Saving Newborn Lives in Ethiopia

I had to wait to draft my post about the field visit yesterday because the travel there and back took so long, the traffic was so horrendous, and I was so tired… but here I am in the fresh light of a new day, well rested and ready to focus on the important stuff!

mother and her child outside the health post

Six of us headed south Friday morning at 7am into the Oromia District. We were scheduled to visit a village health post (the lowest-level of formal health care here in Ethiopia) and a health center (the next level up). We were visiting places that our Saving Newborn Lives program is working with to make sure that babies in the first 7 days after birth are being attended to.

Saving Newborn Lives is a project funded by the Bill & Melinda Gates Foundation and JSI is working with the Ethiopia Federal Ministry of Health (FMOH) and Save the Children to—as the title says—save newborn lives.

It turns out that many health programs in countries such as Ethiopia focus on the health of pregnant women and they focus on getting children immunized, but somehow newborns are forgotten! This is particularly tragic as more than 100,000 newborns die in Ethiopia every year, most of these deaths—42% within the first week of life in fact. So having even minimally-trained health workers (or volunteers in villages, as the case may be) who can recognize some basic danger signs of severe illness (as well as postpartum hemorrhage among women who have given birth) is critical.

The Saving Newborn Lives project's Community-based Interventions for Newborns in Ethiopia (COMBINE) initiative has developed some simple checklists that are all graphical—because many of the volunteer community health workers are illiterate—and is now training these volunteers that they need to visit women and their newborns three times in the first week, the danger signs to look for, and to encourage them to visit the health post for immunizations. If it looks like the baby or mother is in trouble, the volunteer can also get the health extension worker at the health post.

The three community health promoters we met

In the village, we met three community health promoters (CHPs) at the health post. All three are mothers, two can write their names but not read, the third can’t even write her own name. Yet, they were each selected by their community to be a volunteer community health worker and accepted the role. As a volunteer they have the opportunity to try out what they learn at home, too. The first thing volunteers learn about is how to build a latrine. They build one in their yard and then show their neighbors! They’re expected to talk about what they’ve learned about—from latrines to keeping water jars covered (so flies don’t deposit dirt in there that makes everyone sick) and, importantly, to visit the health post if you’re pregnant.

Prenatal care isn’t something women think about here. They tend to keep their pregnancies secret until they can’t any longer and something like 90% of women deliver at home—and and of those, just 15% use a “traditional birth attendant.” Typically TBAs have no formal training, just lots and lots of practice delivering babies. The family members who deliver the other 85% of home births typically have had not one bit of training aside from having had babies themselves!

 

Is it a wonder then that many of those babies die within the first week after being born?

The community promoters took us to a few houses where new moms were living. One’s child had “fast breathing,” indicating a respirator-track infection, which can be lethal. Another’s child had had terrible diarrhea. It might not sound like much, but diarrhea is the second leading cause of under-five deaths a year—killing about 120,000-200,000 kids in Ethiopia a year (estimates vary). It’s a huge issue, so knowing when to tell a mother to get her child to the health post or being able to make her a simple salt solution to rehydrate the baby can make all the difference.

It turns out that in just the two years since our JSI Saving Newborn Lives team trained the health extension workers at the health post and the volunteers, the rate of women who deliver at either the health post or health center has increased a bit to 10%, so there’s still a long way to go!

The volunteers were pretty shy about talking about themselves, but the three women we met all said that they appreciate being able to help mothers in their community. They also gain social status, which is significant for illiterate women. Another project I’ve visited here in Ethiopia, the “Last 10 Kilometers Project,” which is also funded by the Gates Foundation, is looking at how to keep volunteers engaged through “nonfinancial incentives”—not surprisingly, community recognition is huge. The health post we visited also has the CHPs photos on the wall, which is another form of recognition for them.

Until social norms change and people know when to visit the health post or understand the importance of prenatal care is understood by all, the work that CHPs are doing is critical.

Here the health extension worker shows us the family health card, which JSI introduced in-country that helps track basic health of the children.

It was a fascinating visit and it was fulfilling to learn that our Saving Newborn Lives team really is saving lives!