Category Archives: Ethiopia

Health Poverty Action promoting health for pastoralists in Ethiopia

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http://www.themummyblogger.co.uk/wp-content/uploads/2012/08/health-poverty-action.jpg

Health Poverty Action works with some of the most marginalised and poorest communities in the world. Health Poverty Action works with Ethiopia to improve the health of pastoralists, particularly women and children.1

Ethiopia has the highest maternal mortality rates and lowest rates of health expenditure per individual in the world. 50 mothers die for every 100,000 live births and an estimate of nine in 10 births are not attended by a skilled health worker. Statistics for pastoralist groups are worse.1

Pastoralism is defined as the traditional way of life centering around livestock herding for food, materials and trade, which has been developed over many centuries as a sustainable livelihood in the world’s arid and semi-arid regions.5 Pastoralism is seen in all parts of Africa, where pastoral areas occupy 40% of Africa’s land area. It constitutes a central part of Africa’s heritage, history and culture. Pastoralists are nomadic, a group of people who move from one place to another to search for foods and water.5

There are approximately 12 to 15 million people from 29 different ethnic groups in pastoral regions of Ethiopia.1 There are poor equipments and insufficient health workers in the pastoral regions of Ethiopia. A large number of Health Extension Workers has been deployed by the Government of Ethiopia in the past few years to improve the accessibility and coverage of health services.1 However, the health coverage of the pastoralists remains low. Health Poverty Action provides on-the-job training to improve the quality of health services provided by the Health Extension Workers.1

Mobile clinics and community-constructed birthing huts can be constructed and implemented by NGOs such as Health Poverty Action.1 However, NGOs need to persuade state authorities to implement these interventions to tackle the lack of healthcare accessibility.1

http://www.healthpovertyaction.org/wp-content/uploads/2013/08/IMG_0552.jpg
http://www.healthpovertyaction.org/wp-content/uploads/2013/08/IMG_0552.jpg

Health Poverty Action works with pastoralist communities who live along the border of Ethiopia and Kenya, to increase healthcare accessibility in the Dollo Ado District in Ethiopia and Mandera West and Mandera Central districts in Kenya.2 This project is supported by European Union. The pastoralist communities are geographically isolated and are socially and economically marginalised.2 These communities are underrepresented and do not possess political authority in the government sectors.2  Health Poverty Action aims to train key health workers, provide more family planning options at local health facilities and raise health awareness for pastoralist communities.2

Health Poverty Action trains local organisations about health rights.2 Volunteers promote family planning and counselling.2 They also provide transport to healthcare services.2 Furthermore, they train traditional birth attendants in child care and counselling.2 Traditional birth attendants are provided with mobile phones to refer women to healthcare services. Health Poverty action strengthens local health networks so that women can gain quick access to healthcare services in case of pregnancy complications.2

http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/saving-mothers-lives-in-the-bale-lowlands/
http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/saving-mothers-lives-in-the-bale-lowlands/

The project in Bale Lowlands area of Ethiopia is funded by the European Commission. This project provides life-saving sexual and reproductive health services to pastoralist women in Bale lowlands.

Rainwater harvesting schemes are installed in healthcare facilities to improve quality of maternal and child health services and hygiene.3 Health staff is trained to provide life saving assistance to women during childbirth.3 Furthermore, Health Poverty Action increases awareness about HIV, harmful practices like female genital mutilation and encourages pastoralists to realise their right to health.3

http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/health-services-in-south-omo-and-dollo-ado/
http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/health-services-in-south-omo-and-dollo-ado/

The project to improve health services for South Omo and Dollo Ado pastoralists is funded by the Big Lottery Fund.4 Pastoralists are affected by drought and floods as they depend heavily on livestock. There are high maternal and child mortality rates as well as high levels of preventable diseases in the area.4

Health Poverty Action supports mobile voluntary counselling and testing outreach services for HIV. In addition, they support women’s health insurance groups to lend money for maternal child health emergencies.4 There are support groups for educating the communities of HIV and other sexually transmitted diseases.4 Tuberculosis and polio vaccination programs are provided for children.4

Health Poverty Action provides health advocacy principles and strategies to raise awareness via education campaigns. Healthcare services and vaccination programs are allocated for children to improve overall health of pastoralist communities.

