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.

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