Mobile Health and Nutrition Teams Providing Crucial Services for Pastoralist Mothers As They Cope with Drought

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Mutas does not look at his mother. He is not looking anywhere, rather he lays still, his unfocused pupils covered occasionally by heavy eyelids. While we talk, his mother, Bedra Dek, keeps her eyes entirely on him. Her one-year-old son is suffering from severe acute malnutrition (SAM) and despite the food and water shortage and her two other children, she explains that all her thoughts are focused on him improving.

“When your child is well, spiritually you feel happy. This is what I am waiting and hoping for. Nothing else is in my mind except this,” Bedra speaks softly, her eyes never wavering from her son.

About six months ago, Mutas became sick with a cold. Since then, he has fought that illness and intermittent diarrhoea while they lived in remote rural areas. Living in remote areas means even farther than where we are now, which is over 300 km from the regional capital and 63 km off the paved road through desert sand – no roads. Bedra walked yet another 15 km to the settlement just outside Al-Bahi kebele (sub-district) after hearing that there was a mobile health and nutrition team (MHNT) providing lifesaving services. She knew Mutas was not improving, and indeed, shortly after her arrival, he had become lethargic and largely unresponsive.

MHNT in Somali drought 2017
Bedra Dek, 21-years-old, looks at her one-year-old Mutas Abdulahi, who is ill from malnourishment. ©UNICEF/2017/Tesfaye

At 21-years-old, Bedra has 7- and 4-year-old daughters in addition to Mutas. They are a pastoralist family, living in a rural village and often traveling vast kilometres in search of water and grazing land for their livestock.

While the semi-arid Somali region is often dry, the drought brought on by the negative Indian Ocean Dipole (IOD) in the past few months is beyond anything Bedra has experienced. Her family’s herd of over 200 goats and sheep is now down to four, and their physical appearance is too poor to sell in the market.

Upon arriving in Al Bahi, she went to the MHNT, which has temporarily set up as a static clinic in the site to service the hundreds of families in the area. MHNTs were initially set up over a decade ago in this region as a unique and necessary component of the emergency health service delivery system to reach nomadic families such as Bedra’s. They respond to disease outbreaks, provide routine immunizations and basic healthcare including treatment of common illnesses, conduct screening and manage uncomplicated cases of malnutrition as well as refer to higher levels of care as necessary. Here, the team has encountered high levels of malnutrition and the majority of children have low immunization status. The team is both responding to emergency care needs as well as conducting mass immunization and other preventative measures to ensure that a temporary settlement like this does not create further disease and suffering.

Once a child is diagnosed with SAM, they are provided with ready-to-use-therapeutic-food (RUTF) and medications which should help them to quickly improve. To ensure progress, mothers are instructed to come weekly to have their children checked. We meet Bedra, as she waits with Mutas for his weekly check.

MHNT in Somali drought 2017
The homes of pastoralists gathered at the temporary Al Bahi site starting from December 2016, in Gashamo woreda, Somali region. ©UNICEF/2017/Tesfaye

UNICEF continues to support the GoE’s MHNTs through vehicle provision, transportation allowances, emergency supplies and technical guidance. UNICEF emergency health and monitoring consultant, Kassim Hussein, was present when Mutas was referred. When asked about his role, he explained how he roves around the region providing technical support. “During emergencies, things may be done in a haste, there may be staffing or technical knowledge gaps, or the situation may reach extreme levels and the team is too busy to report. I make rounds to all the teams, providing technical support and ensuring standards of care and supplies are available at adequate levels. I then report back to UNICEF and the regional health bureau,” explains Kassim.

Now Mutas is being seen by Mohammed Miyir, the team leader of the MHNT in Al-Bahi temporary settlement. Originally, he diagnosed Mutas with SAM; now his condition has developed medical complications, making him unable to receive fluids or medicine. This development signals the need for him to be sent to a stabilization centre (SC) at the Gashamo woreda (district) health centre, where he will receive in-patient advanced care until he reaches a minimal level of improvement in his responsiveness and weight.

Bedra is perplexed. Just minutes before they told her this news, she had said she wanted anything for him to improve. Now that it may happen, a new reality hit her. Her two daughters will need to be left behind – there is no room in the MHNT car. This is often an issue mothers out here face. With husbands caring for the grazing livestock, if they need to go to a SC for further treatment, who will take care of their other children? Some find neighbours to watch their kids, other mothers choose to stay and hope for the best, concerned about finding their children again as people are so mobile.

For Bedra, she has another 10 minutes to decide until the car will be ready for her.

Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from ECHO. The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

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She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

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The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

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Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

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Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

 

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.

