Reaching Mosebo village, about 42 kilometers outside of Bahir Dar in rural Ethiopia is not for the faint at heart. It requires a land cruiser, patience, and a bit of adventure to cover the hour and a half drive on bumpy, muddy roads to reach Mosebo and see how over 90% of Ethiopians live. If it starts to rain as it frequently does during Ethiopia’s three month rainy season, the road becomes dangerous and impassable.
I visited Mosebo village as an International Reporting Project fellow to learn more about the miraculous success Ethiopia has made by achieving MDG 4 – reducing child mortality rates for children under five by two-thirds. Ethiopia stunned the world by achieving MDG 4 well ahead of the 2015 deadline yet there is still much progress to be made in reducing newborn deaths, particularly within the first 28 days of life which are the most dangerous days to be alive.
Per Save the Children’s “Ending Newborn Deaths Report”, every year one million babies die on the first and only day of life accounting for 44% of all deaths for children under the age of five. Nearly two million more children will die within their first month. Four out of five of these deaths are due to preventable, treatable causes such as preterm birth, infections and complications during childbirth.
To combat maternal, child and newborn deaths the Ethiopian government has trained and deployed an army of over 38,000 Health Extension Workers (HEW) who have been critical to Ethiopia’s amazing success story at reducing child under five deaths as well as maternal deaths. These women are selected, trained and paid by the government to live within and cover a rural Health Post that serves up to 5,000 people within the community. The HEW program launched in 2003 and has saved many lives.
We arrived at Mosebo village to the sounds of children cheering and herders curious, gentle smiles. At the village, we were introduced to Tirigno Alenerw and Fasika Menge, two of Ethiopia’s 38,000 trained Health Extension Workers, who work at the Health Post located in Mosebo. Mosebo is a model village run by Save the Children’s Saving Newborn Lives Program and represents the best case scenario for health care coverage and services for Ethiopia’s rural people.
The Mosebo Health Post covers 3,700 patients in the community which encompasses an area of up to an hour and a half on foot each direction. The Health Post has morning office hours from 8-10 am where Tirigno and Fasika see patients for a wide variety of services such as family planning, pre and post natal care, vaccinations, treatment of minor health issues, and education and consultation on health issues. The rest of the day is spent on foot visiting patients in other villages at their home. Tirigno and Fasika also consult expectant mothers about the importance of delivering in a hospital, exclusive breastfeeding, and family planning. They contribute the lower maternal, child and newborn deaths to their services and over the six years they have worked within the community there have been no maternal deaths.
The Mosebo Health Post is part of the Ethiopian government’s three-tier health care system to reach its 90 million people, of which 85% are located in remote, rural areas. There are currently 16,000 Health Posts like Mosebo in Ethiopia yet the country needs many more as some people walk as much as two hours or more on foot through difficult, mountainous terrain to reach a Health Post.
Every Health Post is linked to a Health Center where expectant mothers are urged to give birth by a trained birth assistant. There are currently 3,500 Health Centers in Ethiopia and only 130 Hospitals, serving 90 million people. Per the Ministry of Health, 185 new hospitals are in the process of construction and hopefully will be completed soon. However, visiting an urban and regional hospital proved that even with the new hospitals it still may not be enough. Lines of patients and their families waiting for hours to be seen is a common sight in an Ethiopian hospital.
The infrastructure of Ethiopia is also significantly improving thanks to the Chinese who are building new roads throughout the nation. Over the next several years, the government hopes to connect all Health Posts to a gravel road which will make it easier for expectant mothers to reach a Health Center for delivery. Currently, laboring mothers will reach the Health Center either on foot or if there are complications, by “traditional ambulance” which basically means the woman is carried on a wooden stretcher for sometimes up to two hours to reach a road. Obviously improving the roads in rural Ethiopia will save many maternal and newborn lives.
At Mosebo, we had the chance to meet Fasika Dores and her nine-day old baby. Her baby is her fourth child, and has not been named yet which is common in Ethiopia given the high newborn mortality rates. However Fasika and her husband Minwiyelet plan on naming their child Ketema which means “city” in Amharic as he was their first child born at a hospital in a city.
Like over 80% of Ethiopian women, Fasika gave birth to her children at home unassisted by a trained birthing attendant. However, her newborn was the first child she delivered in a hospital thanks to the encouragement and education she received from the Health Extension Workers. Both Fasika and her husband are thrilled to have access to better, more informed maternal and pediatric health care services.
As a nation, it is estimated that 80-90% of women still give birth at home without a trained assistant in Ethiopia, which significantly contributes to Ethiopia’s high newborn and maternal deaths. Although maternal mortality rates have decreased from 1 in 24 to 1 in 67 women since 2000, the rates are still way too high, and newborn mortality rates have shown little progress. Per Save the Children, the 1-59 month (i.e. five year old) mortality rate is declining 6.1% while the neonatal rate is only declining 2.4% annually. Getting more villages like Mosebo and training Health Extension Workers as midwives would significantly reduce maternal and newborn mortality rates in Ethiopia.
As we left Mosebo village, the children ran after our cars smiling and waving goodbye. It was a happy place and all we can hope is that more villages will have access to better maternal, child and newborn care.
This post is based on my reporting trip to Ethiopia with the International Reporting Project.