Healthy mothers, healthy children, making healthy communities in Ethiopia

Dugem, Tigray REGION, Ethiopia, 21 December 2017 – In the health post at Dugem village, in Ethiopia’s Tigray region, Berhan Zebraruk, 25, gently strokes her child’s cheek and then gives him a sweet tickle on the tummy. Her first born, Awot Kaleab, is quick to respond to her touch. He cracks a beautiful smile displaying his toothless gums and looks his mother right in the eye for the play to continue. The little boy is restless. He grabs his mother’s cell phone and when that is taken away from him, he turns his attention to the baby next to him.

“My boy likes to play with everything he holds,” says Berhan. “I have to keep an eye on him, otherwise he put things in his mouth.”

Awot is now 9-months-old and it is time for his measles vaccination, which would complete his set of basic vaccinations for children under the age of 1, as recommended by WHO and the Ethiopia National Expanded Program on Immunization.

It is a special day for Berhan. Shortly after Awot received the vaccine, the health extension worker, Genet Desta, registered his name in the vaccine book. Then she called out Berhan’s name and handed her a certificate, a recognition that is given to mothers when their children complete taking the necessary vaccines.

Berhan is applauded by the other mothers in the health post for successfully vaccinating her child. She is also recognized as a role model for her best child feeding practices, including exclusively breastfeeding her son for his first six months.

Berhan attended school up to grade 10. Since she was a little girl, her dream was to become a doctor. Instead, she got married and became a housewife like many other women in her village. Yet, her education is considered an achievement in the eyes of fellow villagers.

“I wanted to become a doctor because I saw health workers treating people in my village,” says Berhan. “That wasn’t meant to happen for me, maybe it will for my son,” she added, gazing down at him.

Berhan understands that her child can only fulfil her unrealized dream if he grows up healthy and well. When she knew that she was pregnant with him, she started her pregnancy follow-up relatively earlier than other mothers.

‘’Berhan attended all of the four antenatal follow-ups and took the iron supplement properly,” says Genet, the health worker. “She was very conscious of her health and that’s why her child is very healthy.”

In Ethiopia, an increasing number of women are receiving care by skilled health workers both during pregnancy and childbirth. In the Tigray region, where Berhan lives, for instance, 90 percent of women receive antenatal care by skilled attendants, at least once, during their pregnancy, which is well over the national average of 62.4 percent.

In addition, 59 percent of the region’s mothers are giving birth in health facilities, instead of the old tradition of home delivery.

The country has seen significant improvement in immunization coverage over the past two decades. In 2000, it was only 14 per cent of Ethiopia’s children under the age of 2 who have received all the basic vaccinations, but in 2016, that number soared to almost 40 per cent.

Owing to its well-established community-based health service provision, Ethiopia is also enjoying a reduction in maternal and child deaths. Maternal mortality which was 871 deaths per 100,000 live births in 2000 has dropped to only 412 in 2016, a reduction by more than half in just 16 years. The same is also true when it comes to child mortality. More children in rural Ethiopia are celebrating their fifth birthday than ever before.

The nearly 40,000 female health workers, together with the women of the Health Development Army, easily access women and children in every household and provide much needed advice and services, including immunization to prevent the most debilitating child illnesses.

UNICEF is supporting the different components of the programme by providing both financial and technical assistance. UNICEF also supports the management of common childhood illnesses including malaria, pneumonia, diarrhoea and severe acute malnutrition at the health post level, contributing to a significant reduction in deaths.

Berhan’s task as a mother, caring and nurturing for Awot, symbolizes the bright future that lies ahead of children in rural Ethiopia. She is well equipped with skills and knowledge that will enable her to provide critical health and nutritional care for her son. Further help is also available since services, even for those in remote communities, are now more accessible.

Light after dark – Solar lamps improve children education in rural Ethiopia

BASHABUDA, BENISHAGUL GUMUZ, ETHIOPIA 28 September 2016 – Three years ago, when Selwa Mensur was a fifth grader, something arrived in her school which immediately changed her life. Solar lamps were distributed to help students with their education.

In rural village of Bashabuda in the Benishagul-Gumuz region of Ethiopia, electricity is considered as luxury. This means children, especially girls, who need to support their families after school do not have the chance to study at night. “I am the first girl child in my family. I have to support my mother in the house after school until it gets dark”, says Salwa explaining her usual routine. “When I got the solar lamps, I was able to review those topics, which were difficult to understand, before I went to sleep”.

