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The Female “Army” Leading Ethiopia’s Health Revolution

Tigrai Online
May 18, 2012

Ethiopia, Africa’s second most populous nation, is also overwhelmingly rural. Bucking the global trend of mass migration to cities, over 80 percent of Ethiopians still live in hard-to-reach areas. This isolation presents a formidable challenge for the government’s health sector, which, to complicate matters further, suffers from a severe shortage of doctors and health professionals. In a country of over 80 million, there are only 2,152 physicians—one for every 36,000 people.

Around a decade ago, the infant mortality rate in Ethiopia was nearly 10 percent, and the rate of those dying before their fifth birthday topped 16 percent, both statistics among the world’s highest. At a time when world leaders were gathering to set ambitious targets to raise the bar on global health with the Millennium Development Goals, Ethiopia’s numbers demanded attention.

And while progress in child health has been made—over the past five years, the under-5 mortality rate has decreased by 28 percent, from 123 to 88 deaths per 1,000 live births—the Ethiopian Government still considers the death rate intolerably high as one in 11 children today still do not live beyond their fifth birthday.

Finding answers to several questions was considered central to making greater gains: How do you bring quality health services to rural villages? How do you empower families to take charge of their own health? How do you encourage pregnant women to seek preventive care and dissuade them from potentially dangerous home deliveries? After babies are born, how do you ensure they are fed properly, and are vaccinated to survive those tenuous first months and years of life? How do you give mothers the information they need to improve their family’s health, including the benefits of birth spacing? When government-sponsored care is available, how do you encourage deeply traditionally people to use it?

While these basic questions barely warrant a second look within developed health systems, to the Ethiopian Health Ministry, they often represent a matter of life and death.

Women at the Center

The government’s response, according to Ethiopian Health Minister Tedros Adhanom Ghebreyesus, has been to methodically construct a “women-centered” health system “by linking leaders at the national, regional and district levels with women’s groups in every village across the country.”

The plan was officially rolled out in 2003 in the form of the landmark Health Extension Program (HEP). The government would first train a fleet of young women for a year to provide basic, largely preventive, primary health services to rural villages, and then deploy them in pairs around the country to alert communities to unhealthy practices and empower families to take charge of their own health. The program was designed to tackle both the rural access problem and the health-sector workforce gap.

The HEP works like a countrywide referral network, rippling up from its foundation at rural health posts (home base for the extension workers), to the larger, better-equipped health centers, each serving around 25,000 people. At the top of the pyramid are the country’s 122 hospitals, each staffed with at least one doctor.

Additionally, as of last year, Ethiopia’s front line—the health extension workers—began to count on even deeper levels of grass-roots support when the government-named “Women’s Development Army” was formed. These community-level volunteers are trained by the health extension workers to focus more intensively on sparking local behavior change. They make regular rounds to check on neighbors and encourage practices like latrine building and setting-up separate cooking spaces. They are from “model families” and serve as living examples that the health extension workers’ messages are being heard.

“These model families influence other families to follow suit, and the changes seen at the community level are phenomenal,” says Jeanne Rideout, health team leader for USAID/Ethiopia, which funds the Integrated Family Health Program (IFHP), a five-year project providing technical, managerial and financial support to the Health Extension Program.

The government has a lot riding on this network of women. “These development teams are being empowered to monitor health and well-being. Through the aggressive social mobilization of this massive army of health extension workers and local development teams, we are determined to bring about the fundamental grassroots change needed to achieve our MDG targets,” wrote Tedros in the forward to the Health Sector Development Plan IV, the government’s road map to improving health in the next five years.

Health from the Grassroots

Wubalem Bezabih, 25, and Fetelwork Gezahegn, 28, are two of the roughly 35,000 health extension workers the government has trained under the program to date. Their base camp, Remeda Health Post in the Southern Nations, Nationalities, and People’s Region (SNNPR) of Ethiopia, is a small concrete structure. From there, the women provide basic primary health care and outreach for around 5,000 villagers.

Source: USAID Read More-http://www.usaid.gov/press/frontlines/fl_may12/FL_may12_ETH_HEALTHWORKER.html

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