Helping health workers save Ethiopia’s youngest children

By Demissew Bizuwerk

Kejelo, Tiro AFETA, Oromia, 14 June 2018: Inside the small room of Kejelo health post, health extension worker Amelework Getachew carefully monitors her stock of medicines stacked on a small wooden shelf. She checks to make sure that an Oral Rehydration Salt (ORS), a fluid replacement used to prevent and treat diarrhoea, Amoxicillin Dispersible Tablet and Gentamicin injection, antibiotics used to treat children with pneumonia and serious bacterial infections, are available in good quantity. She cross checks the numbers on each bin card and the actual quantities on the shelf. “I can’t afford to run out of these medicines,” says Amelework, pointing towards a stock of sachets of ORS and packs of amoxicillin tablets and gentamicin injections. “They are lifesaving.”

After Amelework is done taking inventory, she collects her essential job-aids for home visits and attends to five-month-old Aziza in her home as part of her routine house-to-house visit. This way, Amelework makes sure that pregnant women and newborn babies get health follow-ups.

When Aziza was only 45 days old, she suffered from pneumonia, the common killer of infants in Ethiopia. “I was so worried when my child was sick,” says Rawda, Aziza’s mother. “She was struggling to breathe and had it not been for ‘doctor’, my child would not have survived.”

“I was so worried when my child was sick. She was struggling to breathe

Amelework, whose name also means “a golden character,” is a committed health worker. Her nine-year journey as a health extension worker started in a remote village of Kereyu Dodo when she was given the daunting task of changing people’s attitudes on a range of health-related misconceptions.  It wasn’t easy for her to convince people to dig toilets or use bed nets to keep them safe from malaria. “They used to call us names like the ‘toilet controllers’ or ‘bed net checkers,” she remembers.

CNBC Jimma, Oromia
Amelework examines five months old Aziza. When Aziza was 45 days old, she suffered from Pneumonia. But now she is growing up healthy. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

But Amelework is now dubbed ‘doctor’, a name bestowed to her out of love and respect by the village women.  She is key to the livelihoods of the community, saving mothers and newborns including little Aziza in the small village of Kejelo.

Although Ethiopia has managed to significantly reduce its under-five child mortality, newborn deaths have declined at a much slower pace.  Twenty-nine newborn babies die out of every 1,000 live births from preventable causes such as complications due to prematurity, birth asphyxia, and infections like sepsis, and pneumonia[1]. Newborn deaths also account for a greater and growing share of all deaths among children under 5; almost 44 per cent.

Supported by UNICEF, the Government of Ethiopia introduced the Community Based Newborn Care (CBNC) strategy in 2012. CBNC aims to empower health extension workers, such as Amelework, with skills to provide maternal and child health services during pregnancy, childbirth and postnatally. Heath extension workers are also trained to identify and treat newborns with severe bacterial infections or sepsis where referral is not possible. They provide treatment for sick children both at the health post and in houses during their regular visits.

“The treatment we are providing is free of charge,” says Amelework. “This is encouraging mothers to bring their children early when they are sick.  It is also helping us to save young children from serious illnesses like pneumonia.”

Amelework is trained to provide CBNC services by JSI Research & Training Institute, Inc/ The Last Ten Kilometers Project (JSI/L10K), which is implementing the programme with technical and financial support from UNICEF.  She also gets constant support and follow-up from the CBNC supervision team who regularly visit her health post to make sure that she is applying the standard operating procedures.

CNBC Jimma, Oromia6658
Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K supports Amelework with regular visits to her health post. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

“We train and support Amelework to deliver her very important work by effectively identifying sick children in the village during her regular immunization outreach work and when she is providing house-to-house postnatal care,” says Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K.  “We also monitor and evaluate her records to ensure key information is recorded and stored in the treatment book.”

Amelework is also provided with guidance and support on supply management. She keeps track of her medical supplies to avoid shortages of crical drugs that she needs for immediate use.

“Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses”

UNICEF is supporting the scaling up of CBNC services with funds from the Margaret A. Cargill Foundation. Working in coordination with the Ministry of Health, it is expected that the positive experiences observed in villages like Kejelo will be expanded to pastoralist areas.

CNBC Jimma, Oromia
Amelework is the indispensable medical person for Kejelo village mothers and children. She is dubbed ‘doctor’ by the local women for saving their children. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

A humble hard worker such as Amelework embodies Ethiopia’s hope to end preventable newborn and child deaths within this generation. “Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses,” she says, “I am a mother myself and I know the feeling.”