Today, Selwa, 17, is enjoying her summer break before she starts class in the eighth grade as a senior in her elementary school. It is indeed a great achievement for her. Many girls in Selwa’s village have little chance in pursuing with their education. They have to prove themselves to their parents who rather prefer to send them to marriage than to school at early age.

Like in many rural settings in Ethiopia, Bashabuda’s children, especially girls, spent much of their after-school time helping their families at home and in the farm. They cannot study at night because there is no light. This has negatively impacted their school performance. Failing classes and dropping out was quite common. When girls drop out, their chance of returning to school is very slim. Many parents in the village often see marriage as the best alternative for their daughters’ future.

Selwa Mensir, 17 from Bashabuda primary school studies with her solar energy at her house. The solar lamps were supplied by UNICEF with the support from the IKEA foundation. © UNICEF Ethiopia/2016/Tadesse

The solar lamps were supplied by UNICEF with the support it got from the IKEA foundation. A total of 12,272 easy to use pieces were distributed in three woredas (districts) in the Benishangul-Gumuz region including Bashabuda village- which received 350 of them.
When the lamps arrived, UNICEF and the regional education bureau representatives discussed with the school community on how to make a fair distribution of the limited amount of lamps allocated to the village.

Priority has been given to girls who are in grade five and above. This is because students in such grades do more homework than those students in the lower classes.

“We used to make a local torch [made of a stick soaked into a wood resin], so that our children study at night. But it only burns for short time”, says Mussa Tufala, who is a father and member of the school Parent Teacher Association (PTA). “But this lamp brought light to the whole family”.

The lamps also helped those siblings in the house to study with their brothers and sisters who have got the lamps.

The solar lamps lights up the education of Bashabuda elementary school children for last three years. It has been observed that those students who received the lamps showed encouraging improvement in their education.

The school principal Semaegizer mentions that the number of girl students who rank 1st to 3rd in grades between five to seven increased in the past three years. He owes this success partly to these solar powered lamps.

Though the solar lamps brought visible difference in the performance of young students in Bashabuda for the past three years, a new challenge is making the students worried again.

Suleman Mohammod, 7, solves the classwork on the blackboard at Bashaguda primary school. ©UNICEF Ethiopia/2016/Tadesse

Ali Imam was an average student. After he received the solar lamps, he started to excel in his class. But like many solar lamp recipient students, he is worried about its conditions. His three year old lamp keeps losing power and the on/off button is also malfunctioning. So he pays 40 birr (US$1.9) each time he took it to a local technician; too expensive to him and too expensive for his family. Therefore, Ali need a replacement so that he can prepare better for the national exam that he is expected to take before he joins high school. Ali also urges if there are more lamps available to his fellow school children who did not get the chance to have one before.

For rural children in Ethiopia whose only study time is at night, solar lamps are treasured properties. The three hours lamplight the tiny instruments provide seems short but they brighten the future of female students like Selwa much longer than that. “I want to be a teacher when I finish high school,” says Selwa “I came this far with the support of my teachers. They’re my role models and I want to be like them.”

Selwa’s future in education is taking shape. She believes girls like her will only succeeded when they are supported to study at home. And simple technology like solar lamps are indeed an integral part of that support as they provide the much needed light after dark.

Ministers of Water, Sanitation and Hygiene to meet in Ethiopia

Minister of Water, Irrigation and Electricity, H. E Motuma Mukassa, announces that Ethiopia is hosting the meeting of Ministers of Water, Sanitation and Hygiene which is organized by the Sanitation and Hygiene for All (SWA) and convened by UNICEF. ©UNICEF Ethiopia/2016/Bizuwerk

Ministers of Water, Sanitation and Hygiene from around the world will meet in Ethiopia from 15-16 March 2016 to plan and prepare for the implementation of the Sustainable Development Goals (SDGs) related to sanitation, water and hygiene.

The meeting is organized by the Sanitation and Water for All partnership (SWA), and convened by UNICEF. SWA has over 100 partners, mostly governments, and works as a platform for encouraging and coordinating political dialogue and action around water, sanitation and hygiene issues.

“This meeting will be different from all other high level meetings organized by SWA previously, mostly because of the timing: it will be the first global meeting on these topics after the UN Member States agreed on the Sustainable Development Goals last September, “says Motuma Mukassa, Minister of Water, Irrigation and Electricity of Ethiopia. Mr Motuma also underscores that the SDG targets on water and sanitation requires a higher level of coordination, alignment and communication both at global and national levels.

