Let our sisters learn

For pastoralist children in the isolated Afar region of Ethiopia, access to education has always been extremely limited. For girls, there is even less opportunity. The Afar Pastoralist Development Association (APDA), which began its first literacy program in 1996, is responding to the situation.

Since APDA started the literacy program, it has evolved to improve the coverage and quality of education in the Afar region, with an emphasis on education options that are appropriate for pastoralist children. While primary level education was being achieved in many areas through a combination of mobile and static education, the next challenge was to come up with a solution for how the children would continue their learning.

As an extension of the literacy program, APDA has been piloting a strategy that will ensure more girls gain access to education on an ongoing basis.

In the first year it was difficult to get girls into the student hostel, but over time pastoralist families have come to realise the benefits of giving their daughters the opportunity to learn. Image: Kate Holt / Anglican Overseas Aid

The Road Less Travelled project partner APDA is working with remote pastoralist communities in the Afar Region of Ethiopia to increase girls participation in education.
Image: Kate Holt / Anglican Overseas Aid

Through The Road Less Travelled, a partnership project led by Anglican Overseas Aid, APDA has established a student hostel in the town of Asayita. Pastoralist children from remote rural areas move to the town to live in the student hostel accommodation during the school term, so they have the opportunity to continue learning. The project supports the students to live while they attend the local government school from grade five onwards.

A key priority of the hostel is to increase girls’ participation in education – a challenge that has been met with some resistance from pastoralist communities. One factor that has helped to pave the way for Afar girls is the presence of the hostel house mother, Lako.

Lako is a mother from the same remote community as the students, and responded to APDA’s search for a volunteer house mother.

“They needed someone, so I said I’d go,” she says. “The best thing I can do is look after children. If our children learn, we can have a great future.”

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Improving the use of maternal, neonatal and child health services in rural and pastoralist Ethiopia

This guest post is written by Dr Ruth Jackson of the Alfred Deakin Research Institute. Dr Jackson is working on a project focused on improving the use of maternal, neonatal and child health services in rural and pastoralist Ethiopia. The project is funded by the Australian Development Research Awards Scheme. Dr Jackson has been learning from the experiences of Women’s Extension Workers who work with the Afar Pastoralist Development Association, a partner in The Road Less Travelled project.

“You won’t believe us – we start walking in the morning up til night time to collect water. Then we grind the wheat, collect sticks for firewood and take water to the animals. Sometimes if we have to sleep where we collect water, we take our baby with us, otherwise we leave the baby in the house.”

– Women’s Extension Worker, Logya, Afar Region, Ethiopia, 25 March 2014

We are sitting in the shade at the Afar Pastoralist Development Association (APDA) training facility with 19 Women’s Extension Workers. The women, many with young children and babies, are attending their annual refresher training. It’s too hot to sit inside the training centre but relatively cool in the shade of the building.

Along the fence line are the rooms in which the women stay for the month. Although they are square and joined together they are built of the same materials as the Afar huts or aris. Aris are normally hemispherical and made of palm ribs covered with matting. They are light and portable and easily dismantled – a job usually done by women.

While the Women’s Extension Workers are away from home attending training their husband or mother has to collect water. Men don’t like collecting water as it’s “women’s work”. But one Women’s Extension Worker explained that they had to help their husbands understand that “helping each other is good. Some men joke about doing it while others don’t like doing it … in the past, some men even refused to allow their wives to come to training.”

Fatuma is a Women’s Extension Worker Coordinator for the Afar Pastoralist Development Association, with a total of 12 WEWs in her team. Image: Kate Holt / Anglican Overseas Aid

Fatuma is a Women’s Extension Worker (WEW) for the Afar Pastoralist Development Association, and coordinates a team of 12 WEWs in her area.
Image: Kate Holt / Anglican Overseas Aid

Afar Region in north-eastern Ethiopia is dominated by the Danakil depression in the north, which is largely desert scrubland with shallow salty lakes and long chains of volcanoes. In the south, the Awash River flows into the northern lakes rather than to the sea. Much of Afar is below sea level and it is one of the hottest places on earth, with temperatures higher than 50°C in the summer. About 90 per cent of the regional population base their livelihood on livestock rearing – cattle, camels, goats, sheep and donkeys – with limited agriculture along the river basins and low-lying riverine areas.

The Ethiopian Ministry of Health acknowledged in Health Sector Development Program IV (2010/11-2014/15) that there was a lack of appropriate health service delivery packages to address nomadic and semi-nomadic communities in Afar Region.

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Hospital deliveries in Afambo: a success story

Abdella Isse, Monitoring & Evaluation Coordinator for the Afar Pastoralist Development Association, sat down with mother of six, Kulsuma Ahmed, to talk about her experiences of giving birth in Afambo in the Afar region of Ethiopia.

Kulsuma Ahmed is a mother of six from Afambo in the Afar region of Ethiopia. Image: Abdella Isse / APDA

Kulsuma Ahmed is a mother of six from Afambo in the Afar region of Ethiopia. Image: Abdella Isse / APDA

Many pastoralist women such as Kulsuma Ahmed, pictured above, from Afambo in the Afar region of Ethiopia, give birth at home. It is the cultural norm within the nomadic Afar community, despite not being the safest delivery setting for mothers and their newborns.