Amidst risks posed by drought, joint response brings scabies under control

By Paul Schemm

ADIGUDOM, Ethiopia, 27 April 2016 – For Kibrom Mekonnen, the itching was the worst at night, all over his hands and chest and keeping him awake.

“When I slept it just kept itching,” said the 14-year-old, sitting in the examination room at the Adigudom Primary Hospital in Hintalo Wejarat Woreda (district) in the Tigray Region. “But I was afraid if I started scratching, it would get worse.”

Scabies response in drought-affected areas
Kibrom Mekonnen, 14, listens as a nurse explains how to use the special soap and medication to combat scabies. ©UNICEF Ethiopia/2016/Balasundaram

Kibrom’s instincts were right because he has scabies, a contagious skin infection caused by mites that burrow along the top layer of the skin, lay eggs, hatch and spread throughout causing terrible itching.

The real danger, however, can be in the scratching which opens up sores in the skin.

“By itself, it is irritating and itchy but it also exposes you to other infections,” explained UNICEF Heath Specialist Yayneshet Gebreyohannes. “It can result in systemic infections if left untreated.”

Drought brings scabies revival

Scabies has actually been fairly rare in Ethiopia for the past several years, but with the sharp drop in the availability of water due to the worst drought the country has faced in decades, it reappeared.

Casual contact, a handshake or even a hug, is not enough to transmit the mites. There has to be prolonged skin contact or sharing of clothes, which means that outbreaks often happen within the tight confines of homes and schools.

With less water available to wash and maintain personal hygiene, there have been outbreaks in the country.

In the Tigray Region for instance, there were 27,000 new cases reported between October last year to March this year, and nearly 10,000 of those were in Kibrom’s woreda.

Since then however, there has been a significant drop in the number of cases due to the Government leadership and solid response and also UNICEF support to prevent and treat the disease.

In addition to providing medicated soap and permethrin lotion to treat the disease, UNICEF has distributed brochures and teaching guides to educate people about how to combat it and most importantly, not to stigmatize the victims.

Stopping the itch

Kibrom thinks he was infected by a visiting relative, about his age, when the latter visited from a rural village and shared Kibrom’s bed about a week earlier.

Scabies response in drought-affected areas
Kibrom applies sulphur ointment, one of the methods used to treat scabies, to his hands. UNICEF has partnered with the Federal Ministry of Health in its scabies response and has provided permethrin lotion, medicated soap and brochures and guides to inform communities about the diseases. ©UNICEF Ethiopia/2016/Balasundaram

The nurse examines his hands where telltale rashes have appeared in the folds of the skin at the joints.

She walks him through the three-day treatment of soap and medication and promises to visit his family home to advise them on precautions to be taken and provide medication for the rest of the family.

For instance his clothes will have to be treated with boiling water, as will his bed linens and many of the fabrics in the house.

Kibrom is lucky in that his home has piped water, but when water is unavailable, health workers advise people to tie clothes into plastic bags for three days – the lifespan of the mite.

Kibrom is also lucky because his area was targeted by the information campaign so that someone at school identified his condition and explained to him what the horrific itching was all about. Otherwise, he might have just tried to endure – and possibly infected others.

“I kept thinking it was going to go away on its own,” he recalled.

The scabies response is part of UNICEF’s health, communication, and water, hygiene and sanitation  response for drought and flood-affected populations. UNICEF also provides financial support, supplies including medicines and vaccines, and technical assistance to the Government for the prevention and treatment of major causes of childhood illnesses and deaths such as acute watery diarrhoea and other diarrhoeal diseases, vaccine preventable diseases, as well as other diseases such as meningitis.

Saving a child too thin to be vaccinated

By Bethlehem Kiros

Fatima Yesuf, 25, brings her 8 months old daughter to the Metiya health center for checkup and to receive the Plumpynuts food supplementsAMHARA REGION, Ethiopia, February 2016 – Moyanesh Almerew, a Health Extension Worker in Arara Kidanemeheret Kebele (sub-district) in Amhara Region can testify to how bad the current drought in Ethiopia is for children. She is one of thousands employed as part of the nationwide Health Extension Programme, a community-based programme bringing basic health services to the doorstep of Ethiopia’s large, rural population. According to Moyanesh, they have had seen many more cases of severe acute malnutrition among children this year as compared to previous years and the cases they are receiving are worse. Among them, six-month-old, Fikir, whom Moyanesh saw during a home visit, stands out.

