Supporting Rural Health Centres in Ethiopia

To tackle the high rates of NCDs in Ethiopia, THET has collaborated with the Ministry of Health, Health Poverty Action (HPA)/Health limited (HL), and Novartis Global Health to launch the Healthy Family (Tenama Beteseb) programme. The initiative seeks to decentralise healthcare in order to cater to those who may find health facilities too expensive, or too inaccessible. The programme wishes to increase access to services for beneficiaries through capacity building, developing human resources and decentralizing the screening, diagnosis, treatment and care of NCDs. The programme began with the aim to reach and screen 200,000 people, and enrol 15,000 of these in the care and treatment program.  

The Healthy Family project comprises of a total of 14 hospitals and 45 health centres;the 14 hospitals include 3 General Hospitals and 11 Primary Hospitals in 6 regions. Namely, Oromia, Amhara, Southern Nations, Nationalities and Peoples (SNNP), South-Western Ethiopian Peoples (SWEP), Benishangul-Gumuz & Afar Regional States) and Addis Ababa city administration. The programme specifically tackles hypertension, diabetes, epilepsy and chronic respiratory diseases. By decentralising care in this way, we can take a community-centric approach towards healthcare, with a greater focus on engaging directly with those who may have difficulty accessing healthcare and thus may be neglecting it. We are excited to report that as of October 2022, a total of 289,910 individuals were screened at target health facility level for the four NCDs, out of which 16,948 were put on treatment, exceeding our target!  

As our operational areas in North Gondar and North Wollowere war fronts, health facilities have been damaged, looted and unable to deliver required basic services (including NCD care). We are happy to report that the situation in North Gondar has relatively improved and facilities have re-started their operations; however, North Wollo still needs support in terms of equipment, reconstruction, stocking the facilities with medicines and necessary infrastructure.   

Your generous contributions will assist us in tackling the reconstruction of health facilities and continuing our operations towards bettering NCD management in remote regions of Ethiopia. We are grateful for your unending support through such a turbulent year and look forward to reporting our ongoing efforts. 

In Ethiopia as in much of sub-Saharan Africa, high blood pressure is a common health problem. Which, if untreated, leads to severe illnesses including heart disease, stroke and kidney failure. Although the THET Ethiopia NCD Alliance (THENA) is involved in the effort to screen individuals for high blood pressure, a big problem is persuading patients to attend the clinic and take their treatment. Many patients abandon the clinic for a variety of reasons; there is a strong preference for traditional healers and the use of herbalists, holy water and the like.   

Story telling is a traditional and well-established way of communicating ideas in Ethiopia. WIth your generous and unwavering support, we commissioned the production of a short story written by the well-known Ethiopian author Daniel Worku (one of the country’s foremost children’s authors), and illustrated by an Ethiopian artist Gabreiyesus Asmare. 

Our objective was to produce a short, illustrated book (see picture 1) aimed at 10–14-year-olds - the next generation who are now in school, are about to join the workforce, and assume some of the caring responsibilities for older family members. This generation will also be that from which the next group of health workers will be recruited.

In producing this story our aims were for it to stand on its own by having a multiplicity of layers/strands that deal with aspects of life that are relevant to this age group; things such as the tension between tradition and modernity, gender differences and tensions, generation gaps and more. Needless to say, the message regarding the perils of ignoring the modern medical clinic is clearly articulated in the story and runs throughout it. We worked to produce a story that is indigenous in topic, and composition. With the hope that it might be adopted as such and be propagated, in time, from within the community itself. The aim is that the message embedded by us is not one that competes or contradicts indigenous cultural ways and beliefs. 