In the portable dome-shaped huts in which nomadic families live and women give birth, sanitation and hygiene are constant issues, water is not always readily available, and mothers are a long way from skilled medical support if they run into complications. Communities often live 30-40 kilometres from the nearest road.

Traditional birth attendants (TBAs) usually assist women during pregnancy and childbirth due to challenges of distance and lack of health facilities. The percentage of deliveries assisted by qualified health personnel in the Afar region is just 6.2 percent – compared to the national average of 18.4 percent.1

The Afar Pastoralist Development Association (APDA), Anglican Overseas Aid’s partner in The Road Less Travelled project, has been working with pastoralist women to educate the community about the benefits of attending a health facility at the time of birth. This education is delivered to the pastoralist women through the organisation’s Women’s Extension Workers and Health Extension Workers.

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Mobilising communities in the fight for safe motherhood

Momina sits on the bed in the hut where she will give birth to her third child. The bed is a traditional Afar “oloiyta” made of thatched sticks and slightly raised. She is ready to deliver any day now.

“The baby has been moving around a lot,” Momina says. She is nine months pregnant, and is visited twice a week by a Women’s Extension Worker (WEW) from the Afar Pastoralist Development Association (APDA) – the Ethiopian partner of Anglican Overseas Aid in The Road Less Travelled project.

Momina is nine months pregnant and waiting to give birth at home, with the support of a trained traditional birth attendant. Image: Kate Holt / Anglican Overseas Aid

Expectant mother, Momina, is waiting to give birth at home in the remote Afar region of Ethiopia.
Image: Kate Holt / Anglican Overseas Aid

The WEW has monitored Momina throughout her pregnancy, and provided antenatal care. However, this has not always been the case for women giving birth in the Afar region of Ethiopia. In one district surveyed by the project, 66 percent of women reported having received no antenatal care during their most recent pregnancy. (Read more in our Baseline Report).

As a country, Ethiopia has one of the highest ratios of maternal mortality in the world, in 2011 recording 676 maternal deaths for every 100,000 live births.1 For women in the Afar, the risks of injury or death during childbirth are even greater.

Due the remoteness of the Afar pastoralist communities and their nomadic lifestyle, communication, transport and access to health services has in the past been extremely limited or non-existent. There are also significant cultural or attitudinal factors that affect the care mothers receive during pregnancy, delivery and post-delivery.

APDA is improving the chance at life for Afar mothers and their children, by mobilising members of the community in the fight for safe motherhood. With a 20-year history working within the pastoralist setting, the organisation is uniquely positioned to facilitate relief and development activities that are relevant to the community, and implemented by the community.

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The Afar tradition of disability inclusiveness

Teacher Humaid Said shared his experiences of disability inclusiveness in the Afar community of Ethiopia with Tanya Caulfield of the Nossal Institute for Global Health – Anglican Overseas Aid’s partner in The Road Less Travelled project.

When he was 12, Humaid Said contracted polio and lost the use of his leg.

In many developing countries, Humaid would have been consigned to a life on the margins of his community. People with disabilities are among the poorest and most vulnerable and are often at greater risk of social exclusion.1 This, in turn, reduces their access to education and healthcare, along with opportunities to participate in decision-making and provide for themselves and their families.

But for Humaid, growing up in the rural Afar region of Ethiopia was an entirely different experience that challenges the notion that development work must always teach people about how to include people with disabilities.

The nomadic pastoralists of the Afar have a deeply embedded traditional social support network, and the concept of excluding an individual from family and community life based on their disability is perceived to be counter to Afar cultural laws.

Teacher Humaid says that in Afar culture, people with disabilities are active participants in the community.  Image: Tanya Caulfield / Nossal

Teacher Humaid says that in Afar culture, the community perception is that no one should be treated differently.
Image: Loretta Pilla

“When I was younger, I would see others participating in activities when I couldn’t, so I wished to be like them,” he explained. “But the community perception is that no one should be treated differently – there is a law in Afar tradition not to treat people differently in the family and the clan.”

Despite wishing at times that he had full use of both legs, Humaid said that in Afar culture people with disabilities are active participants in the community and are involved in different ways in socioeconomic activities.

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From Australia to Afar, all mums matter

This month, The Road Less Travelled was honored to have our partner, Valerie Browning, in Australia to share firsthand the realities, challenges and innovative approaches the project has adopted to improve maternal health in the remote Afar region of Ethiopia.

Read our article on the Mamamia blog or listen to the radio interview with Valerie on 3ZZZ.

While she was in Australia, Valerie connected with health professionals, educators, students, researchers, and members of the general public, to talk about what life is like for the nomadic pastoralists she works with.

Many of the audience left feeling inspired by Valerie’s determination to do whatever she could to help the Afar in developing locally-appropriate solutions to the immense development challenges they face.

