Saving the lives of women and children through access to health services

Abdella Issa, Monitoring & Evaluation Officer with the Afar Pastoralist Development Association (APDA), was interviewed by Ernest Etti from the AACES Resource Facility, about the changes he has noticed in the pastoralist communities of Ethiopia since he became involved in the AACES program, through The Road Less Travelled project.

Can you tell me about when and how you became involved in the AACES program?

I joined the AACES program in August 2011 and this was during the orientation of staff and government in the seven target districts in Ethiopia. I was recruited as a Monitoring and Evaluation Officer, and was briefed about my roles at that time.

What do you think are some of the changes you have experienced since you have been involved in the AACES program, thinking in particular about AACES partnerships and about civil society?

There are indeed changes in maternal and child health in the seven districts. There are changes on the ground like improvement of mothers delivering at hospitals. Malnutrition among children has also decreased and there are changes at a district level as well, like the establishment of stakeholder committees, which meet every six months to review progress of the project and discuss improvements of services on the ground.

There are also annual reflection meetings at a district level, to review progress of work for the past twelve months and then agree on plans for the next twelve months. These meetings have also improved relations among stakeholders; district local government, community leaders and other NGOs working in the same districts.

The project also conducted research at a regional level to investigate the role of women extension workers at community level. The key finding was that women extension workers are central to reaching out to pregnant women in pastoralist communities. Previously, there were more male extension workers, a situation that hindered access to health services on the part of pregnant women in pastoralist communities. Research results were shared with district and regional officials and it is expected that government will in future start recruiting more women extension workers in the field of maternal and child health.

You have mentioned a number of changes relating to the AACES program, AACES partnerships and civil society. From your point of view, which do you think is the most significant?

The most significant change is about mothers accessing health services, and women delivering at health facilities. For example, the story of Fatuma Ahmed; a 23 old mother of four children (three boys and a girl). One of the boys, third born, died during delivery as the mother sourced services of a Traditional Birth Attendant (TBA). The TBA did not remove the placenta for two days, risking the life of Fatuma. She was then referred to the hospital where it was taken out. The hospital is within the AACES catchment area and is supported by AACES. She got treated and went back home well. From then on, she started getting health services and during her fourth pregnancy, for the first time she started getting antenatal check-ups and counseling at the hospital. Fatuma was previously reluctant to access health services because she didn’t believe that the health facilities offered better services than TBAs. Also, she was shy to be attended to by men at the hospital. But later, she started encouraging other women to start accessing health services. The number of pregnant women accessing health services has now increased by 4%.

Why did you choose this change in particular? Why is it significant to you?

I chose this story because many women are dying during deliveries with TBAs; it’s a major issue in communities. It’s also a major focus area for the project.

What difference has this change made, or will it make in the future?

The fact that many women have started delivering at hospitals means a lot as it will reduce birth complications that lead to deaths of women and children. Previously, birth complications would be referred to hospitals only when the situation had already become really bad; resulting in increased maternal and child mortality. But now, many women have started getting antenatal check-ups and counselling.

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