“You would not believe how thin she was when we first found her,” recounts Moyanesh, “She had never been vaccinated so when we tried to give her the vaccines, it was not possible because she was only skin and bones,” explains Moyanesh. When she was first brought to the Arara Kidanemeheret Health Post, the child weighed just 4.5 kg and the measurement of her mid-upper arm circumference – the criteria for identifying severe malnutrition – was 10.5 cm. She was severely acutely malnourished.

Thankfully, after receiving treatment, Fikir has gained 2kg after treatment, which included medicine and therapeutic food for several weeks, and her mid-upper arm circumference grew to 11.8 cm, which puts her in the moderately acutely malnourished range. She continues to receive outpatient treatment at the health post.

Moderately acutely malnourished children are enrolled in the World Food Programme-supported Targeted Supplementary Feeding programme through which they receive fortified blended food and vegetable oil for six months to aid their nutritional recovery. Both this and the UNICEF-supported treatment for severe acute malnutrition are routine responses which are all the more critical in a crisis.

Weynitu Demissie, 34, has a 7 months old daughter who is recovering from acute malnutrition
Weynitu Demissie (far left) walks a long distance to get to Arara Kidanemeheret Health Post where she receives therapeutic food for her seven-month-old malnourished daughter, Mastewal. ©UNICEF Ethiopia/2016/Nahom Tesfaye

Seven-month-old Mastewal is another child who has been treated at the Arara Kidanemeheret Health Post. Her mother, Weynitu, says that the drought has taken quite a toll on her family, especially on Mastewal. The child was extremely emaciated before receiving treatment for severe acute malnutrition. Weynitu walks for more than two hours over steep hilly ground to get to the health post for Mastewal’s treatment but she says it is worth all the hardship since her daughter has shown a lot of progress in the last few of months.

To Moyanesh, it is a relief to see the wonders that therapeutic food treatment does for the children. “I doubt that some of these children would have survived if they didn’t receive this treatment,” she says.

Across the country, 458,000 children are expected to need treatment for severe acute malnutrition in 2016. More broadly, 10.2 million people, 6 million of them children, are in need of emergency food assistance due to the drought. UNICEF, the Nutrition sector lead agency, continues to coordinate the nutrition emergency response. With the support of donors, UNICEF provides supplies for the management of severe acute malnutrition and supports the treatment of malnourished children through the community-based management of acute malnutrition, along with training, quality assurance and monitoring of the nutrition emergency response. UNICEF is also supporting efforts to provide drought-affected communities with access to clean water and health services to address major causes of child illnesses and deaths that have been exacerbated by the drought.

To continue nutrition emergency response activities over the coming months, additional funds of US$5 million are needed, subject to needs-based revisions. A further US$ 42 million is needed over the next four years to strengthen nutrition services and build resilience to future shocks among communities that are worst-affected by the drought.

UNICEF and EU save new-born lives in rural Ethiopia

By Efa Workineh, CBNC Project Officer, Save the Children, Ethiopia; Tadesse Bekele, Regional Programme Manager, Save the Children, Ethiopia; Hailemariam Legesse, Health Specialist, UNICEF Ethiopia; Asheber Gaym, Health Specialist, UNICEF Ethiopia  

Ginde Beret
Elias with mother Shure after completion of his new-born sepsis treatment provided at the village health post ©SCI/2015/Efa Workineh

Abuna Gindeberet Woreda is one of the eighteen woredas (districts) found in West Shoa Zone, Oromia Regional State, 182 km west of Addis Ababa, Ethiopia’s capital.

Baby Elias Suyum Belacho was born in Guro Furto health centre in Gartoke Kebele (sub district) of Abuna Gindeberet Woreda on September 20 2015.  His mother, Shure Negasa and father, Suyum Belacho took good care of Elias, the fourth born in the family, even prior to his birth.  During her pregnancy, Shure attended three Ante Natal Care (ANC) visits at the Guro Furto health centre. Unfortunately, she had not received the required post-natal visit schedule following her delivery.

When Elias was three weeks old, he attended the routine community based new-born care assessment provided as part of the community based new-born care programme of the national Health Extension Programme (HEP) package. (The HEP is a community health programme covering the whole of Ethiopia provided by two female community health workers (health extension workers) working at rural health posts, at present over 38,000 health extension workers are providing services in over 16,000 health posts across Ethiopia. The community based new-born care programme (CBNC) is one of the key public health interventions provided by HEP through extensive partner support. UNICEF is the major supporter of CBNC scale up in Ethiopia). Emushe Abebe, the health extension worker providing CBNC noted that Elias’ respiration rate was found to be 72 breaths per minutes in two counts; much higher than the upper limit of 60 expected at his age. During the assessment, Emushe asked Shure if she has noted any other symptoms that Elias has been showing recently. Shure explained that Elias had been coughing for the last two days. Thanks to her Community Based New-born Care (CBNC) training, the health extension worker correctly diagnosed Elias’ condition as new-born sepsis; a potentially lethal advanced infection in new-borns. In addition, she found out that Elias was underweight, which was caused by not enough breastfeeding.  As per her CBNC training, she classified Elias’s condition to be very severe. Shure was not aware that she had to breastfeed at least eight times per day and because she did not realise that Elias was seriously sick, she never reached out for medical assistance.

