Tibre arrived at the home of Medhin Haileselasie – a 37-year-old woman with six children. They talked about child nutrition, sanitation, and the family’s use of mosquito nets. The health extension worker also discussed experiences about health issues in her home and in the neighborhood. Family planning services provided by the health post helped Medhin to space her children, having each one after a gap of about two years.
In Ethiopia’s national strategy, the primary health units are the health centers, each linked to five health posts. A health post serves a population of about 5,000 and is staffed by two health extension workers, who are supported by a health development army – volunteers who serve as the eyes and ears of health extension workers in the valleys and hills. Lem Lem Alemayo, a member of the army, said she works with Tibre because she has to fight hard against the ills that continue to kill people in her community.
Ayalew Asgedon, the head of Work Amba Health Center says the network of frontline workers “stops diseases before they get here.” Earlier in the day at the health center, which supports four health posts like hers, Tibre had talked with Ayalew and other health officials – reporting concerns at the village, delivering data from the field and refilling her supplies. The petite health worker also met members of the health development army. In a soft sing-song voice that was filled with passion, Tibre talked to her troops about the importance of women using contraceptives, families sleeping under mosquito nets and the community adopting stronger disease prevention measures.
Great systems for health are pivotal in improving the health outcomes in any country. The health extension workers are a critical of Ethiopia’s health infrastructure. The country is a leader in building resilient and sustainable systems for health in countries with fewer resources. The investments are bearing fruit. Since the program was launched in 2004, life expectancy has jumped by 10 years, from 54 years at birth to 64.
Additionally, the program has also allowed thousands of women to enter the workforce, providing them with improved income opportunities and transforming gender roles in their communities. In a country where unemployment is still high, finding fulfilling work can be life changing. The health extension worker program has transformed the lives of thousands of workers who have become breadwinners for their families, says Dr. Kesetebirhan. A better livelihood for her family is an added reason why Tibre and other health extension workers of Tigray take the less-travelled roads to save lives of people in their communities.
Ethiopia seems like a country in a hurry to achieve as much as it can for its people as soon as it can. With the support from partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the country is expanding the numbers of health extension workers and the quality of their work by training and retraining the health workers to keep them up to date and growing. The program is becoming a symbol of pathways that other low- and middle income countries can follow to bring health care closer to the people. Many countries in Africa have been visiting Ethiopia to see the health extension worker program and learn from it, Dr. Kesetebirhan says.
At the College of Health Sciences in Mekelle, Dagnew Araya, the Dean of the school, said he has more than 300 students studying to become health extension workers or to upgrade their skills. “With this training, we are doing our part in contributing to creating healthy communities,” Dagnew says.
As the students file out of their classes, they seem to exude a special sense of purpose.
Birhan Atsebha, 26, left her village health post 70 kilometers away, where she was already serving as a health extension worker and came to advance her knowledge and skills. She will return home with expertise to tackle bigger health challenges and in a better way. Birhan says she became a health extension worker because she wanted to live and serve her community. When the opportunity to become a health extension worker happened it was godsend, allowing her to live in her village and do gratifying work while earning her livelihood.
The training will keep her away from her husband and her five-year-old daughter for much of the year. She cannot wait to be back to her family, she says. She also cannot wait to be back to the health post to attend to her community, which calls her ‘Doctor Birhan.’