Doyole Hotesha, holds her three month old baby boy and standing beside her is the Health Extension Worker Belaynesh. Photo Credit: Save the Children/ Tadele Shonde.

Belaynesh Mulugeta is a Health Extension Worker at Hida Kality health post in Dale district. She serves more than 5,000 people in her locality along with one other Health Extension Worker. They deliver services both at the health post and by going directly to people’s homes. The health extension programme has 16 health packages. In this community, there is a particular need to focus on maternal and child health issues. A key part of the Health Extension Worker’s role is to educate families and reduce traditional practices that can harm children’s chances of survival.

Belaynesh says “With the knowledge received from my training I have already been able to save many newborn and children’s lives. For example, Doyole went into labour at around 3am in the morning. We referred her to the nearest health centre and helped arrange for an ambulance to take her there to deliver a healthy baby. After she returned home, I visited Doyole to carry out some postnatal check-ups. During one visit I found her newborn was very feeble and had difficulty breathing. Doyole’s mother-in-law refused my advice to take the baby to a clinic saying that the child would get better soon. After long discussions with family members, we were able to convince them to start treatment at home. I immediately returned back to the health post to bring medicines and started treating the baby with antibiotics. Thankfully, after seven days the child’s health became normal.”

Doyole says “Here in our community there is a long-held belief that a neonate can’t be treated, as his/her body has not well developed and should not be given injection that is why I refused to take my baby to the hospital for treatment. At first, most of my family members refused to accept the advice from the health extension worker to treat the child. I desperately wanted him to get better which is why I allowed for the health extension worker to give him the injections she recommended. We realised that it was due to the treatment that my baby’s condition started improving starting on the first day. We are grateful to the health extension worker for treating and saving our child’s life.
I will continue to spread this message to all members of the community so that neonates receive timely treatment and remain healthy when faced with different life-threatening diseases.”

Neonatal mortality rate  (per 1,000 live births) (2011) 31
Under-five mortality rate (per 1,000 live births) (2011) 77
Maternal mortality ratio (per 100,000 live births) (2010) 350
Number of doctors, nurses and midwives per 10,000 people (2010) 2.8
Births attended by skilled personnel (2011) 10%
Total expenditure on health as a percentage of gross domestic product (2011) 4.7%
General government expenditure on health as a percentage of total expenditure on health (2011) 57.7%

A key element of the health care financing reforms in Ethiopia is to systematise waiver and exemption systems, with government allocation to facilitate access to health services showing improvement over the last years (reaching 2 million beneficiaries). However, challenges remain in identification of beneficiaries and allocation of resources from local government.

Ethiopia is making significant progress towards MDG 4 but communicable diseases are still a huge burden on the population. The density of skilled health professionals is lower than indicative thresholds, and there may be challenges in geographical access with a highly unequal distribution of physicians. A low percentage of female doctors (18%) may also indicate problems with acceptability, although the ratio of nurses to doctors is above the OECD average.

The Health Sector Development Plan includes a major focus on HRH development, including support for salaries and training. The institutionalization and scaling-up of Health Extension Workers through the Health Extension Programme is yielding positive results and has had a major impact on efforts to improve child survival. Increasing the capacity of training institutions is also seen as a priority. There is a recognised need to improve systems for collecting health workforce data.

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