The number of people who die from malaria has been halved in just three years through the distribution of nearly 20 million insecticide-treated bed nets and widespread use of antimalaria drugs. The dramatic fall in deaths from a disease that kills one in four people in Ethiopia was made possible with Global Fund support and a small army of health workers.

Turnaround

In 2005, only two percent of households owned an insecticide-treated net and almost half the population had no access to any health care services at all. A plan to get nets out to farming families was floundering, partly because of the sheer number of nets required and partly because of the challenge of distributing them to remote areas.

Ethiopia’s minister of health, Tedros Ghebreyesus, describes the situation in simple terms, “We were in a mess.” He led a rapid assessment and galvanized the country into a proactive response to malaria. An arrangement was made with the Global Fund to speed up the flow of funds: money allocated for three years was released for spending in just one.

An Ambitious Program Exceeded All Previous Targets

In a scaled-up program, more bed nets were distributed than had previously been planned - 20 million insecticide treated nets to protect the most vulnerable, particularly women and children for whom malaria is more dangerous due to their bodies’ inability to fight the parasite.

Health Extension Workers

The idea is simple, broaden the outreach: train two high school graduates per village to act as health advisers. Thirty thousand young women have been mobilized to transfer health skills to the entire community. Their top-up training, disease test kits and drugs are paid for by the Global Fund.

Firehiwot takes basic health services to remote villages by making home visits on foot. She talks to housewives woman-to-woman, which makes it easier to address sensitive health issues. She advises pregnant women to sleep under a bed net and ensures they know how to obtain one.

Early detection of malaria is vital for effective treatment. Firehiwot is able to carry out tests for malaria on the spot thanks to a new lightweight disposable test kit. Paracheck is much easier to use than the traditional microscope. A drop of blood is absorbed by the dip stick and results are displayed in a window, similar to a pregnancy test.

If the malaria test result is positive, Firehiwot gives patients a three-day treatment of Coartem, which is based on a plant extract called artemesinin combined with other ingredients to prevent the development of drug resistance. Before Firehiwot’s visits, families ignored malaria symptoms because the nearest health post was too far to go for help. Now they don’t fall ill so often and are happier as a result.

Prevention is Better than Cure

Preventing people from getting sick not only improves their well-being, it is also better for their livelihood and reduces the strain on the health care system. Heath Minister Tedros explains the thinking behind the scheme: “It’s the knowledge gap that is exposing people to HIV, malaria, TB, diarrhea … so the health extension workers actually help them in changing their lifestyle. They can take the responsibility of helping themselves, because they can prevent diseases on their own.”

Putting health care in the hands of the community is a good way of ensuring people get healthy and stay healthy. Grassroots health care is not costly and its impact is massive because eliminating the risk of the disease means avoiding the expenses triggered by diagnosis, treatment and follow up.

Health Minister Tedros’ commitment to fighting malaria is inspiring the continent. As chair of the international Roll Back Malaria Partnership, he is using his country’s model to inspire others in the region. Strong leadership and commitment combined with financing from the Global Fund and assistance from development partners are driving the fight against disease in Ethiopia. The only country in Africa never to have been colonized has fought off invaders in the past and is now effectively fighting off malaria.