Mobile Health and Nutrition Teams Save Lives in Remote Drought-affected Areas

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Under the shade of a tree and settled on plastic mats, the mobile health and nutrition team (MHNT) is in full operation. An array of bright coloured fabric represents the crowd of mothers and children gathered around them, all in varying stages of screening, vaccinations, treatment or referral. In the rural Somali region, Gashamo woreda (district), 63 km off the paved road, the MHNT has been operating as a static clinic for the past two months as part of the response to the Horn of Africa drought caused by the negative Indian Ocean Dipole (IOD).

MHNT in Somali drought 2017
The MHNT in full operation with MHNT team leader Mohammed Miyir at its centre in white. ©UNICEF/2017/Tesfaye

Facing food and grazing shortages and in need of water, drought-affected pastoralist families and their livestock began traveling long distances in search of water. As one of the most vulnerable communities across the country, unique interventions are required to provide them a safety net in times of emergency.

The Government of Ethiopia (GoE) has provided a swift response by setting up five temporary sites in Gashamo woreda, which offer health and nutrition services as well as food and water. This arrangement is crucial and specific to pastoralist communities, where families are scattered across hundreds of kilometres of harsh semi-arid desert.

28-year-old Mohammed, a senior clinical nurse by training, works alongside two nurses who treat and manage cases, in addition to two health extension workers (HEWs) who screen patients and conduct community health education. Mohammed and his team were assigned to this hotspot priority one site by the Somali Regional Health Bureau (RHB), following a recent updating of hotspot woredas, which are most affected by malnutrition according to the latest meher seasonal assessment.

“My family is 200 km away and I am not sure when I will visit them. Probably when the drought is over,” says Mohammed. “But our work here is very important, there are thousands of people who otherwise would not have access to any health services. Especially during a severe drought, our services save lives.” He explains further that while the Ethiopian health system is highly developed, utilizing catchment areas for a tiered health facility structure is not feasible in pastoralist communities.

“Pastoralists are always on the move in order to provide grazing and water for their livestock, so expanding health facilities in these remote areas does not add value. Right now, there are over two thousand families in this location, so why not set up a permanent health post to serve them? Because perhaps in one or three months, there will be 20 families here, or none. Across the region, there are remote areas where people come and go, so the normal health system does not serve its purpose [in this context].”

MHNT in Somali drought 2017
Mohammed, 28-years-old, explains the unique pastoralist context at Al Bahi temporary site where over 2,000 households have gathered. ©UNICEF/2017/Tesfaye

This is the reason MHNTs were created and why they have helped improve the health and nutrition situation of pastoralist families for the past decade. From regular risk assessments and categorization of vulnerable woredas by the Ministry of Health and partners, including UNICEF, MHNTs are deployed for a minimum of three months, depending on the emergency situation and needs. With the onset of a sudden disease outbreaks or other emergencies, the MHNT will temporary relocate to the affected area to provide initial rapid response and then return to their assigned woreda.

The MHNTs work six days per week, traveling from location to location and setting up mobile clinics along the way. They make contacts with social mobilisers, volunteers from the community, to ensure everyone knows the day and place where the MHNT will be. The social mobilisers know their community well, even those families that are spread out across a vast terrain, and they guarantee everyone receives the information. Every time, a crowd of mostly women and children are gathered, anticipating the needed treatment and care.

The MHNTs conduct screening for malnutrition, provide routine immunizations and basic healthcare treatment, ante-natal care and emergency delivery services, common illness management, health education and promotion, as well as refer patients to higher levels of care as and distributing household water purification supplies as necessary. When the latter happens, they often utilize their vehicles to bring patients to the nearest health facility, as it would be near impossible for timely care otherwise.

UNICEF supports the GoE’s MHNT programme with the generous effort from donors, through vehicle provision, transportation allowances, emergency supplies and technical guidance. There are 49 MHNTs currently operating in Somali and Afar regions, moving around their respective regions according to the identified need.