Aziza is growing up healthy, her mother’s wish is to see her daughter becoming a ‘doctor’, like Amelework. “She [Amelework] saved my child’s life and I want my daughter to also do the same when she grows up,” says Rawda, with eyes full of hope to see a bright future for her baby daughter.

[1] EDHS 2016

Ethiopia’s reduced child mortality rate

Not so very long ago Ethiopia had one of the worst child mortality rates in Africa but it’s managed to slash the death toll by two-thirds, three years ahead of the Millennium Development Goal’s (MDG’s).

On a recent interview with CCTV, UNICEF Representative to Ethiopia, Ms. Gillian Mellsop, said “The key heroes in reducing child mortality by two third in Ethiopia are the 38,000, mainly women government salaried, health extension workers in addition to the political commitment and the vision of the government and sustainable funding.”

See the full programme which was aired on CCTV below:

Saving the innocent: Ethiopia is keeping the promise it made to its children

By: Dr KesetebirhaneAdmasu, Minister of Health, Federal Democratic Republic of Ethiopia; Co-Chair, A Promise Renewed and the African leadership for Child Survival Initiative

Dr Peter Salama, UNICEF Representative to Ethiopia

Health extension worker Bruktawit Mulu
Bruktawit Mulu, left, Health Extension worker, counsels Wagage Finte, 35, with her infant son Eshetu Belish at home in the Kerer Kebele, Machakel distict, West Gojjam zone, Amhara region of Ethiopia, 2 July 2013. ©UNICEF Ethiopia/2013/Ose

In 2000, the world made a promise to reduce deaths among children under-five by two thirds by 2015, compared to 1990, the benchmark year for the Millennium Development Goals (MDGs). With less than 460 days left until the deadline, great progress has been made in Ethiopia.

It is worth remembering that, just last year, Ethiopia achieved the child survival millennium development goal (MDG 4), three years ahead of time by cutting under-five mortality from 204per 1000 live births in 1990 to 68 per 1000 live births in 2012.

New UNICEF figures published last week in the Committing to Child Survival: A Promise Renewed report, show that Ethiopia continues to make progress in preventing deaths among children. Presentlythe number of under-five child deaths has fallen to 64per 1000 live births and more children are living to celebrate their fifth birthday.

Ethiopia’s experience and success can show world leaders some important lessons.

The first lesson is about leadership and country ownership. Governments need to lead and countries own the commitment. It may seem obvious but, despite much rhetoric, too often development priorities are still determined in Geneva or Washington rather than by the governments most concerned. By incorporating the MDGs into its national development plan, the Growth and Transformation Plan, and setting ambitious, national targets, the Government of Ethiopia has demonstrated strong leadership and country ownership, and consistently backed its decisions with high level commitment.

Second, evidence needs to determine policy choices. About 10 years ago, in order to address the increasing urban-rural gap in access to health services, the Government of Ethiopia launched the Health Extension Programme. The package of interventions wascarefully tailored to the major causes of mortality and morbidity, with epidemiology determining the priorities.

The early years were challenging, because delivering services to more than 80 million people in a vast and diverse country is not an easy task. However, year after year, the system has becomestronger and stronger, presently deploying over 38,000 government salaried rural and urban health extension workers. Starting from a focus on basic health promotion and disease prevention, incrementally high impact curative services have been integrated into the programme.

Side by side, multi-sectoral agendas have been incorporated to address root causes of childhood disease, such as food and nutrition security and water and sanitation. Community-based treatment of diarrhoea, pneumonia, malaria, severe acute malnutrition and, most recently, new-born sepsis and the inclusion of new vaccines are all now central components.

That leads us to the third lesson: that governments need to resource the plan and do so at scale. By putting the 38,000 mainly rural women on the government payroll, the government not only backed up its decision to bring health services to the doorstep of its rural people with real resources, but also sent a strong message that these health extension workers (HEWs) were here to stay. Sustainability was virtually guaranteed. The HEWs have since become a cornerstone of the health system. These young women represent the true heroes, or more precisely heroines, of this MDG story.

