Ethiopia's rural care crisis eased by community health workers
www.canadianhealthcarenetwork.ca
July 27, 2011
Community health worker Almaz Doiso is responsible for bringing health care closer to home for more than five hundred families in one of the most remote regions in the world – South Omo Ethiopia.
She travels the rough terrain by foot. The weather is hot, the climate is dry and dusty and the infrastructure is weak. Access to formal health care is almost inexistent. There is one hospital serving half a million people and there are not
nearly enough professionally trained staff.
“I’ve learned a lot from Almaz,” says South Omo resident Amira from her small thatched roof home. “I lost my first baby but this time I want to have a safe delivery at the health clinic.”
Almaz checks Amira’s blood pressure, listens to her unborn baby’s heartbeat and advises her on a healthy diet.
“There is a big difference in the community now. When I started in this area women used to hide their children when we would call them for vaccination,” Almaz says. “But now after two years, we announce a vaccination campaign and every woman brings her child.”
Almaz was trained by the Nairobi based African Medical and Research Foundation (AMREF). Founded in 1957 as the Flying Doctor Service, AMREF now has community based health development and health worker training programs in over thirty countries across Africa. Every year AMREF trains 10,000 community health workers like Almaz.
In South Omo, AMREF works closely with Ethiopia’s Ministry of Health who in 2005 committed to training 30,000 new community based health workers to provide urgently needed care.
Rural Health Crisis
Like many countries in sub-Saharan Africa, Ethiopia is suffering from a severe health worker shortage. In 2005 the International Organization for Migration reported there are more Ethiopian doctors in the city of Chicago than in all of Ethiopia, Africa’s second most populous country home to 82 million people.
Across Africa the health care worker crisis is most severe in rural areas, where 80 per cent of the population lives.
In remote communities doctors and nurses are extremely isolated working in difficult conditions that lack resources. Motivation is understandably low so when a position in a city or town with better facilities and a better standard of living is available the majority seize the opportunity.
Its community health workers like Almaz who are closing this huge gap in access to health care.
Shifting Tasks to the Community Level
Community health workers rarely have a formal clinical training. Instead, they are selected by their own communities and receive basic training in locally relevant activities like preventing, diagnosing and treating HIV, distributing bed nets to prevent malaria, teaching TB patients how to take their treatment and basic maternal and child care. They also learn how to recognize serious illnesses and know how and where to refer these patients.
The impact is undeniable in South Omo where the number of women delivering babies at a health clinic with a trained midwife or nurse has increased 20 per cent in only two years.
“These women are now having clean births, we are reducing maternal and neonatal mortality,” says AMREF program officer in Ethiopia Tilahun Bezabih.
Training community members to be part of the formal health workforce is more than a makeshift solution to Africa’s rural health crisis – it is now a critical component of primary service delivery recognized by the World Health Organization and numerous governments around the world.
Last month Columbia University’s distinguished Earth Institute published the One Million Community Health Workers report, which recommends scaling up the number of community health workers to a ratio of 1 for every 650 people in rural Africa.
The report says training community health workers is a “strategic solution” that addresses the growing shortages of highly skilled health workers.
The Canadian government has also made a commitment to help.
Last December the Canadian International Development Agency (CIDA) announced its support for a new AMREF program that will train more than 2,000 community health workers in four African countries over the next three years.
The program will help improve health for approximately 500,000 people in Kenya, Tanzania, South Africa and Uganda.
AMREF is also working closely with Ministry officials in all four countries to ensure the newly trained health workers are properly integrated into the local systems and receive the support and supervision they need.
“These cadres of health workers have a vital role to play in providing essential health services to communities who otherwise wouldn’t have access to them,” says AMREF’s Director of Training and Education Dr. Peter Ngatia.
Simple Interventions result in Major Impacts
Back in South Omo Almaz is visiting new mother, Malo Washto.
Malo holds her tiny baby as Almaz turns the page on a brightly illustrated book with photos of mothers and newborns. The manual was created by AMREF and provides basic information on newborn care including nutrition, disease prevention and vaccinations. Many of the women in South Omo can’t read so the large illustrations are used to pass on the life-saving health messages.
This is Malo’s fourth baby and the first time she’s received any information on newborn care and family planning methods.
“All of my pregnancies have been difficult with very long labours,” Malo says. “Thanks to Almaz I now know that I can use family planning as I don’t want another baby soon.”
The services Almaz provides may seem very basic but for the 6,000 women, children and men she visits they are life-saving.
Rx Africa: Prescriptions for Better Health is a seven part editorial series between Rogers Healthcare Group and AMREF Canada on AMREF's innovative solutions tackling Africa's health care worker crisis.
Read past articles in the series;
Reliable Diagnostics a huge barrier to improving health across Africa (June 27, 2011)
E-learning program for nurses improves access to training by 1,400% (May19, 2011)
Surgical Outreach Leaves Lasting Legacy in Underserviced Africa (April 29, 2011)
Bringing Care to Africa from Above (March 22, 2011)
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