ten years old, the first flames of hunger were flickering throughout Ethiopia. It was that year my mother died due to birth related complications. In those days, in my village, this was not very unusual.

My mother died following birth complications. The women of the village tried to help, but when I think back I realise that none of them really knew what they were doing.

In so many ways, we have made progress in saving the lives of mothers and their newborns since then. Today, the number of children dying before their fifth birthday has been halved since 1990.

The number of women who die in childbirth has declined by almost a third – that’s millions of kids who get to grow up with a mother and millions more getting a chance at life.

What we have achieved so far must be celebrated. The actions of our governments over the last fifteen years have brought about the greatest leap in children’s wellbeing survival in history. This change has been brought about by bold political leadership at the highest levels.

But even today, half of all women giving birth in sub-Saharan Africa give birth without any skilled help. Globally, 2 million women also give birth completely alone.  A direct result of this lack of skilled health workers, as Save the Children has shown in a new report today, a million newborn babies die on their first day of life. A single baby’s death is one death too many.

The good news is that we know what needs to change: ensuring every birth is supported by quality trained health care workers who have the expertise to help premature babies survive, deal with birth complications and prevent newborn infections can, with some wider steps, help prevent as many as two-thirds of these newborn deaths.

Every country in the world must ensure that all mothers-to-be have access to a midwife with life-saving medicines and equipment.

Africa is finally a continent on the rise – and children are the key to our continuing success. I want them to grow up to be the doctors, lawyers, teachers and even athletes that they are meant to be. The race for survival is a marathon, not a sprint. We are in this for the long haul. Like long distance running, this will take endurance, commitment and conviction. We have seen the incredible results when we put our minds to it.

The prize for these children is much greater than an Olympic medal. They get a fair chance at life, regardless of how poor their parents are, where they live or whether they are a boy or a girl. This is a race that we can win.