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,, 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.

Continue reading

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.

Continue reading

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.

Continue reading

Keeping track of The Road Less Travelled

We are pleased to announce the publication of The Road Less Travelled Annual Report for 2013-14.

Cover of Annual Report

The report provides detailed feedback about the impact of the project in Ethiopia and Kenya, as well as narrative stories of transformation and life-change. Of paramount importance is the engagement with, and benefit for, the most marginalised people within the project communities, especially women.

This is done through a strengths-based approach to community development, in which communities are at the centre of their own development vision and recognise and draw on their existing assets to achieve their development aims.

“People want to live a good life, so they see the value of our work in the community.
The level of knowledge in the community is slowly increasing.
People are beginning to change.”

Cecilia, a Community Health Worker in Longewan, Samburu County, Kenya

Significant progress has been made, with:

  • 2584 additional people having access to sustainable, safe water.
  • 3283 additional people having access to appropriate sanitation.
  • 506 additional people accessing a modern family planning method.
  • 1278 additional children receiving vaccines within the first 12 months of life.
  • 379 child deliveries occurred with a skilled birth attendant present.
  • 317,150 people received vital health education messages around measles, malaria, diarrhea, pneumonia and nutrition.

“Mille hospital has changed the lives of mothers. There is less threat of abnormal presentations and good food is supplied to expectant mothers.”
(Response from a men’s Focus Group Discussion)

You can read the report here: The Road Less Travelled Annual Report 2013-14

Providing water in Naibor: building businesses in return

This post was written by Loretta Pilla, an Australian volunteer who is currently working in Kenya as a Program Management Officer with Anglican Overseas Aid’s The Road Less Travelled project.

Jchabure Lengunya is a mother of six children between four and 16 years of age. In addition to her family responsibilities, she is also an active member of the Naibor Water Committee. With Jchabure’s youngest child wrapped tightly around her neck, we sit beneath the shade of an acacia tree 50 metres uphill from the recently built rock water catchment in Naibor group ranch, in Laikipia County of Kenya.

“We are now entering the wet season,” she explains, pointing at the vast red clay landscape stretching to the horizon. It is barely flecked with green foliage, with even less houses in between.

Before the water catchment was built the women of Naibor travelled long distances during the wet season to the Naibor open spring to dig for water, and even further during the dry season to the Nanyuki River.

Image: Loretta Pilla / Anglican Overseas Aid

Women of Naibor in Laikipia, Kenya, wait to collect water from the tank at the base of the rock water catchment built by the community with support from The Road Less Travelled project. Image: Loretta Pilla / Anglican Overseas Aid

Jchabure explains that the water committee is responsible for ensuring the sustainable use of water by community members. This is an important role given the pressures the harsh weather conditions and often extended dry seasons can have on water availability.

Continue reading

The work of the community

This post was written by Chris McKeon, Writer and Production Assistant at Arete Stories.

About three hours north of Nairobi around a high, rocky hill is a collection of small huts. They are part of the Maasai community of Naibor, in Kenya’s Laikipia region.

As well as the mud huts, there is also a small primary school built of metal sheeting and a track, carved through the red dust, linking it to the towns of Nanyuki and Doldol. The odd goat grazes along the side of this track and women can be seen trudging through the red dust daily with water containers on their backs. The lack of water in the community becomes increasingly apparent the closer one gets.

The dusty track that links the Maasai community of Naibor to the towns of Nanyuki and Doldol.  Image: Matthew Willman / AOA

The dusty track that links the Maasai community of Naibor to the towns of Nanyuki and Doldol.
Image: Matthew Willman / AOA

“We were in difficulties with water,” explains James Supa as he sits on a rock near the roadside. “In the dry season, mothers have to walk to the river or Doldol or Nanyuki for water. It can take a whole day to fill their buckets with water.” (Read our earlier blog post about the effects of the water burden on women in Naibor.)

The little water they do find is often contaminated by animals or can only be reached by digging in the mud where the river used to flow, five kilometres from Naibor. Supa acts as a link person between The Road Less Travelled project (TRLT) and the Maasai, to ensure any development activities are locally-appropriate and meet the needs of the community. TRLT is a project of Anglican Overseas Aid, which works in partnership with local organisation the Mothers’ Union of the Anglican Church in Kenya (MUACK).

In Naibor, the community identified the chronic water shortage as a key development challenge.  Image: Matthew Willman / AOA

In Naibor, the community identified the chronic water shortage as a key development challenge.
Image: Matthew Willman / AOA

Women of Naibor at a community meeting. The new rock catchment will mean less time walking long distances to collect water for their households.  Image: Matthew Willman / AOA

Women of Naibor at a community meeting. The water shortage is a burden that is felt most heavily by women, whose task it is to walk long distances on a daily basis to collect their household’s water.
Image: Matthew Willman / AOA

The past few years have seen increasingly long dry spells in the Laikipia region, and the water shortages have worsened. When TRLT started and a community development committee was formed, the people of Naibor identified the chronic water shortage as a key challenge, and appealed for support from the project to alleviate the problem.

After community discussions, the suggestion was made to use the local environment and build a rock water catchment to store water during the rainy season. TRLT supported the initiative, which made use of local labour and resources to build two low walls along the hill’s bare rock face, as well as a storage tank. The walls channel the rainwater down the rock face and into the tank for use during the long dry season, when water is scarce.

Continue reading

Easing the water burden

This post was written by Greg Armstrong, Research Fellow at the Nossal Institute for Global Health, Anglican Overseas Aid’s partner in The Road Less Travelled project.

We met Natana Nalikite and Kumontaare Mayani by an open spring in Naibor, a Maasai group ranch in Laikipia County, Kenya. A rock water catchment is being built nearby to ease the water burden on the local community. It is a burden that is felt most heavily by women, whose task it is to walk long distances on a daily basis to collect their household’s water. Our recent baseline survey in Naibor found that 77 percent of women walk two or more hours per day to fetch their household’s water supplies.

The women of Naibor walk long distances every day to reach the open spring, where they place their containers in a queue and wait for their turn to collect their household’s water.
Image: Greg Armstrong

Natana is in her 40s, a mother of five and the only wife to her husband. Her youngest child, a six month old girl named Sawaoi, is cradled in a sling that sits around her shoulders. Her surname, Nalikite, means to walk slowly, yet Natana assures us that she has greater strength in her legs than her name suggests.

Continue reading