by Jenny Dyer, PhD
Upon the conclusion of the seventeen-year Ethiopian civil war, the region of Tigray, the northernmost province in Ethiopia, is the home to the Ethiopian People’s Revolutionary Democratic Front. Their late Prime Minister Meles Zenawi who led the revolution and won is celebrated still across the country. Today marked the annual Tigray People’s Liberation Front Celebration and the town of Mekele took a holiday to celebrate in a public event.
Our delegation, however, was there for another reason. We wanted to learn more about the Health Extension Worker program, and how it worked. To do so, we first visited a Health Post. This post serves a population of about 5,000, and they are placed throughout Ethiopia. A HEW who has achieved an education to the tenth grade and then one year of HEW training is placed with one other HEW colleague at a Health Post and lives in the village she works. Almost all of the HEWs are women.
The drive from Mekele to Gemed Kebele took us over a landscape not unlike that of New Mexico. We wound around paved roads that showcased a vast expanse of an arid landscape with a background of rocky mountains. We traveled up a dirt road the last part of the trip into a small, quiet village where some children were seen carrying yellow water jugs and others were racing through the valley. We finally arrived at the health post to meet Miheret Gebrehiwot.
This health post is a simple concrete structure lacking running water and electricity. But it has a patient bed, sparse pharmaceuticals, and a space to keep data on the health of the community.
Miheret is a trained HEW who is one of two who manages the health post. She presented herself in a white coat and welcomed us inside her office and patient’s room. There, she described the kinds of services she provides, largely for mothers and children. She has detailed charts covering the walls, meticulously keeping data on diagnoses and disease in the area. She must then report this data monthly to the Health Centre, which we will visit tomorrow.
Miheret herself was a child-bride. She was married at the age of 11 while she was just in the third grade. Upon marriage, she left school to take care of her new home. She bravely retold her journey to becoming a HEW and her passion for educating women about healthy timing and spacing of pregnancies. Miheret had her first child at the age of 16. She knew then that she had to return to school for a better life for herself and her children. With help from her mother with her child, Miheret pursued graduation from the 10th grade. She then sought training to become a HEW. Miheret has been able to space her pregnancies, have a second child, and pursue a happier, healthier life for herself and her family. She wants to become a nurse someday.
The Health Posts, just like the one in Gemed Kebele , provide critical family planning services to women in rural communities who might otherwise lack access to contraception. Moreover, they have HEWs who keep track of their choice of contraception and when they are due for their next appointment. At the Health Post, they offer Depo Provera, an injectable, which is the favored contraception of choice in the area, and it lasts three months. Other options include Implanon (an implant which can be performed by the HEW), birth control pills, and condoms.
If these women can access consistent contraception, they can better plan their families according to the best timing for their own health and the health of their children. Again this leads to better opportunities for the mother to return to school or return to work and provide a more substantial income for her family.
HEWs also provide Antenatal care. They carefully track pregnancies in the communities. For every pregnant woman, they recommend four medical visits including one to the Health Centre. They also advocate for the mother to travel to the Health Centre to deliver her baby. There they can have access to skilled attendants, running water, and electricity. Alongside the rising contraception prevalence rate of expansion of family planning, these combination may be the key to combatting maternal mortality.