Ethiopia is selected to host this meeting for its commitment to implementing innovative ways towards achieving universal access to sanitation, water and hygiene by coordinating different ministries, increasing sector funding and investing in the training of health workers. The country’s One WASH National Progrmame (OWNP), launched in September 2013, is one of the most ambitious in the sector. It is based on a sector-wide approach and involves the ministries of water, health, education and finance and the government’s main development partners. Ethiopia devises this programme to modernize the way water and sanitation services are delivered to its people.  Recently, with UNICEF’s support, Ethiopia also started a South-South collaboration with Brazil in the area of urban sanitation and regulatory framework for WASH service delivery.

The Ministerial Meeting is a unique opportunity for countries to identify the major bottlenecks to achieving the SDG water, sanitation, and hygiene targets and lay groundwork for clear action plans, strategies and milestones.

High-level delegates, including the Prime Minister of Ethiopia, Hailemariam Desalegn, Kevin Rudd, Chair of SWA and the 26th Prime Minister of Australia and Anthony Lake, Executive Director of UNICEF will attend the meeting.

 

Moving the conversation forwards: Religious leaders vow to join hands for children with UNICEF

Ethiopia has come a long way, in development terms, since it adopted the Millennium Development Goals (MDGs) as part of its national agenda. Remarkable achievements have been registered within various social wellbeing parameters. Most notably, the country has achieved MDG 4 – to reduce child mortality by two thirds – three years ahead of schedule. A lot remains to be done, however, particularly in reaching the most disadvantaged children – 3 million are out of school, 40 percent of under-fives are malnourished, only 7 percent of births are formally registered, less than one-third of pregnant women deliver in health facilities, key vaccinations are achieving less than 70 percent coverage and a high number of girls are being exposed to a variety of harmful traditional practices.

While Ethiopia is on track to achieving the majority of MDGs before the 2015 deadline, the involvement of stakeholders, such as religious leaders, is crucial. This is particularly true in reaching the most disadvantaged communities. In line with this premise, UNICEF held a consultative workshop with religious leaders on Monday, 23 June 2014, in Addis Ababa. The half-day workshop targeted the creation of shared values and common ground in bringing a more prosperous future to the children of Ethiopia.

“We aim today to begin a new conversation, enabling us to work together towards a common goal,” said Dr Peter Salama, UNICEF Representative to Ethiopia, whilst opening the workshop, further emphasising that religious institutions are able to reach out to communities at a grassroots level more effectively than any other social network. They are also instrumental in influencing positive behaviour and social norms, and thus working with these institutions is not considered as a second option. Dr. Salama spoke of the need to scale up UNICEF’s work with religious leaders on what they are uniquely positioned to achieve among their millions of followers – mobilisation for action in the wellbeing of children.

After a brief presentation of UNICEF’s guide on partnerships with religious communities and the situation of children in Ethiopia, the workshop continued with discussions centred around experiences and priority intervention areas.

Best Experiences Shared

The civic engagement of religious institutions in Ethiopia is commendable.  For instance, the experience shared by the Ethiopian Orthodox Church revealed that the church’s 42-year-old development wing has been actively involved in numerous developmental activities placing women and children at the centre of the issue. The Ethiopian Orthodox Church Development and Inter-Church Aid Commission has developed declarations on gender based violence and harmful traditional practices, as well as safe motherhood.  What was interesting for participants was the church’s adoption of a “Development Bible”, which contains 360 daily teachings, incorporating over 45 contextualised messages. These include a focus on gender equality, Female Genital Mutilation/Cutting (FGM/C), maternal health, HIV/AIDS and Harmful Traditional Practices (HTPs).

Similarly, the Ethiopian Muslim Supreme Council shared information of their work towards a “fatwa” (declaration) against FGM/C. A representative from the Council recounted how talking about FGM/C had been a taboo for religious fathers of previous years. However, leaders are now speaking out against the practice and bringing change in project areas. The Council also underlined the need to scale up the intervention, in order to stop the practice altogether. The experience of the Ethiopian Catholic Church in the development of the Child Protection Policy and the concept of ‘serving the whole person’ expressed by the Ethiopian Evangelical Church, Mekanyesus, and the Kale Hiwot Church, was also shared with participants.

Three umbrella Forums – the Ethiopian Interfaith Forum for Development Dialogue and Action, the Inter-Religious Council Ethiopia and the Evangelical Church Fellowship Ethiopia – also shared their experiences in mobilising member institutions in various projects. These included maternal and child health, peace building and HIV prevention. The efforts to mainstream the UN Convention on the Rights of the Child (CRC) and HTPs in theological schools was also highlighted.

