“What makes me most proud”, says Marifa, “is knowing that I am saving lives.”
Two years ago, a policy introduced by the Ethiopian government enabled Marifa and her fellow Health Extension Workers (HEWs), Rosa and Tamar, to provide treatment for common childhood illnesses and malnutrition for the first time.
Before this, the women already played an important role in preventing illnesses and promoting healthy behaviours.
But they found it frustrating when a sick child was brought to their health post in Bededo, a village outside Dessie (a rapidly growing town in the Amhara district of Ethiopia), and they couldn’t treat them.
By the time the child was taken to the health facility and seen by a professional health worker, it might be too late.
Now children can be diagnosed quickly and treated closer to home – and lives are being saved as a result.
Bringing healthcare to the community
Like in many parts of sub-Saharan Africa, the main causes of illness and death among children under five in Ethiopia are pneumonia and diarrhoea.
The greatest disease burden falls on the poorest children in remote and rural areas. By contrast most doctors, nurses and midwives prefer to work in urban areas where living standards and career opportunities are better.
Ethiopia’s Health Extension Programme, launched in 2003, sought to address this problem by training 34,000 frontline community health workers such as Marifa to deliver preventive and basic curative high-impact interventions to those in greatest need in the places where they live.
It’s a model that has enabled Ethiopia to make considerable progress in reducing child deaths and the lessons learned are helping to shape policies in other countries too.
Save the Children is supporting these efforts by training Health Extension Workers on integrated community case management (ICCM) of neonatal and childhood illness in 25 districts in the Amhara region.
To date, more than 17,500 children with common childhood illness and malnutrition have been treated.
Transferring knowledge and skills
Marifa, Rosa and Tamar spend most of their time doing home visits – travelling up to 15km per day to reach the most remote families – to provide health education and identify pregnant women and children who would benefit from health services.
They also provide practical advice on how to make home improvements that will have a positive impact on the health of the family.
To reduce their growing workload, HEWs train volunteers (usually mothers) on healthy behaviours, how to spot children with common illnesses, and how to seek appropriate health services.
Each volunteer then shares this knowledge with five more families, creating what the government calls a ‘health development army’.
Rosa says that this has resulted in increased demand for services such as immunisation and family planning.
They’ve also noticed that more women are choosing to deliver in facilities and are having fewer children.
Both of these measures mean that maternal mortality rates are reducing.
Marifa and her colleagues are proud that their ICCM training is saving lives and feel that there’s even more they can do to serve their local community.
“I became a Health Extension Worker,” she says, “to be nearer to children and mothers who wouldn’t access health services otherwise. I would like to receive further training and upgrade my skills so that I can help more people.”