Our visit is cut short as the team has just identified two children who are not responding to malnutrition treatment – as per the protocol, severe acute malnutrition (SAM) cases should return to the MHNT on a weekly basis to record progress or be referred to higher levels of care. These cases have been escalated to SAM with medical complications and the mothers are encouraged to gather their belongings and take the MHNT car to the nearest stabilisation centre about 30 km away. “Working in a static clinic may be nice,” says Mohammed, who has been working on the MHNT for nearly seven years, “and over time, as Somali region becomes more developed, the health system may be able to cover all areas. But until then, I know there is a great need and I am proud to be working on this team.”

In South Omo, Education- a gateway for children but a competition for parents

By Zerihun Sewunet

Students attend class at Alkatekach primary school

DAASANACH, Southern Nations, Nationalities, and People’s Region (SNNPR), 18 December 2013 – Omorate village in South Omo Zone of the SNNPR is a semi-arid area where the Daasanach tribes live. Their houses are dome-shaped made from a frame of branches, covered with hides and patch works. These houses are scattered along the site where the Omo River delta enters Lake Turkana of Kenya. Most tribes in South Omo are pastoralists. In Omorate too, the people’s lives are bound to the fate of their herds of cattle, sheep and goats that they raise.

Children play a critical role in the pastoralist lifestyle. Boys as young as 6 years old start to herd their family’s sheep and goats, while girls marry very young so parents get additional livestock through dowry. Therefore, parents do not send their children to school. In the Daasanach tribe, education is considered as a luxury. For teachers of Alkatekach Primary School this is their biggest challenge. They use the Alternative Basic Education (ABE) system to cater for the need of the children. The Alternative Basic Education system responds to the urgent need for an education that suits the special needs and constraints of pastoral life. It provides flexible school hours, allowing pastoral children fulfil their household responsibilities of herding cattle to find water and pastures while still finding time for school.

Meseret Chanyalew, Director of the school, explains there is an increase in the number of children from last year because of the continuous effort to enroll and retain students. “We enroll students throughout the year to encourage children to come to school. We also discuss with the community to create awareness on education by going house to house to convince parents to send their children to school.”

Located five kilometers from Omorate town of Kuraz district, the Alkatekach Primary school has only 79 registered students for the 2013/2014 academic year and the highest grade these students can reach is fourth grade. This is because there are no classes set up above the fourth grade.

The Lucky ones in the family go to school

Temesgen Qoshme, 14,  attends a class in Alkatekach primary school14 years old Temesegen Koshme is a third grade student in Alkatekach Primary School. He is sitting in a class exercising the conversion formula for different measurements. His favorite subjects are mathematics and social science. Unlike Temesgen, children his age are taking care of family cattle or are married off. “I prefer coming to school than looking after my parents’ cattle. Alkatekach is where I grasp knowledge,” says Temesgen, “When I go to school in the morning my brother and sister look after the cattle. After school, I go straight to the field to take over”.

Temesgen’s parents told him that his younger sister is waiting to be married off, “I tried to explain that she has to come to school, but they did not listen to me” says Temesgen concerned about his sister’s future. Temesgen is one of the lucky ones to be enrolled this year. For him school is his happiest place.

Agure Amite, a father of twelve, living in Omorate village, sends two of his children to Alkatekach Primary School. When asked why the others do not go to school he says, “Some of them have to look after my cattle and others are not ready for school because they are below 10 years old.” Some parents in the Daasanach tribe send their children to school when they reach age 10. However, nationally children start school at age 7.

Alternative Basic Education (ABE) accommodates the pastoral children

Children, not students, play at Alkatekach Primary SchoolThe 2012 study on situation of out of school children in Ethiopia shows that SNNPR has 46.5% of out of school children making it the third highest region after Oromia (49.2%) and Amhara (48.7%).

With the support of UNICEF and the generous donation of US$240, 000 received from ING the Daasanach tribe now has ABE centers close to in their area. In addition to the construction of ABE centers, ING’s support also helped to provide furniture, training for ABE facilitators and education materials to pastoralist and economically disadvantaged children. For Meseret and her colleagues at the Alkatekach Primary School, this means increasing the schools capacity up to sixth grade means that children like Temesgen will be able to receive education within their community for the next two years.