After counselling by the health extension worker, Shure agreed to start the treatment at home immediately and to continue taking Elias to the health post. 48 hours after initiating the standardised (Chart Booklet) treatment with gentamicin and amoxicillin antibiotics, the HEW assessed the status of the child and found that he was rapidly improving. By now he was physically stable:  he showed a lower breathing rate of 48/minute and he was breastfed more than 10 times a day. Following the seven days’ full course treatment, Elias completely recovered from his illness.

Elias’ mother Shure Negasa, who was not aware of her child being in life threatening condition, has promised to seriously take care for her new-born child and other children. From now onwards she will seek health care when ever needed and she will teach her neighbour’s what she experienced.

When Ethiopia along with 196 other countries signed the Millennium Declaration in New York in 2000, maternal and child health situation was bad for the majority of the population. Under five mortality rate – number of children dying before their fifth birthday from 1000 born alive- in 1990 (the beginning of measurements for the MDGs) was 222; one of the highest in the world. Many were sceptical that the country would achieve the targeted reduction of two thirds of the 1990 levels by 2015. Against all odds, the country has achieved child health target of the millennium development goals MDG 4 three years ahead of 2015 by reducing the 1990 child mortality rate to less than 68 child deaths per 1000 live births.

Clear health policy and strong implementation supported by coordinated international partnership; a large scale community health programme targeting rural villages through the health extension programme; sustained investments in health and sustained economic growth are among the reasons for this success story.

Highly appreciable as the improvements in child health are, an under five mortality rate of 68 translates to the unacceptable number of over 200,000 child deaths annually. More than 43 per cent of these child deaths occur during the first 28 days following child birth (the neonatal period) the majority occurring in the few days following birth. Breathing difficulties; premature birth and new-born infections/sepsis are responsible for the majority of neonatal deaths and most are preventable or easily treatable with currently available medical care. Access to health care is nevertheless essential to obtain the benefits of these lifesaving interventions. For the tens of thousands of new-borns born at home and far from health facilities, accessing these lifesaving interventions have been largely impossible.

To overcome this formidable challenge to access key new-born health interventions, Ethiopia in collaboration with its major child health partners including UNICEF has adopted novel public health interventions of ICCM/CBNC (Integrated community case management of childhood illnesses/ community based new-born care). ICCM/CBNC interventions rely on task shifting of key child health interventions responsible for majority of child deaths to community health workers who receive training on detection and treatment of key childhood illnesses at home or at village clinics (health posts). They also timely refer new-borns and older children with severe illnesses to higher level care.

The EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project, allocated Euro 42 million for a three-year support to maternal and new-born health to Ethiopia from 2014-2016. The EU is one of the major partners for the national scale up of ICCM/CBNC programme in Ethiopia. Since its inception in 2013, the ICCM/CBNC programme has rapidly scaled up to increase availability of CBNC services in 75 per cent of the total health posts in the country. Key interventions of the programme include training and mentoring of health extension workers on key skills of detections of new-borns and infants with illness through clear symptoms and signs and provision of essential interventions including provision of antibiotics to sick new-borns.  

Emushe Abebe, the HEW who provided the critical intervention that saved the life of Elias is one of the 2500 health extension workers who received training through EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project support. She is saving lives of many children like Elias, and teaches mothers like Shure the importance of seeking health care.

In a quiet rural area of Ethiopia, a three year old boy holds the promise of a healthy nation

By Johnny Magdaleno

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges Teshome 3 years old with his mother Kokeb Nigusse in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEFEthiopia/2015/Michael Tsegaye

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.

Today, Moges is beaming with life and colour. Three years ago, he was close to death as pneumonia and diarrhoea nearly robbed him of his life within months of his birth.

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.

Health Extension Worker checks baby Moges's breathing to determine improvement of pneumonia
Health Extension Worker Haimanot Hailu checks two month old Moges Teshome’s breathing to determine if his pneumonia has improved. © UNICEF Ethiopia/2012/Getachew

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.

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEF Ethiopia/2015/Tsegaye

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.”

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges’ and his family in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEF Ethiopia/2015/Tsegaye

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.