References

  1. Health Poverty Action (UK). Strengthening marginalised communities along the Ethiopian and Kenyan border [Internet]. Health Poverty Action (UK); 2014 [cited 2014 Apr 3]. Available from: http://www.huffingtonpost.co.uk/sarah-k-edwards/health-ethnic-minorities_b_4766112.html
  1. Health Poverty Action (UK). Strengthening marginalisedcommunities along the Ethiopian and Kenyan border [Internet]. Health Poverty Action (UK) [cited 2014 Apr 3]. Available from: http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/strengthening-marginalised-communities-along-the-ethiopian-and-kenyan-border/
  1. Health Poverty Action (UK). Saving mothers’lives in the Bale lowlands [Internet]. Health Poverty Action (UK) [cited 2014 Apr 3]. Available from: http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/saving-mothers-lives-in-the-bale-lowlands/
  1. Health Poverty Action (UK). Improving health services for South Omo and Dollo Ado pastoralists [Internet]. Health Poverty Action (UK) [cited 2014 Apr 3]. Available from: http://www.healthpovertyaction.org/where-we-work/africa/ethiopia/health-services-in-south-omo-and-dollo-ado/
  1. International Human Rights. Pastoralism and the discrimination of sustainable livelihoods [Internet]. Australian International Human Rights; 2013 [cited 2014 Apr 3]. Available from: http://intercontinentalcry.org/pastoralism-and-the-discrimination-of-sustainable-livelihoods-21183/
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Poor access to health services: ways Ethiopia is overcoming it

The limited distribution systems and weak infrastructure in low-income countries limit access to health services, particularly in rural areas.1

  • relatively few and widely dispersed government health outlets
  •  Private-sector sources often favour wealthier urban areas which result in uneven available service within a country.1
  • Reproductive health is generally poor in Ethiopia, with significant regional disparities in access to services and in health outcomes.1
http://www.msf.org.au/from-the-field/field-news/field-news/article/we-face-an-alarming-increase-in-malaria-cases.html
http://www.msf.org.au/from-the-field/field-news/field-news/article/we-face-an-alarming-increase-in-malaria-cases.html

Improving health in Ethiopia requires:

  • Improving in physical infrastructure
  • Strengthening primary health care system
  • Decentralising health service provision
  • Require major investments and time
  • Mobilising, educating and training communities and individuals1
  • Pay attention to quality of services, strengthening community participation
  • Provide reproductive and other health services through primary health care facilities1
  1. Population Action International (USA). Poor Access to Health Services: Ways Ethiopia is Overcoming it [Internet]. Washington, DC (USA): Population Action International (USA); 2007 [updated 2007 April; cited 2014 Mar 23]. Available from: http://populationaction.org/wp-content/uploads/2012/01/Health_Services.pdf

Meeting challenges of the future

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http://www.theguardian.com/books/2011/sep/23/three-famines-starvation-keneally-review

Ethiopia is creating a primary healthcare system from scratch.

  • Currently, more than 85% of the population gains access to primary healthcare.1
  • The percentage of births have doubled between 2004 and 2008, during which more than 50% of the number of women receive antenatal care in addition to number of infants who receive full immunisation.1
  • There is 52% decline of under-five mortality over the last decade, down to just 88 per 1,000 live births in 2010.1
  •  Strong leadership from the Ministry of Health driven healthcare policy doubled the number of Ethiopia’s health workforce in three years.
  •  A mobilisation campaign was target at young women to train health extension workers.1
  • Furthermore, Ethiopia complements private-sector investments in new hospitals and the government is close to building 15,000 new health posts and 3,200 health centres in Ethiopia.
  • Future challenges include further scaling to meet the expectations of a national health system and to sustain current efforts in the sector.1
  • It will be challenging to meet the maternal health targets set by the Millennium Development Goals (MDGs) in Ethiopia. There needs to be universal access to basic healthcare service before achieving health MDGs.1

References

1. The Economist Intelligence Unit Limited. The future of healthcare in Africa[Internet]. The Economist; 2012 [cited 2014 Mar 10]. Available from: http://www.economistinsights.com/sites/default/files/downloads/EIU-Janssen_HealthcareAfrica_Report_Web.pdf

Income and Wealth Distribution affects Ethiopia Healthcare

The length of life inequality has decreased and life expectancy increased between 2000 to 2011 in Ethiopia.1 There is a larger length of life inequality between rural and urban residents, also between less wealthy and more wealthy people.1 The population level health in Ethiopia can be assessed by estimating length of life inequality and life expectancy to provide a baseline for priority setting and resource allocation.1 Therefore, distribution of money, income and wealth play a significant role in affecting in health which is measured by life expectancy.

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Figure. 1. Mortality distribution for highest and lowest wealth quintile 2011. Mortality given as deaths per 1000 (y-axis) plotted against five-year age groups (x-axis).

From Figure 1, we can see a distribution of deaths among different five year age-groups for lowest wealth and highest wealth quintile respectively.

  • The highest number of deaths per 1000 for the highest wealth quintile is age group 75-79, with an estimate of 140 deaths per 1000.
  •  The highest number of deaths per 1000 for lowest wealth quintile is age group less than 5, with an estimate of 140 deaths per 1000.
  • Significant high death rate for age group less than 5 for highest wealth quintile, with an estimate of 85 deaths per 1000.
  • peak number of deaths for age group 70-74, an estimated 90 deaths per 1000 in highest wealth quintile.
  • lowest number of deaths for age group 5-9 for lowest wealth quintile, with estimate of 10 deaths per 1000.
  • lowest number of deaths for age group 5-9 for highest wealth quintile, with an estimate of less than 10 deaths per 1000.
  • Both curves show a steep drop in number of deaths per 1000, followed by a gradual increase across the age groups reaching a peak in age groups 70-74 and 75-79, before a steep decrease in mortality rate again.

