Mobile Health and Nutrition Teams Key to Behavioural Change in Somali Region

By Matt Sarson

DHANDAMANE, SOMALI REGION, ETHIOPIA, 23rd October 2013 – As we drive through the Valley of Marvels between JigJiga, the Somali Regional capital, and Babille, which straddles the neighbouring Oromia Region, the emerald glow of vibrant plant life sits in stark contrast to the florescent copper shimmer of the soil below. The road is smooth tarmac and carves a winding path through the sparse moonscape.

This western tip of what is classified as one of Ethiopia’s four developing regional states is currently blessed with more precipitation than its eastern extremities, but drought, regular disease outbreaks, flooding and limited access to healthcare have blighted the majority of the region for a number of years.

Adawe Warsame is a Health & Nutrition Officer with UNICEF.Adawe Warsame is a Health & Nutrition Officer with UNICEF. Having grown up in the nearby city of Dire Dawa and a Somali himself, he is well aware of the historic complications of the region.

“The issues the people face in the Somali Region are multi-layered,” he explains. “In one part of the region there is a flood, which is followed by a disease outbreak; in another, severe drought. This has a huge impact on both the health and nutrition of the people here, as well as the ability of the government to provide adequate services.

“Most regions are underdeveloped in terms of health facilities, human resources and education. It is difficult to provide even the most basic of services in many areas.”

Accessing Hard to Reach Areas

The next morning we continue along the same road through Babille towards Dire Dawa, entering the Oromia Region, before leaving the asphalt and turning back on ourselves towards the Koro kebele – a more direct access road does not currently exist.

Our driver first has to remove branches from the road, which have been placed there by the neighbouring Oromia village. After a brief exchange, in which they question why the support is being provided solely to the Somali people, they help to clear the path for us. With regional governmental offices only responsible for their own kebeles, this is a common occurrence. By working closely with the Ethiopian government, UNICEF are able to mitigate such issues and access areas that others cannot.

“UNICEF is a little privileged in terms of movement compared to other NGOs,” Adawe assures us. ” As we work closely with the Regional Health Bureau, the vehicles have special plate numbers and the staff are also from the government side.”

The MHNT helps to train Health Extension Workers (HEWs) through a 16 package programme, which includes disease prevention and control, family health services, hygiene and environmental sanitation, health education and Harmful Traditional Practices (HTPs). They also provide immunisations, deliver medicine and supplies, support Traditional Birthing Assistants (TBAs) and treat severe malnutrition. UNICEF currently supports 24 MHNTs in the Somali region. There used to be others operated by different NGOs, but due to financing restrictions these have now ceased to be operational.

As we arrive in the village, we are met by Mohamed Almur Musu, the kebele leader, who informs us that he is responsible for protecting both the people and the animals in his community. Adawe briefly explains the purpose of our visit before we begin to make our way through the village.

“We are on the border between the Somali and Oromia regions, and so have been a little neglected,” Mohamed explains at the entrance to one of the village houses. “Nowadays, we have better support and a new health facility, which makes us feel more secure. The problems we face here are many, but slowly things are improving.”

The Plight of Harmful Traditional Practices

Mohamed Almur Musu, Babile,Koro kebele lider father of 8
Mohamed Almur Musu, Babile, Koro kebele leader father of 8. ©UNICEF Ethiopia/2014/Tsegaye

One of the biggest and often most sensitive issues in the region is HTPs, such as early childhood marriage and female genital mutilation (FGM). According to the 2011 Welfare Monitoring Survey (WMS) report, the region has the third highest rate of FGM (in 0-14 year olds) in Ethiopia (31%), after Afar (60%) and Amhara (47%).

“Prior to the government intervention, religious leaders were advising us not to practice these things,” Mohamed informs us, a nervous smile directed at those around him indicating that the issue is still one he is not altogether comfortable with. “The change wasn’t really monitored though and people were still doing it.”

Beyond the obvious initial pain of the procedure, the long term physiological, sexual and psychological effects of FGM are well documented. The consequences can even include death as a result of shock, haemorrhage or septicaemia. Long-term complications include loss of libido, genital malformation, delayed menarche, chronic pelvic complications and recurrent urinary retention and infection. Girls who have undergone FGM or also prone to various complications during birth and are more at risk of contracting HIV.

“We now have a very strong community stance against it. I can confidently say that it is no longer a part of our lives here,” Mohamed exclaims proudly.

At the first Girl Summit – held on July 22, 2014, in London, and joint hosted by UNICEF – Ethiopia’s deputy Prime Minister (DPM) Demeke Mekonnen announced a package to eradicate both FGM and early childhood marriage by 2025. This is the most recent step in a decade’s long struggle, but statistics are now starting to indicate that real progress is being made and this new target is a realistic one.