Having produced the book the next step is to gauge responses of both children and parents. This is underway, by Tsion Afework of Addis Ababa University and Daniel Worku, the book’s author. So far, we have done a public reading at a book fair at the Addis Ababa Exhibition Centre (see picture 2) and plan readings at I Care Ethiopia (a charitable organisation that provides homeless mothers with children with childcare day provision and assistance in starting up new small business enterprises), and within several private homes where there are children of the target group. After readings there will be discussions led by Tsion Afework (see picture 3). These discussions will be directed at getting a sense of the audience’s understanding of the story, the variety of topics involved and whether the story - text and illustrations - is one that engaged them to want to read it again and pass it on.  

We are keen to see how the embedded message regarding the dangers of ignoring what the modern clinic has to offer is received.

Despite the social and political challenges facing Ethiopia, at the moment, the THET team continues to provide vital health systems strengthening services to aid patients with non-communicable diseases (NCD), made more vulnerable to COVID-19. We conduct training sessions and are developing telemedicine services, through providing telephone consultations, for those especially vulnerable or residing in remote regions/areas of unrest.

Whilst Ethiopia has managed the coronavirus pandemic with great success, preparations have focused on larger hospitals in Addis Ababa and the larger urban centres in Ethiopia, thus, THET has chosen to target central and northern Gondar zones. It should be noted that it is rural communities with poor housing conditions who are most susceptible to infection, as overcrowding and difficulties in maintaining adequate hygiene create a higher likelihood of infection. Those travelling from rural regions are facing barriers towards access to healthcare as national regulations have reduced passenger loads on vehicles and are curtailing movement, thus travel has been made difficult and expensive. To tackle this issue THET is promoting the use of tele-consultations.

It is only through your continued support that THET has trained 39 health professionals in COVID-19 preparedness, across three hospitals. Of the 39 health professionals, 13 will act as trainers who will further cascade knowledge to the wider healthcare community. This will greatly benefit patients as it means a greater improvement in the healthcare providers’ knowledge, and skill on management and prevention of Covid-19 at primary level with a focus on NCD patients.

The unrest occurring in Ethiopia has caused delays and logistical challenges towards delivering training sessions, yet the THET team is determined to pursue our goals. We sincerely thank you for your unfaltering support - without which our projects would not come to fruition.

2021 has been a challenging year for health workers around the world, but none more so than those in LMICs. Health systems have been overwhelmed by not only Covid-19, but the increasing burden of other the persisting non-communicable, communicable, maternal and child health challenges.

Through your unwavering support, THET has been able to provide essential Covid-19 with a specific focus on protecting NCD patients who are so vulnerable at this time.

Those with NCDs have been impacted so acutely by this pandemic due to their extreme vulnerability in the face of the virus. One of the major problems in Ethiopia is that patients from rural areas have to travel long distances to access care for NCDs, as this is delivered in hospitals.The hospitals are overwhelmed, and often don’t have the resources to deal with these additional responsibilities.

Working with the Ministry of Health, THET has been working to shift NCD care to health centres. We work to build not only capacity within these centres to screen NCDs, but to train staff to properly treat NCDs. As these diseases are often asymptomatic, patients are often not screened early enough, which unfortunately leads to complications and advanced diseases which cannot be reversed. Untreated NCDs can result in death or major disabilities that compromise quality of life, and cause patients to suffer physically, economically socially and spiritually.

In addition to this because of Covid-19, the existing care has been further compromised because of diversions of human resource and finance to fight the pandemic. Travel restrictions initially and fear of contracting Covid-19 has kept patients away from screening and care.

Last month, THET conducted training to 12 primary hospitals and health centre staff on Covid-19 infection prevention and control, how to protect their NCD patients who are one of the most at-risk, gender equality and social inclusion in their approach to prevent Covid-19 as well as to take care of NCD patients.

This training was delivered in a way which meant it could be cascaded to other health workers in the facilities, to have an even wider reach. The training also introduced remote telephone consultations which will help avoid frequent hospital visits. The early results are very promising, but if this succeeds further, it will enable vulnerable patients to receive the care they need in the safest possible way.

It is only through your support that this work has been possible. From the whole THET team, we wish you a happy and safe festive season.