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Figure 2. Life expectancy (central dotes) and the absolute length of life inequality (high and low bar) for wealth quintiles indicates larger within- than between-group inequality.1

There is a clear socio economic gradient in Ethiopia

  • The life expectancy ranging from 53.4 years in the lowest wealth quintile to 62.5 years in the highest quintile, a significant difference of 9 years in life expectancies.
  • The middle and highest wealth quintiles have highest life expectancies of 60 and 62 years respectively.
  •  The lowest life expectancies are 54 and 55 years for lowest and second wealth quintiles respectively.

1.      Tranvåg EJ, Ali M, Norheim OF. Health inequalities in Ethiopia: modelling inequalities in length of life within and between population groups. International Journal for Equity in Health [Internet]. 2013 [cited 2014 Mar 10];12(52). Available from: http://www.equityhealthj.com/content/12/1/52

Ethiopia: The Threat from within

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http://abbaymedia.com/2008/05/31/ethiopian-children-go-hungry-as-government-response-faulted/

International aid and government funding have been misused for political gains rather than investing in social and economic rights. Corruption is reflected by the government policies which influences distribution of funding towards investments which benefit government politicians. These funds are taken away from areas of desperate need such as healthcare, food and agricultural resources.1

Human Rights Watch discovered inequalities in developmental projects and policies in Ethiopia. The government in Ethiopia has utilized donor-supported programs, training opportunities and salaries to control the population, punish those who dissent and suppress political opponents.1 Opposing party members are denied access to fertilisers, seeds, food aid, agricultural land and other resources for development because of conflicting political opinions. However, if these members write a letter of regret to the administration for siding with the opposing political party, local officials offer them food and money.   Discrimination is widespread in Ethiopia. People are excluded from development programs just because of their religion, gender, ethnic backgrounds and disability.1

Human Rights Watch research also shows that people in the Gambella region of Ethiopia are forced to move away from their existing homes to new model villages where they were promised to have improved infrastructure and better services. Sometimes the government orders soldiers to beat and abuse people who are opposed to moving away from their homes. Government pledges are not fulfilled as the relocated populations face hunger and starvation despite being promised food and agricultural assistance.1 There are serious human rights abuses against indigenous peoples and other ethnic minorities under the government’s “villagisation” program.

The Ethiopian government sold these areas of land to India for cheap farm lands.

Moreover, the Ethiopian government has failed to consult and compensate Indigenous groups for alternative means of livelihoods when they are forced to relocate. For the purposes of this ‘villagisation’ program there has been the creation of 245,000 hectares of state-run sugar plantations along the Omo River.1 Intimidation and assaults are forced upon these people who questioned and opposed to relocation plans.

Future commitment by the international community should be to protect the peoples rights and prevent violations of these rights. There is a need to recognise specific rights of Indigenous people and their right to ancestral lands.1 Education, healthcare, water and sanitation and other socio-economic rights should be considered for Indigenous people.1

Human Rights Watch raises awareness by posting online websites and urged international donors to ensure that they are not providing support for forced displacement or facilitating rights violations in the name of development.2

Cultural Survival increases awareness through a campaign known as Global Response Campaign Alert Ethiopia. Volunteers can post polite letters to governments of the United Kingdom and the United States to express concern of the Ethiopian government violating human rights through villagisation program. They can also urge UK and USA not to fund for villagisation schemes that violate human rights.3 Letters should encourage USA and UK should use their influence as donor nations to demand Ethiopia to reinforce its own constitution and laws to protect Indigenous people’s rights to their ancestral lands.3

References

1.  Human Right Watch (USA). Discrimination, Inequality, and Poverty A Human Rights Perspective [Internet].  United States of America: Human Right Watch (USA); 2008 [updated 2013 Jan 12; cited 2014 Mar 10]. Available from: http://www.hrw.org/news/2013/01/11/discrimination-inequality-and-poverty-human-rights-perspective

2.  Global Development. Thousands ‘forcibly relocated’in Ethiopia, says HRW report [Internet]. Global Development; 2012 [updated 2012 Jan 7; cited 2014 Mar 29]. Available from: http://www.theguardian.com/global-development/2012/jan/17/ethiopia-relocation-programme-report

3.  Cultural survival (UN). Global Response Campaign Alert Ethiopia [Internet]. United Nations: Cultural Survival (UN); 2012 [cited 2014 Apr 13]. Available from: http://www.culturalsurvival.org/sites/default/files/ethiopia_action_alert.pdf