Members of the health development army-Kilte Awlalo District-Tigray Region
Members of the health development army who have come to discuss health service related issues with the Japanese Ambassador and UNICEF Representative to Ethiopia at a health post in Kilte Awlalo District, Tigray Region ©UNICEF Ethiopia/2012/Getachew

Prompted and encouraged by the success of the Health Extension Programme, Ethiopia has recently embarked on a new social mobilisation scheme which is referred to as Health Development Army (HDA).  HDA is a network of women volunteers organised to promote health, prevent disease through community participation and empowerment. The HDA has effectively facilitated the identification of local salient bottlenecks that hinder families from utilising key Maternal, Neonatal and Child Health Services and to come up with locally grown and acceptable strategies for addressing ongoing issues.  To date, the Government has been able to mobilise over three-million women to be part of an organized HDA.

But Ethiopia could not have done this alone. The fourth lesson is that international partners need to support the vision. In the concerted effort to save children’s lives, partners have played a key role. The bilateral government donors, the World Bank and UN agencies, NGOs and civil society, philanthropic foundations, and the private sector, have all played a key role through their funding, programmatic, operational and technical assistance, and their belief that Ethiopia could achieve its goals. Thanks to these coordinated efforts, Ethiopia has slashed child mortality rates. In 1990, 1 in 5 Ethiopian children could be expected to die before reaching the age of 5. Today, the figure is closer to 1 in 15. Well over 1 million children have been saved during this period.

While we deserve to celebrate our accomplishment, we also need to remind ourselves that we have a long way to go, because close to205,000 children under five years of age are still dying every year and nearly 43 per cent of these children are dying in their first 28 days of life. This means that more than 500 Ethiopian children die every day, mostly from preventable diseases. We also need to further address disparities in the delivery of services between rich and poor, urban and rural, pastoralist and agrarian areas, able and disabled and women and men. We also have to work hard to increase the quality of services rendered.

But Ethiopia has shown that a poor country, once only associated with famine and conflict, can become a leader for global health and development. The country is on a trajectory to bend the curve and achieve a major goal of “A Promise Renewed”, which is reducing the level of child death to 20 under-five deaths per 1000 live births by 2035.​  For Africa, there are no longer any excuses.

Health Extension Workers: Key to Reducing Malnutrition in Ethiopia

Eneayehu Beyene and Tena Esubalew, helth extention workers Amhara rigion of Ethiopia.
Eneayehu Beyene and Tena Esubalew, Health Extension Workers in Delma kebele of Machakel woreda Amhara region of Ethiopia. Preparing their monthly report on community based nutrition activities to submit to the health. ©UNICEF Ethiopia/2014/Tsegaye

AMHARA REGION, 3 April 2014- Tena (meaning health in Amharic) Esubalew, 25, and Eneayehu Beyene, 27, are the heroines of Delma kebele as they have become the health confidants of the community. Delma Kebele (sub district), which is located in Machakel woreda (district) in the Amhara Region in northwest Ethiopia. Delma is a community 10 kilo meter from an asphalt road with a population of 4,733. As part of the EU funded Africa Nutrition Security Project (ANSP), UNICEF launched a community health programme (2012-2015) in 20 districts across three regions of Ethiopia to help the Government boost the nutritional status of children under two in communities like Delma where child malnutrition has been alarmingly high.

Key to the programme’s success has been the role of community Health Extension Workers (HEWs). From Delma, Tena  and Eneayehu have received intensive training with the support from UNICEF on nutrition so they can effectively carry out health extension duties.

“It is clear to us that three years ago no-one in this community could identify if a child was malnourished or not, this problem has been recently solved through the programme’s awareness strengthening on nutrition,” says Eneayehu

Breast Feeding-Tena Esubalew Health Extension Worker coaches Etenesh Belay positioning of the child for effective breast feeding
Tena Esubalew Health Extension Worker coaches Etenesh Belay positioning of the child for effective breast feeding Amhara rigion of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

Eneayehu and Tena spend most of their days walking between households in Delma, visiting young mothers in the community and engaging them about the importance of child nutrition. They are trained to identify mild and moderate malnutrition and also growth faltering – based on which they provide age-tailored counselling. Additionally, they can diagnose if a child has Severe Acute Malnutrition (SAM) with or without complications. If a child is suffering from SAM with complications then the health extension workers will quickly have them referred to a health centre in the nearest town.

The health post where Tena and Eneayehu  work is  situated on top of a hill surrounded by open fields and grazing livestock. It is a busy hub frequented by the community’s young mothers, who are eager to learn about their children’s health status. The walls are plastered with graphs charting the health and development of the community’s under-five children. It is here that growth monitoring of all the community’s children under-two-years is conducted on a monthly basis and compared with World Health Organisation growth standards.

