International Women’s Day 2015: Celebrating women’s role in the promotion of primary healthcare in Ethiopia
By John Dusabe, Daniel G. Datiko, Jarso Tulu and Sally Theobald
Every year we celebrate International Women’s Day (IWD) on 8th March. IWD draws our attention to women’s challenges and contributions in our society in past times, today and in the future. Women’s contribution to health includes basic science and discovery, management and treatment of diseases as well as promotion and improvement of health care internationally, nationally and within communities and households. Recognition only is not enough. There’s still work to be done - such as institutional gender mainstreaming to ensure health programmes are responsive to the needs of women, men, boys and girls; that information is used appropriately to meet this goal and that the gendered needs and requirements of all health workers are met. In 2012, the World Development Report prioritised Gender Equality and Development and highlighted progress made in different countries; taking stock and reflecting on progress and evaluating the impact of gender-focused initiatives. For example the report highlighted success in initiatives that promote productive resources for women, such as giving land titles to women in Ethiopia.
Ethiopia has also spearheaded recognition of women’s contribution to the health system through innovative community approaches. The government launched the Health Extension Programme (HEP) aimed at the provision of primary healthcare. The HEP engages health extension workers (HEWs) who are exclusively women. These women are trained, certified and employed through government systems to provide health services including maternal and child health, TB, HIV, malaria, immunization, nutrition hygiene and sanitation as well as health education. Within 5 years of the HEP launch there were more than 30,000 HEWs providing health services nationwide, and provision is in place for additional support if HEWs go on maternity leave. HEWs devote 70% of their time to making house-to-house visits providing a range of services. For example in tuberculosis their roles include early identification of TB cases, provision of DOT, linkage to facility-based services and referral while in maternal and child health (MCH) they provide ANC, and support women to give birth in health facilities. Women HEWs come from, and are committed to, improving the health of the communities they serve. Under the health centre and health post links, their contribution has expanded and functions beyond the primary health care unit as the lowest tier of the health system. REACH Ethiopia have been working with LSTM to take forward research in partnership with the HEP and HEWs to promote vulnerable and rural women (and men) to access health care. For example the TB REACH project worked with HEWs to bring TB diagnosis to the community level, significantly increasing the number of women diagnosed with TB (see Yassin et al 2013). REACHOUT in Ethiopia uses quality improvement cycles to work with women HEWs and others to improve access to a high quality service for pregnant women.
The existing health information management system (HMIS) that support the HEP depends on paper based reports, transported from health posts to health centers, districts, zones and finally to the region. This system can lead to delays, incompleteness or inconsistency of data, inadequate data collection tools and monitoring can lead to poor documentation and under-utilization of existing data hindering prompt and responsive action. Through IDRC’s Governance for Equity Health Systems (GEHS) funding, an e-Health project is being implemented in Southern Ethiopia to support female HEWs, their supervisors and zonal health department to improve this HMIS system for HEP through mHealth resources. Back in 2010 the Ethiopian Federal Ministry of Health (FMOH) designed an m-Health strategic framework to improve health management information system to provide better health service. This IDRC-funded e-Health system is embedded within that strategic framework, to provide an important facilitative policy-backed innovation with electronic data systems. The project involves a 7-step process including baseline evaluation, e-Health system design, HEW training, e-Health system implementation, TB and MCH indicator review, revision of the e-Health system and final evaluation.
HEWs, their supervisors, district and zonal health officials have been involved in the design of research tools and development of the e-Health system. Local developers have specifically been involved in the design of the e-Health system to boost HMIS linkages and interoperability as well as capacity building. Indicators from that system will serve to improve HEWs’ TB and MCH reporting from village to health post, district, zonal, regional and FMOH levels.
What we want to achieve for gender equality is “to end discrimination against women in all forms” as adopted by the Convention on Elimination of All Forms of Discrimination against Women (CEDAW) in 1979. Our mHealth project will contribute to this by supporting vulnerable individual’s and household’s access to services; and empowering women HEW with the information and support they need to better provide integrated services to their communities and feed information and priorities from their communities into decision making processes. Our focus on introducing a robust and responsive e-health process for individuals will support HEWs with the robust usable local health data to better meet the different dimensions of health needs of women and men laid out in the Women and Gender Equity Knowledge Network Report. The official UN theme for this year’s International Women’s Day is “Empowering Women – Empowering Humanity: Picture it!”. Working with an all-women HEW team supports this theme and provides important driver for the transformative post-2015 agenda. The Ethiopia Federal Ministry of Health echoes this: in the recent mHealth Conference at University College London, Dr. Kesetebirhan Admasu the Minister of Health said that the Ministry is committed to supporting HEWs to reach communities and demographics never reached before. Reaching the previously unreached is one of the general goals of mHealth. Recently, in a blog hosted by Research in Gender and Ethics (RinGS), Linda Waldman and Marion Stevens argued that mhealth could overcome barriers of patient privacy and confidentiality, limited availability of medical equipment and challenges of health information sharing and dissemination. These are key factors for reaching health services in the underserved communities.
Lastly women are not the only individuals needed to promote empowerment of women and societies. We need men to get on board too! Indeed, for us to attain full human potential it is important that men work alongside women to ensure access to sexual and reproductive health services and protection against gender-based violence. On this International Women’s Day men’s engagement in gender equality is needed now more than ever.
Photo of Fetlework Gezahgn, Health Extension Worker at Remeda Health Post, Sidama Health Zone Ethiopia
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This project is funded by the European Union.