ADDIS ABABA, February 28, 2013—The road to Dongore Difurda, a kebele or locality in Ethiopia’s large Oromia state, runs east from Addis Ababa. It is congested with traffic heading to Djibouti and the coast. About 125 km along this road, a vehicle would have to turn off onto an unmarked dirt track, passing donkey carts and grazing camels to reach the main village nestled beneath a low hill.
Amid earthen huts with distinctive conical roofs of thatch, a young woman named Etagegn Gebre surveys a line of patients waiting to see her outside the small one-storied building that houses the local health post. They include a heavily pregnant woman with a toddler clinging to her dress, a farmer with an injured hand, and a man who might have malaria.
Etagegn ushers the pregnant woman into a room with a clean pink curtain. There she swiftly conducts an antenatal check-up, palpating the abdomen and taking measurements and notes. She sends the woman away with vitamins and words of encouragement. Back outside, she disinfects and dresses an injury, and administers a rapid diagnostic test for malaria.
“I like my job because I’m able to solve my community’s health problems and that’s a big thing,” says Etagegn, “What I like most is being able to save lives instead of working solely for the sake of getting money. That’s the pleasure I get in my work.”
Over 35,000 health workers now serving rural areas
Etagegn is a trained health worker, one of over 35,000 that Ethiopia has deployed over the past few years to get healthcare to rural areas. Two women like her, who have passed Grade 12 and have a year of training, are assigned to every kebele. They are complemented by male volunteers who refer people with health problems to these trained women health workers.
Outside Etagegn’s health post, children play energetically, their singing and clapping echoing against the walls, and their feet kicking up great clouds of dust in the hot afternoon sun. A small girl, Derartu, watches shyly from a distance as the older children run.
“We treat no less than 10 to 30 children every day; they come for all sorts of conditions like malaria, malnutrition, diarrhea, and others,” Etagegn explains as she pats Derartu on the head. “If we are able to treat them here, we do so. Otherwise, we write them a referral.”
On track to meet many key health targets
Ethiopia’s network of health workers is a great asset as the country strives to reach the Millennium Development Goals (MDGs) on health. The country is already on track to reach some of these targets by 2015, including those for reducing child mortality, HIV/AIDS and malaria.
For example, the share of deaths of children under age five in Ethiopia has fallen from 123 per 1,000 live births in 2005 to 88 in 2011. While the current level of child mortality is still high, the rate of progress in the country has been encouragingly rapid.
“Ethiopia has made a significant effort to improve health delivery at the local level,” says Mr. Ahmed Shide, State Minister for Finance and Economic Development. “Still there are significant challenges. No mother should die while giving birth; a child has the right to live to full life potential.”
Intensifying efforts to reach pregnant women and mothers
Besides providing information on better nutrition and feeding practices to groups of village women, visiting pregnant women at home is part of Etagegn’s job. She carries a large kit with her as she walks down a shady path to reach the home of Dase, a 25-year old mother of two.
Uncomfortable in her final weeks of pregnancy, Dase is happy to see her, and the two women have a long conversation inside Dase’s two-room house built of earth and wood. One of her children, a two-year-old girl, stays close to her mother’s side throughout the visit.
“When I was pregnant with my first child, I went to Walanchite for health services,” Dase recalls. “I used to walk long distances and was forced to deliver at home. When I got pregnant again, I had to go all the way to Adama, and that was challenging so I had to deliver at home.”
Home deliveries are still very common in Ethiopia, contributing to still-high maternal and neonatal mortality rates. However, with Ethiopia’s commitment to achieving the MDGs, things are expected to continue changing for the better for children, as well as for women.
Partnering with donors to ramp up lifesaving services
“We still have a lot of gaps…the government with the support of our development partners and donors will continue to make a significant effort so that Ethiopia will achieve all the Millennium Development Goals particularly related to health service delivery,” says Minister Shide.
Many development partners are supporting Ethiopia to strengthen its health system further and ramp up lifesaving health services, with a renewed focus on results. Together, they are contributing about US$4.5 billion to the current health sector development program, along with about US$1.5 billion from the government.
The World Bank’s new Health MDGs Program-for-Results (PforR) zero-interest loan to Ethiopia, approved in February 2013, links disbursement of US$100 million with the achievement of specific health-related results over the next four years.
“These results include increases in the number of women receiving antenatal check-ups, the share of deliveries attended by skilled workers, and many other well-defined targets,” says Ramana Gandham, Lead Health Specialist at the World Bank and Task Team Leader for the PforR. “I am confident that Ethiopia has the building blocks in place to achieve these results and this first PforR in health in Africa will help in shifting the focus from inputs and transactions to tangible results and credible systems to measure such results.”
“Tying money to specific results will give the government the incentives and leverage to be able to work on bottlenecks, address problems, and really try to find some sustainable solutions,” adds Angela Spilsbury, Senior Health Adviser at the UK’s Department for International Development (DfID) in Addis Ababa, and co-chair of the Health Development Partners Group.
The World Bank PforR funding will be complemented by a $20 million grant from the Health Results Innovation Trust Fund, which is supported by the UK and Norway. The Fund supports the use of results-based financing to improve the coverage of essential maternal and child health services.
“It’s a very exciting opportunity to see how we can use money in the most effective way to deliver results on the ground,” Spilsbury says. “We’re hoping that the lessons learnt from this program can then help inform the way that we do aid across the world, not just in Ethiopia.”
In Dongore Difurda, Dase is pleased about the health post that is now located close to her home, sparing her the very long journeys of the past.
“From now on I prefer to go to the health post to give birth,” Dase says. “I don’t want to regret it later.”