Breast Feeding-Yedeneku Aynalem 38 with her son Barkelegn 10 month
Yedeneku Aynalem 38 with her son Barkelegn 10 month, who is benefiting from community based nutrition Machakel woreda Amhara region. ©UNICEF Ethiopia/2014/Tsegaye

Yideneku Aynalem, 38, reaches up to a mud shelf in her hut and retrieves an illustrated booklet. “This is a very important document”, she says carefully opening the page to reveal a colourful chart. The HEWs have distributed  the materials printed with the support of UNICEF throughout the community to enable lactating mothers to track their child’s weight. Yideneku points to a graph and traces with her finger a green upward curve signifying the trajectory of a healthy child’s development based on optimum height and weight measurements. She explains with a smile how her 10 month old child Barkelegn Walelign’s growth has started to correlate with the green line on the chart. “I have been given the knowledge and it is now my responsibility to keep putting this learning into action so that my child can remain strong and healthy”, she says. Yidenku’s child is one of 270 children under-two years of age that have benefited from the EU-UNICEF supported package of high impact interventions in Delma.

The community results are encouraging: the rate of underweight young children has reduced from six per cent to one per cent in two years. “At the start of the programme, six children in the village were diagnosed with Severe Acute Malnutrition (SAM) – this year only two children suffered this extreme health condition”, says, Tena.

Sudan and its partners learn how Ethiopia brings nutrition and health to doorstep of its people

By Sylvie Chamois

Team of visitors from Sudan getting a briefing on the Health & Nutrition programme
Salwa Abdelrahim Surkati Hassan, FMOH nutrition director, Nada Yahya Omer Hamza, WHO IMCI coordinator and Naglaa Osman Khidir Babikir, UNICEF nutrition officer visiting Tula health post in Babile woreda, East Hararghe zone of Oromia region ©UNICEF Ethiopia/2014/Gemeda

From the 24th to the 28th of March 2014, the Ethiopian Federal Ministry of Health (FMOH) and UNICEF Country Office had the pleasure to host a team from Khartoum composed of the Sudanese FMOH (planning, nutrition and IMCI[1] departments), WHO, WFP and UNICEF.

The objective of the visit was to learn how Nutrition has been integrated in the Health system and how the Government of Ethiopia managed to bring Health & Nutrition services to the doorstep of its people.

Following an opening meeting with the State Minister of Health, H. E. Dr Kedede Worku, the team proceeded directly to the domestic airport heading to East Hararghe zone of Oromia region. They were introduced to the programme by the Zonal Health Department’s head, Ato Ali Abdulai, before visiting Babile and Gursum woredas.

In the two districts, they were able to visit and discuss with the one-to-five network, a team of Health Development Women; female Health Extension Workers working in health posts; Health Workers in health centres and finally, nurses and doctors in Bessidimo hospital.

Team of visitors from Sudan getting a briefing on the Health & Nutrition programme
Team of visitors from Sudan getting a briefing on the Health & Nutrition programme in Babile health centre, Babile woreda, East Hararghe zone of Oromia region on March 25, 2014
©UNICEF Ethiopia/2014/Gemeda

In Harare, Frehiwot Mesfin presented a project managed by Haromaya University, with the support of UNICEF and FAO, to produce complementary food for children under two years of age using exclusively locally available ingredients.

Back in Addis Ababa, the team had the opportunity to visit the local producing factory for Ready-to-Use Therapeutic Food[2], Hilina PLC.

On the last day, during the debriefing meeting at the FMOH with Ato Birara Melese, head of the Nutrition unit, the visitors appreciated having been able to see all levels of the Health system, from the Federal Ministry down to the households with the one-to-five network. They said that they were impressed by the very well organised and functional system and confident that they can adapt the Ethiopian experience to integrate child and maternal Health & Nutrition to the lowest level. Sudan is working hard to accelerate the achievement of the Millennium Development Goal 4 – to halve child mortality by 2015.

Ethiopia’s model families hailed as agents of social transformation

Ethiopia is boosting its healthcare statistics by enouraging rural households to adopt and disseminate a range of good habits

by The Guardian

Wudinesh Demisse, right, and her model family, part of the Ethiopia’s so-called health development army. Photograph: Lauren McKown/Pathfinder International

Wudinesh Demisse raises her hand above her head, showing off the matchstick-sized birth-control implant embedded just beneath the skin of her upper arm.

