Does education empower Health Extension Workers in 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.

“…Across the world, as we talk about women in developing countries, there’s been increasing recognition that empowering women and girls is a key change agent for development.”

– Julia Gillard, time.com, 24 September 2014

Last year Hillary Clinton and former Australian Prime Minister Julia Gillard announced US$600 million in private and public funding for girls’ education. The project aims to reach 14 million girls around the world in the next five years.

Clearly, girls’ education is a good thing – but I’d suggest that education doesn’t automatically give girls or women agency – or the ability to make choices about what they want to do and to act on those choices (World Bank, 2012).

Ethiopia, ranked 173 out of 187 on the gender-related development index (GDI), has significant disparities between women and men. According to the Ethiopia Mini Demographic and Health Survey (Central Statistical Authority, 2014), 66% of rural women cannot read and write – more than three-quarters of these women are over 30 years of age.

During my current project funded through Australian Development Research Awards Scheme (ADRAS), I’ve met many Health Extension Workers (HEWs) in Ethiopia who’ve had some, but who all want more, education and training.

The criteria for HEW recruitment is that they are over 18 years of age, have grade 10 education and speak the local language. HEWs attend vocational training for one year before going back to their communities to become one of two HEWs for each rural village or kebele. Each kebele has a health post that serves around 5,000 people and functions as the operational centre for the HEWs. HEWs provide services in 16 packages in hygiene and environmental health; family health; disease prevention and control; and, health education and communication.

A rural health post in Ethiopia. Image credit: Ruth Jackson

A rural health post in Ethiopia.
Image: Dr Ruth Jackson

After training, HEWs were also expected to provide focused antenatal care (ANC), clean and safe delivery, and essential newborn care services. Recent policy changes mean that HEWs should now refer pregnant and birthing women to health centres staffed with skilled birth attendants capable of managing normal birth and Basic Emergency Obstetric and Neonatal Care (EmONC). Health centres refer women to hospitals that are equipped and staffed to provide comprehensive EmONC services if required.

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Gender transformative approaches

This post was written by Pamela Onyo, Research Officer in Kenya.

Gender transformative approaches are programs and interventions that create opportunities for individuals to actively challenge gender norms, promote positions of social and political influence for women in communities, and address power inequities between persons of different genders. It creates an enabling environment for gender transformation by going beyond just including women as participants in a project. The approaches are part of a continuum of gender integration into all aspects of program and policy conceptualisation, development, implementation and evaluation.

In the context of health and social and behaviour change communication (SBCC), the approaches address multi-level power hierarchies in communities that impede an individual’s ability to make decisions about his or her health. For women, this can include (but is not limited to) health decisions such as access to health services and birth spacing. These approaches strive to shift gendered community perspectives and social relationships towards perspectives of equality that allow both women and men to achieve their full potential within a society. Accordingly, the approaches go beyond improving health access for women alone, but include benefits for men that also affect women’s health and empowerment.

Image: Matthew Willman / AOA

AOA’s project has aimed to create an enabling environment for gender transformation, by going beyond just including women as participants in a project. Image: Matthew Willman / AOA

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Cultural shifts: women speak now

This post was written by Loretta Pilla, Anglican Overseas Aid.

The Road Less Travelled (TRLT) is an integrated maternal and child health and community development project working with nomadic pastoralist communities in Kenya and Ethiopia, led by Anglican Overseas Aid, Kenya, partnering with the Mother’s Union of the Anglican Church of Kenya and the Maasai and Samburu nomadic pastoralist communities in Laikipia and Samburu counties.

Focused on improving core maternal and child health outcomes, TRLT’s holistic approach involves methods that address education and literacy as well as improve access to water, food security, and sustainable livelihoods. The desire to achieve health equity through the empowerment of women underpins all activity. Three years since the project’s inception, the results are redefining lives and wellbeing, especially for women.

Where we used to stand

Planting seeds. Image: Matthew Wilman/AOA, 2012

Planting seeds. Image: Matthew Willman/AOA, 2012

The Maasai ranch of Tiamamut in North Laikipia, Kenya, is accessible only by an indistinguishable dirt road. Here, in this highly patriarchal society, men’s voices have traditionally drowned out those of women. Land and livestock, which are of paramount importance to the Maasai, are owned by the men, whilst women are afforded ownership of only a few products and resources, such as kitchenware, food, milk, chickens, and hides. The only possessions a woman can inherit are her mother’s ritual beads. Customarily, the viewpoint of many traditional elders has been that women have no rights and thus no role in decision-making within the traditional nomadic pastoralist social structures.

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The changing role of Maasai men in maternal health

James Senjura works closely with the Maasai pastoralist community of Laikipia, Kenya, to improve maternal and child health. He is a Project Officer for Mothers’ Union, Anglican Overseas Aid’s partner in The Road Less Travelled project, and also a father and positive role model for other men in his community. The project works with the community to identify key development challenges, and helps to develop locally-appropriate solutions to deliver basic health care and education where access to formal services is limited. James answers some questions about traditions and gender norms relating to maternal and child health within his culture.

In the Maasai community of Laikipia, how would you describe the traditional role of men in maternal and child health?

Traditionally, men’s role in maternal and child care has been passive. Maternal and child health care was in the hands of traditional birth attendants and old women.

Mostly men provide financial support and organise for transportation, and sometimes in consultation with the traditional birth attendant they decide for further action in case of complications or disease occurring. The father would advise on the estimated date of delivery, so that the woman would be prepared.

Image: Matthew Willman / Anglican Overseas Aid

Traditionally, the role of Maasai men in maternal health and child care has been a passive one. Image: Matthew Willman / Anglican Overseas Aid

It was also the role of man to source food (slaughter animals, draw blood) for the mother during and after pregnancy. When a woman was in the last trimester, the man would ready some rams for slaughter after delivery.

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Education as a catalyst for change in Samburu

Travelling through Samburu County, Kenya, you can’t help but gaze in wonder at the vast, dusty landscape and the huge numbers of livestock that are herded through the region. Beside them is often a child as young as five years.

For children growing up in nomadic or semi-nomadic pastoralist communities, mainstream education has, traditionally, not been an option. As cultural mores dictate ways of life, young girls and boys are often obligated to take up the role of shepherds for their family’s livestock, covering great distances with their animals in search of fresh pastures for grazing.

The vast landscape of Kenya’s nomadic pastoralists, on the road north to Samburu County.
Image: Anglican Overseas Aid / Matthew Willman

Education, in the past, may have been considered low on the list of needs within this setting. Now this view is gradually changing, but the question of accessibility remains. The herding responsibilities of children during day mean they have little opportunity to attend mainstream schools, even with the support of their families. To make any progress in improving education for marginalised communities, alternative education models are required.

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