Pulling together for a healthier Ethiopia
05 September 2007
Two years ago, only two-thirds of Ethiopians had access to health services. In particular, rural areas suffered from a lack of medical facilities and health workers. There was a critical need to bring healthcare to more of Ethiopia's people.
The Health Extension Programme (HEP) aimed to do just that. Implemented by the Ethiopian Government with support from DFID and other partners, the HEP has led to more people using medical services. An example of how donors can work together to tackle a country's major health needs, the programme is being rolled out nationwide following a successful pilot in 2004.
Health inspiration from local women
At the centre of the HEP
are female health workers
operating within local communities. These Health Extension Workers (HEWs) deliver
basic services and encourage people in their neighbourhoods to take
steps to protect their health.
In each rural "kebele" (a community of about 5,000 people), two women are selected to become HEWs and enrolled on a one-year training course. Following successful completion of the course, they are sent out in pairs into their home kebeles, and paid a monthly salary by the local Government.
Professional support for each pair of women is on hand from nearby health centre staff, while supervision is provided by the local council and district ("Woreda") health office.
Female health workers are well placed to deliver the programme, since they are able to gain the trust of local women, and even serve as role models to them. By providing career opportunities to women, the HEP also helps to redress long-standing gender inequalities.
Although the rollout of the programme is not yet complete, it has already improved access to preventive healthcare services in rural areas. One woman's experience illustrates just how gains are being made.
House to house health advice
Twenty-five year old Teguada Terefe is a mother of two children and a health worker in Amhara
region. After tenth grade, she was selected to be
trained as a HEW in her district’s training school. Teguada successfully
completed the course and for almost two years has been working at her local
health post - a post that caters to 6,670 people.
Monday to Wednesday, Teguada goes from house to house to
teach community members about family planning, hygiene and sanitation, and to distribute
anti-malaria bed nets and
give first aid training. Paying visits to new mothers, she talks to them
about breastfeeding, immunisation and how to prepare nutritious meals. She also shows
households how to construct latrines and improve hygiene, and demonstrates how,
by keeping their homes clean, they can combat the flies, mosquitoes and
parasites that carry disease.
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Better access to life-saving care
On Thursdays and Fridays, Teguada stays at the
health post to provide wide-ranging advice. This could touch on family
planning, immunisation, treatment for malaria and diarrhoea, and preventing
HIV/AIDS.
Travelling up to two hours on foot every day, the work is
exhausting but rewarding. "Though I feel tired," says Teguada, "I don’t mind walking
such distances, because the community is very appreciative of our work. There is
nothing that makes me happier than seeing my community’s health
improving."
Recalling the thousands who died of malaria in the district a few years ago,
Teguada reflects on the progress that has been made. "Thanks to the HEP,"
she says, "my community members have better access to
anti-malaria drugs and bed nets, and they live in healthy home environments."
Although she takes great pride in having helped to increase the use of bed nets,
Teguada is striving for even greater improvements.
As she explains: "80% of households in my kebele now use bed nets. The remaining 20% are not
using them because of lack of awareness. I will work hard to ensure the bed net
coverage in my kebele reaches 100% next year."
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A partnership for better health
While the programme is on track to meet some of its key 2008 targets,
the
Ministry of Health
recognises that more needs to be done to achieve its overall objectives. Efforts
are underway to provide continued supervision and refresher training to existing
HEWs. At the same time, the Ministry of Health is increasing the supply
of essential items to healthcare facilities and putting new systems in place
to monitor progress.
The HEP shows vividly how aid partners can work together to make a real difference to the quality of healthcare for people in a developing country. The International Health Partnership (IHP), launched in September 2007, aims to improve the way in which donors cooperate, encouraging them to coordinate their efforts behind a country's individual health priorities.
Ethiopia is one of the first wave of countries in the IHP. With improved donor coordination reducing the burden on the Government of managing different projects, the IHP should enable Ethiopia to make better use of the aid offered to it, bringing vital services to more people.
Key facts
- DFID, the
- Funds provided through Component 1 of PBS contribute to recurrent costs, including HEWs’ salaries. Between June 2006 and June 2007, DFID has provided £90 million through PBS Component 1, of which approximately £7.2 million was spent on health services.
- PBS also has a second component that provides funding for the procurement of vaccines, bed nets, contraceptives and anti-malarial drugs, all of which are crucial to the operation of the HEP. To date, DFID has spent around £10 million of the £15 million it has committed to this component.
- A total of 30,000 HEWs and 15,000 Health Posts are required to provide basic health services to rural communities throughout the country. As of June 2007, 17,653 HEWs had been deployed and over 8,850 health posts had been built.
- Between 2004/05 and 2005/06 the number of bed nets distributed increased by 283%, the number of new malaria cases fell by 20% and the number of women using contraceptives increased from 25% to 36%.
Links
- Prime Minister launches new International Health Partnership