Wudinesh, 28, is a farmer in rural West Arsi, in Ethiopia’s central Oromia region. With three children already, Wudinesh says it is time to stop. “For me, three is enough,” she says, through a translator. “If they are too many, they are too expensive.”

Wudinesh, who lives in a small village 200km south of the capital, Addis Ababa, is one of millions of Ethiopian women who have gained access to modern forms of birth control over the past decade. Today, her local health post stocks a range of products, from condoms and pills to longer-acting injections and implants.

Ethiopia is increasingly touted as a family planning success story. The government, which has made maternal and child health national priorities, is proud of its statistics – the country’s contraceptive prevalence rate, for example, jumped from 15% in 2005 to 29% in 2011 – and says efforts to reach remote, rural areas lie at the heart of its success.

Along with trained, salaried health extension workers – all of whom are female, a step to make families more comfortable with door-to-door visits – thousands of volunteers have been enlisted nationwide in the government’s “health development army”. Read more

Simple, Cheap Health Remedies Cut Child Mortality In Ethiopia

Health extension worker Bruktawit Mulu
Health extension worker Bruktawit Mulu ©UNICEF Ethiopia/2013/Ose

By NPR

Poor countries are starting to realize something that richer ones sometimes forget: Basic, inexpensive measures can have dramatic impacts on the health of a country. And they can save thousands of lives.

Take, for instance, the situation in Ethiopia.

The country used to have one of the highest rates of child mortality in the world.

“If you were a kid born in 1990 [in Ethiopia], you had a 1 in 5 chance of not surviving to your fifth birthday,” says Peter Salama, who directs UNICEF’s efforts in Ethiopia.

Since then, the country has improved that survival rate by about 60 percent. “So [Ethiopia has made] a tremendous achievement in the space of two decades,” Salama says.

This progress isn’t a result of expensive international aid or the recruitment of foreign doctors into Ethiopia. Instead, the country has invested in simple, bare-bone clinics scattered around the country, which are run by minimally-educated community health workers.

Foos Muhumed Gudaal is one of 35,000 rural health extension workers in Ethiopia. She practices at a post in the village of Walgo Yar in the eastern part of the country. The clinic is a simple, cement building with only two rooms: one for Gudaal to live in and one that serves as a consultation room. There is no electricity. There are no lights.

Gudaal’s role at the post is a bit like the old image of a small-town pediatrician. But she isn’t even a nurse. Instead, Gudaal, along with all the other health extension workers, has gone through a special, one-year training program.

Her salary also isn’t anywhere near that of a pediatrician. She earns roughly $35 each month.

But Gudaal can still treat the diseases that often cut a child’s life short in Ethiopia. And she can make sure kids in the village are up to date on their vaccines.

One of the main conditions Gudaal deals with is malaria. The parasite kills about 600 million people worldwide each year, and the vast majority of those deaths occur in children under age 5. Gudaal can diagnose and treat most malaria cases at her health post.

She can also easily treat diarrhea and respiratory infections, two other major killers of children in the developing world.

Because there is no electricity at the clinic, Gudaal has to rely on a kerosene-fired refrigerator to keep her vaccines cold. The aging fridge sits in a small shed next to the consultation room.

Gudaal lifts several vaccine vials out of the fridge. She not only administers immunizations, but she also keeps records for who in the village needs shots and boosters.

Since being launched a decade ago, this health extension program in Ethiopia has had a huge effect in the country, Salama says.

Quite simply, it has saved lives. “Children are now treated right across the country on a scale that was previously unheard of around the world,” he says.

“Take acute severe malnutrition, for which Ethiopia was famous in the ’70s and ’80s,” Salama says. “Today, successfully, these same lady health workers treat 300,000 children [each year] for severe malnutrition.” Previously, these children would have most invariably died, he says.

Despite these improvements, Ethiopia still has a long way to go when it comes to children’s health. Malnutrition is still the leading cause of death for children under age 5 in the country. Nearly 20 percent of Ethiopian babies are born underweight, weighing less than 5 1/2 pounds. And about 40 percent of kids don’t reach a normal height because of malnutrition.

But, Salama says, the beauty of Ethiopia’s health extension program is that it’s sustainable. It’s run by the government, not a foreign foundation or agency. So as long as there’s the political will, it’s able to reach kids across the country.

Original Story http://www.wbur.org/npr/255448192/simple-cheap-health-remedies-cut-child-mortality-in-ethiopia 

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