Women at the Centre of the Progress

Marayma Abdiwahab,Womens group coordinator in Koro Kebele, mother of one 12-year old daughter.
Marayma Abdiwahab, Womens group coordinator in Koro Kebele, mother of one 12-year old daughter ©UNICEF Ethiopia/2014/Tsegaye

The house we are borrowing shade from is that of Marayama Abdiwahad, a confidant woman who plays a central role in the kebele’s women’s group. She has a 13-year-old daughter, Bisharo, and is clearly driven by a desire to improve the quality of life for all children in her community.

“Progress began with just a few simple steps,” she says, directing us to look around at the village as she talks. “The mobile team have taught us how to collect rubbish, to gather it somewhere and to burn it. Before, we didn’t wash our children, and our dishes and utensils were not clean, now we are also doing this.”

Although, this seems straightforward, the impact it has had on the community has been huge,

“Our children always used to get diarrhoea,” she continues. “Now, they are healthy and energetic. If anyone does get sick, we also now have the necessary facilities here to treat them.”

In addition to the hygiene aspect of the 16 package programme provided to the community, Marayama also discusses the role the women’s group has played in eradicating FGM.

“We used to perform FGM, but after receiving the 16 package we have committed ourselves to not performing it,” she says proudly. “We have discussed together the health problems it brings and have vowed to eradicate it from our community.”

When questioned about her own daughter, Marayama is defiant.

Health Extension worker, Abdulallh Abiib, 22, discuss hygine prctices with a women's group in Koro kebele.
Health Extension worker, Abdulallh Abiib, 22, discuss hygine prctices with a women’s group in Koro kebele. ©UNICEF Ethiopia/2014/Tsegaye

“If you yourselves are not ashamed, I will happily show you my daughter,” she insists, with a knowing smile. “I will never allow anyone to perform FGM on her.”

Abdullah Abiid, 22, is the kebele’s only HEW. He has been working in his role for a year now. When we meet him, he is discussing HTPs with the kebele’s women’s group.

“FGM no longer happens here,” he informs us proudly. “There is still early marriage, but now the girls are going to school and learning about this too.” At times, the progress has not been easy, but Abdullah is committed to achieving his objectives and improving life for all in his community.

“Some listen and accept what I am saying straight away, others laugh at me,” he says. “When they laugh, I don’t stop what I am doing because I know they will see what the other women are doing and follow their lead.

“They used to be ashamed to use a latrine even. When I explained that their own hygiene and the cleanliness of the home are important for maintaining the health of their children, they started to make the change.”

Part of a Bigger Picture

The progress in the level of hygiene and the eradication of HTPs is part of a bigger picture, whereby both the health and quality of life of all those in the community is improving – especially for girls.

The training and provision of clean delivery kits to TBAs has had a profound impact on the quality of birthing services, and this has been supported further by Tetanus Toxoid injections, which massively reduces the neo-natal tetanus mortality rate. The presence of the Health Post (HP) and MHNT for emergency situations also enables pregnant women to have more confidence should complications occur.

In the neighbouring Helobiyo Kebele, Ruman Ibrahim Osman, 28, is a prime example of the impact this has had. We are invited into her home where she is sat holding her 1-week old baby girl, Farhiyo. She had previously lost two children during complicated deliveries.

Ruman Ibrahim Osman with her one-week old Farhio Ahemed. Babile, Halobiye kebele“During the delivery of my previous child, the baby was in a difficult position and then got stuck,” she bravely informs us. “I was suffering for around 24 hours. The community tried to help, but finally, after a prolonged issue, the baby died.”

She had also lost another child in similar circumstances just 12 months earlier. With Farhiyo, however, the delivery was much more straight forward and she received support throughout her pregnancy.

“Initially, I met with the MHNT when they came to our village,” she recalls. “They told the pregnant mothers to come and gave us advice, vaccinations and linked us to the birth assistant. Then I got support from the birth assistant and gave birth with her help here at home.”

She is also now receiving continued support from the TBA and HEW.

” I have been told to breastfeed within the first few hours and I don’t give any additional food or water,” she says confidently. ” The mobile team are vaccinating us and our children, and treating diseases like malaria. The situation here is now much better.”

Although there is still some way to go to completely eradicate HTPs from the Somali region and to improve the health and nutrition of all, positive progress is clearly being made. For those working with UNICEF in the region, this is something that they are proud to be a part of.

“As someone with an educational background in public health, it brings me great pleasure to see these poorer communities now learning such important lessons,” Adawe exclaims gleefully back at UNICEF’s Somali regional office in JigJiga. “The people here do not deliberately want to hurt or damage their children.

“Driven by the services of our mobile teams, we are empowering them to protect both themselves and their future.”

Ethiopia boosts its efforts to end child marriage and FGM/C by 2025 at the National Girl Summit 

By Wossen Mulatu

National girl summit 2015
Participants of national girl summit 2015 at Sheraton Addis on 25 June 2015. ©UNICEF Ethiopia/2015/Ayene

25 June 2015, Addis Ababa: Today, the Government of Ethiopia reiterated its commitment to put an end to child marriage and Female Genital Mutilation/Cutting (FGM/C) at the National Girl Summit held for the first time in its capital. The Summit was held as a follow up to the Girl Summit in London held in July 2014 where the Government of Ethiopia took a heroic step by making a ground breaking commitment to end child, early and forced marriage and FGM/C in the country by 2025.

