A lot happens over coffee in Ethiopia. ‘Bunna Tetu’ — a coffee ceremony that is a routine affair in Ethiopian households — is one occasion being utilised by the government to promote healthcare and healthy lifestyle practices.
With a large percentage of rural population, taking healthcare into these often inaccessible regions is a major challenge for Ethiopia, which has unimpressive social indicators.
So, to spread awareness about its healthcare programmes the Ethiopian government adopted the strategy of using the coffee ceremony. In this African nation, whenever coffee is made neighbours are invited and the occasion is used to discuss various issues. Thus the government decided to include healthcare in the discussion, particularly when women were involved in the ceremony. During the ceremony, health workers educate women about contraceptives, institutional deliveries, ante and post natal care, vaccinations and other good healthcare practices.
Africa’s second most populous country, Ethiopia has a total fertility rate of 4.8 as only 29 per cent of married women use contraception. Shockingly, only 10 per cent of the births are attended by skilled personnel and maternal death rate is 350 per 100,000 live births and infant mortality about 590 per 100,000 live births. Child marriage and domestic violence is prevalent and an acute shortage of physicians and specialists compounds the problem.
In 2003, the government rolled out the Health Extension Program (HEP) — a women-centric healthcare plan — by linking leaders at the national, regional and district levels with women’s groups in every village across the country. A fleet of young women were trained to provide basic healthcare services and then deployed at villages. The two healthcare workers in each village create awareness about unhealthy practices and address basic health issues in the community. The district of Kebele has a population of 3 million with 97 health centres and 496 health posts, with two health extension workers at each post.
The country’s 122 hospitals are now connected to the villages through these health extension workers posted at rural health posts under the Integrated Family Health Programme, which is funded by the United States Agency for International Development. This is something similar to India’s Accredited Social Health Activists programme under the National Rural Health Mission.
Subsequently, the Ethiopian government initiated another programme, the ‘Women’s Development Army’, where women volunteers were trained by health extension workers to focus more on behavioural changes such as encouraging good hygiene, sanitation and setting up separate cooking spaces.
Faayituu Dhaaba, 24, is one of the 35,000 health extension workers. She is deployed at the Baga Nagaan Dhuftaan health post in the Arsi zone, which is known for producing the world’s best athletes.
Faayituu is trained in basic healthcare such as immunisation, TB, HIV/AIDS, and mother and child care. She can even help in safe delivery, but only under emergencies when trained staff is unavailable.
Trained for one year, she gets 1,223 Ethiopian Birr per month (about Rs. 4045) and based on her performance she may be upgraded to a senior level where she will get a diploma degree and a raise, while the treatment she provides is free.
Under the IFH Programme, the Ethiopian government has also tied up with healthcare organisations such as Marie Stopes to provide services. But, people have to pay in the private sector, says Tariku Nigatu of the USAID. If health workers feel the patient needs specialised care, then he or she is referred to a relevant healthcare facility.
The results have been astounding for the country as people are more in control of their health now. There are no female genital mutilations, early marriages have come down and institutional deliveries gone up.
Tigost Megersa’s family is a model household in one of the villages that have benefited from the government’s schemes. She has two children — a 12-year-old daughter and a boy who is three. She uses injectable contraceptives and has a toilet and a separate kitchen. Importantly, she ensured that her daughter did not have to undergo female genital mutilation.
Such has been impact of the programme that elders in the village have no hesitation in apologising for the unhealthy practices and social traditions practised earlier that were generally anti-women.