Way Forward

In the past, UNICEF and other organisations predominantly worked with the development wing of religious institutions. However, it is recognised that this undermines the significant return of actively engaging in the spiritual wings. The spiritual wing reaches over 97% of the nation’s population through various religious structures, whilst the regional presence and coverage of development wings is dependent upon resources.

UNICEF is keen to work with both the spiritual and development wings of the major religious institutions and umbrella forums through a long term strategic partnership. UNICEF is also ready to provide technical support, policy advice and capacity building on the key child related interventions conducted by these institutions. The religious leaders have also reaffirmed their commitment to working with UNICEF.

Before the close of the workshop, participants agreed to form a small working group to develop the partnership framework.

Shared responsibility and convergence of interests to end micronutrient malnutrition

Micronutrient Forum Global Conference, Addis Ababa, Ethiopia 2-6 June 2014 Bridging Discovery and Delivery ©UNICEF Ethiopia/2014/Sewunet

ADDIS ABABA, ETHIOPIA, 02 June, 2014 – The third Micronutrient Global Conference (June 2-6, 2014) has been discussing ways of overcoming micronutrient malnutrition. The forum, which brings together researchers, policy-makers, program implementers, and the private sector has been held under the theme of “Building Bridges”, thus emphasising scientific advances and multi-sectoral programming on adequate micronutrient intake.

Honorable Madam Roman Tesfaye, First Lady of the Federal Democratic Republic of Ethiopia, welcomes participants of the Micronutrient Forum ©UNICEF Ethiopia/2014/Sewunet

Officially opening the conference, first lady of Ethiopia H.E. Roman Tesfaye announced: “Ethiopia is committed to sustainably addressing the challenges of malnutrition and micronutrient deficiency.” During a successive speech delivered by the Ethiopia Minister of Health, Dr Kesetebirhan Admassu, it was highlighted how for a developing country like Ethiopia, investment in nutrition at an early stage of life brings a better return both in terms of human capital and economic development. That is why, according to Dr Kesete, Ethiopia has integrated a core nutrition intervention into its Health Extension Programme. The Minister also emphasised three key issues when addressing malnutrition and other health challenges: “integration, implementation at scale and community ownership.”

On behalf of the Health, Population and Nutrition donor group and the four UN agencies involved in Renewed Effort Against Child Hunger and Under nutrition (REACH) and Scaling Up Nutrition (SUN) in Ethiopia, Dr Peter Salama, UNICEF Representative in Ethiopia outlines four lessons that the global nutrition community can take from Ethiopia:

• Integration of services for treatment of Severe Acute Malnutrition (SAM) into the national health system.
• Multi-sectoral approach: linking key line ministries, the private sector, civil society and development partners.
• Making sure that all decision makers understand that spending money on nutrition is one of the best investments in terms of human capital and economic growth.
• Political will on implementation of nutrition programmes.

As the development community turns its attention to a post-2015 agenda, Dr Salama stressed that improving nutrition should become the quintessential Sustainable Development Goal (SDG).

40 UNICEF colleagues from many countries around the world, regional offices and headquarters participated in the Micronutrient Forum, presented poster and gave oral presentations on program implementation, best practices, operations research and partnerships. UNCIEF also is member of the organising committee and funder.

UNICEF Ethiopia provided funding and had various abstracts presented at the forum in poster form or oral presentation. Several staff moderated sessions on food fortification, salt iodisation and the translation of global guidelines into policy and programmers. At a get together of all UNICEF staff, the colleagues shared observations about the forum’s contributions to their work and inter-country exchanges were set up. The Ethiopia sat down with the India country team and identified areas for exchange and support. This will continue after the forum ends.

A child getting a Vitamin A supplementation in Tergol town. © UNICEF Ethiopia/2014/Bizuwerk

Micronutrient malnutrition, also referred to as “the hidden hunger” is a widespread problem in the world mainly affecting developing nations. According to WHO, micronutrient deficiency results in a poor pregnancy outcome, impaired physical and cognitive development, increased risk of morbidity in children and reduced work productivity in adults. Globally, one third of children under-5 are vitamin A deficient. It is also estimated that more than 40 per cent of pregnant women and children under-5 are anemic, while one in four children under-5 years old (more than 160 million children worldwide) are also stunted.

The third Micronutrient Global Conference looks into the challenges and opportunities for scaling up evidence-based policies and programmes from diverse sectors while discussing the effectiveness of nutrition-specific and nutrition-sensitive interventions to improve micronutrient intake and status. The conference also debates on evidence and methods for measuring micronutrient deficiencies, excesses and coverage, with implications for policies and programmes.

More on a successful nutrition-specific programme from Ethiopia

A Day in the Life of a Well-fed Child: Ethiopia