The historic National Summit in Ethiopia was officially opened by H.E. Ato Demeke Mekonnen, Deputy Prime Minister in the presence of H.E W/ro Zenebu Tadesse, Minister of Women Children and Youth Affairs with over two hundred partners drawn from Sector Ministries of Justice, Health, Education and Finance and Economic Development, UN representatives, representatives of religious council, development partners, civil societies, the private sector, members of the media and nine adolescent girls as guests of honour.

National girl summit 2015
H.E. Demeke Mekonnen Deputy Prime Minister of Ethiopia gives opening speech and officially launches National Girl Summit in Addis Ababa, Ethiopia ©UNICEF Ethiopia/2015/Ayene

“We all have an obligation to fight and eliminate harmful traditional practices that are violating the rights of girls who will take over as the future leaders,” said H.E Ato Demeke Mekonnen. “If we are expecting good results and a lasting change to tackle these issues ones and for all, we need to work in a coordinated manner and there has to be accountability. I would like to reaffirm that the Government is on top of the agenda to eliminate early marriage and FGM/C and to build a harmful traditional practice (HTP) free country by working together with all partners.”

The Government of Ethiopia has formulated policies and legal and strategic frameworks to establish an environment whereby all citizens, regardless of gender, should have the right to determine his or her own future. However, harmful traditional practices (HTPs) such as child marriage and female genital mutilation/cutting (FGM/C) are still commonly practiced in the country, due to deeply entrenched traditional norms and values that degrades the lives of girls and women.

According to the Demographic Health Survey (DHS), the national prevalence of child marriage declined from 33.1 per cent in 1997 to 21.4 per cent in 2009/10 and among children aged 0-15 declined to 8 percent in 2011.As to FGM/C, the national prevalence rate was 74 per cent in 2005, 56 per cent in 2008 and 46 per cent in 2010. Among children aged 0-14 years, 52 per cent in 2000, 37.7 per cent in 2010 and 23 per cent in 2011 which shows a consistent decline.

H.E. Minister Zenebu on her part said that the Ministry of Women Children and Youth Affairs will continue to work closely and jointly with its sector Ministries and partners to support all the efforts on the ground including community conversations and also reinforcing the laws associated with harmful traditional practices.

On her keynote address, Gillian Mellshop, Acting UN Resident Coordinator and Representative to UNICEF Ethiopia said that Ethiopia has made significant progress in developing polices and strategies as well as in building the capacity of individuals and institutions to tackle those two harmful practices. She stated, “Now it is our turn as the UN in Ethiopia to maintain the momentum and pledge our support to translate the commitment into concrete action for girls. Let us use this occasion to recommit ourselves to empowering adolescent girls through strategies, interventions and partnerships that deliver results so we can jointly end child marriage and FGM/C by 2025 or sooner.”

Let Girls Be Girls“Female circumcision is neither in the Bible nor in the Koran and it should not be associated with any religion. How could one try to cut and harm a human body that has been created as complete?” exclaimed Dr. Aba Hailegabriel Meleku, Representative of the Inter Religious Council. “Our council condemns both child marriage and FGM and we hope there will be a platform to have one voice at the federal level to eliminate both evil acts.”

At the Summit, adolescent girls’ messages were geared towards the need for more support from religious leaders and law enforcement bodies; more schools for more girls to be educated; education on reproductive health; and above all the support from boys and young men to change their attitude towards harmful traditional practices.

Dr. Kestebirhan Admassu, Minister of Health said, “We should empower, educate and protect girls. Ethiopia’s Health Extension Workers are a great example to the rural girls and women to inspire them pursue their education and give back to their communities. ”

The Ministry of Women, Children and Youth Affairs establishes a national HTP Platform in order to realise the multi-sectoral mechanisms and to ensure effective coordination and collaboration between and among different development partners involved in the fight against HTPs. This National Implementation and Monitoring Platform is established from representatives drawn from relevant stakeholders (Government line ministries, multilateral and bilateral donors, CSOs, women and youth associations and national federations, faith based organisations, and national associations) working towards the prevention and elimination of HTPs.

Finally, the event was made colourful through the viewing of a rap song entitled, “Yalemachin Get” by young rap star- Abelone Melesse, UNICEF Ethiopia National Ambassador. The song sends a powerful message on children’s rights and making the world a better place for girls by educating, protecting and not turning our back on them as they need all our support.

Moreover, an exhibition was part of the summit where local and international NGOs, CSOs and the UN working on the themes of child marriage and FGM/C showcased their work through print and electronic media.

Photos, videos and other resources can be found here