Health extension workers help an Ethiopian community improve health services for women and children

Mother and child at a Health Post in Tahtay Koraro.
(Photo: A. Ameha)

“The community is the greatest supporter in ensuring maternal health” says Ato Arefaine Hagos, the Adimenber Kebele Administrator, explaining the tremendous benefit of having all levels of a community work together to solve problems. This was not always the case in Adimenber.

Adimenaber community members and health extension workers (HEWs) recognized that they needed to improve health services for women and children so they worked together to identify four key barriers to improving maternal and child health outcomes:
  1. Poor road infrastructure prevented timely transportation of pregnant women to health facilities for delivery and/or emergencies;
  2. Lack of transportation vehicles, such as ambulances or carts, to navigate the bad roads that lead the health post from the         various gotts (neighborhoods);
  3. Absence of beds at the health post; and
  4. Inadequate delivery training for HEWs.

To address these impediments, the Gates Foundation's Last 10 Kilometers (L10K) Project, implemented in Ethiopia by John Snow, Inc.,  helped organize a participatory community quality improvement (PCQI)* committee, comprised of HEWS and community members. The group discussed the barriers and carried out the following efforts to mitigate them:

  • Mobilized 295 people to work on and maintain 5 kilometers of road to facilitate transportation of pregnant mothers to the health post.
  • Contributed five carts to transport pregnant mothers, and arranged with the kebele youth association to assist in their transportation.
  • Pooled money to buy a bed for the health post. The woreda health office contributed a mattress and sheets.
  • Arranged for a HEW to be trained at one of the best maternal and child health centers in the region. They also arranged for experienced midwives to mentor the HEW in delivery and immediate newborn care.

In the six months after these actions were taken, 16 mothers delivered their babies at a health post. Moreover, the maintenance of 5 kilometers of roads in the kebele improved MNH services, including antenatal care (ANC), delivery and postnatal care (PNC). The roads provided HEWs with better access to previously inaccessible gotts (neighborhoods) in the kebele, thus enabling them to identify 56 pregnant women over the same period.

“Prior to PCQI implementation, very few pregnant mothers came to the health post for checkups and counseling, but now many of them do,” said Alem Berhe, the Kebele Manager. He discussed the new monthly mother's day meetings, at which, over tea and coffee, pregnant mothers share their experiences and concerns, and HEWs educate and offer services.

The implementation of L10K's Participatory Community Quality Improvement process in the Tahtay Koraro Woreda of Tigray has resulted in better maternal and child health practices in all of the woreda's intervention kebeles. The cooperation of the community in the Adimenaber kebele to improve the health outcomes of their neighbors sets an inspiring precedent for the implementation of future PCQI projects.