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Stories from Afar with Valerie Browning

Inspirational Aussie nurse, Valerie Browning, is currently in Australia to share stories of her work in maternal and child health with the nomadic pastoralist Afar communities of Ethiopia.

Valerie’s organisation, the Afar Pastoralist Development Association (APDA), is a partner in The Road Less Travelled, a project of Anglican Overseas Aid that is supported by AusAID.

Valerie will be speaking at the Nossal Institute for Global Health at the University of Melbourne next Wednesday 14 August, a special event of the Nossal Seminar Series.

Inspirational Aussie nurse, Valerie Browning (centre), is in Australia to share her experiences working with the nomadic Afar communities of Ethiopia to improve maternal and child health.

Inspirational Aussie nurse, Valerie Browning (centre), is in Australia to share her experiences working with the nomadic Afar communities of Ethiopia to improve maternal and child health.

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Report from Afar calls for focus on access and appropriateness of maternal health services

A baseline report released this month by The Road Less Travelled (TRLT) project supports the theory that improved maternal and child health outcomes cannot be achieved through health interventions alone. The project, led by Anglican Overseas Aid (AOA), has adopted a holistic, strengths-based approach to its community development activities, which includes measures to address education and literacy as well as to improve access to water, food security, and livelihoods.

This report presents the findings from a Baseline Assessment undertaken in late 2011 among nomadic pastoralist communities in the Sifra and Yallo woredas (districts) of the Afar region of Ethiopia. The research was carried out by TRLT project partners the Afar Pastoralist Development Association (APDA) and the Nossal Institute for Global Health. It builds on the project participatory design process which identified community assets, important cultural and gender issues impacting on health, and challenges in accessing basic services.

Maternal and child health baseline survey among nomadic pastoralist communities in the Afar region of Ethiopia.
Image: Christof Krackhardt / APDA

A quantitative questionnaire was administered to 400 pastoralist households – 200 from Sifra and 200 from Yallo. The questionnaire was administered to a man and a woman from each of the participating households. Qualitative data was captured via a series of focus group discussions based on semi-structured question guides and through Community Resource Mapping and community forums which identified resources and services available to the communities.

In her Foreword to the report, APDA Project Coordinator Valerie Browning explains:

“The report cries out that access and appropriateness of services and resources, specifically health and water, must receive due attention in order to enable safe motherhood.”

The baseline data allows for a deeper understanding of the knowledge, attitudes and practices regarding maternal and child health and other issues impacting on health in Afar communities.

“Since all issues raised in the report are well within the realms of APDA’s experience and expertise to tackle, this Baseline Report should energise the project team on to greater alliance with the community in the facilitation of the planned safe motherhood initiatives in each of these project districts, while providing a contextual pattern for the remaining project districts.”

If you’re interested in learning more, you can download the full report here.

The Road Less Travelled is a project of Anglican Overseas Aid, and is being delivered with the support of AusAID.

Keeping pastoralist children in school during drought

In the past few months, relief has come in the form of much-needed rain to many drought-stricken districts in the Afar region of northern Ethiopia. Following an extreme dry season in 2012, and two previous years of minimal rainfall, the need for rain was critical in communities that are supported through The Road Less Travelled (TRLT) project.

Before the rains, 24 water distribution trucks were being used in an effort to avert thirst. Many Afar communities were weakened by severe malnutrition, animals were too weak to collect and carry water for households, and communities were unable to reach markets and sell stock as the animals were too emaciated. There was a strong fear that livestock would die en masse, leaving thousands of households destitute.

Between March and May, rainfall in some areas has replenished water storages, however, much of the water is unprotected and highly exposed to contamination. This leads to an increased risk of waterborne diseases among an already vulnerable community. Health extension workers have been working with project-trained health workers to establish community-level sanitation, which is a huge challenge in itself given the Afar nomadic lifestyle.

Rain has provided temporary relief for some communities in the drought-stricken Afar region of northern Ethiopia in recent months, while other areas remain dry.
Image: AVI / Fran Noonan

Other areas remain dry, having received minimal rainfall in recent months, and communities have been forced to move far from their homelands in search of grazing lands for their livestock. With the health of the herd at the heart of the pastoralists’ livelihood, TRLT partner the Afar Pastoralist Development Association (APDA) continually monitors these conditions and supports displaced communities through animal feeding and treatment, and water distribution.

A flow-on effect of the drought is that many pastoralist school children are forced to abandon their studies. Continue reading

Video: Eliminating barriers to skilled birth attendance

Following on from our previous post, here is the second clip featuring our team in action at the Global Maternal Health Conference (GMHC) last month. Valerie Browning of the Afar Pastoralist Development Association (APDA), our Ethiopian partner, led a panel discussion around a topic very close to her heart, “Eliminating barriers to skilled birth attendance.”

This two-part video from the Maternal Health Task Force gives insight into some of the incredible work being done and different strategies being adopted in Ethiopia, Burkina Faso, India and Bangladesh, in an effort to improve skilled birth attendance. (You can view Valerie’s presentation on APDA’s work from the beginning of the second video).

Eliminating barriers 1 from Maternal Health Task Force on Vimeo.

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