In Ethiopia, saving newborn lives through Community Based New-Born Care (CBNC) interventions

UNICEF Ethiopia

AMHARA REGION, 22 May 2014 – Fentiya Asmare is a 32 year old mother of six children living in Debre Elias woreda (district), East Gojjam Zone of Amhara Region. While she was pregnant with her sixth child, Bizuayehu – a volunteer leader attached to the health post came to see her. Bizuayeh provides support to the two health extension workers in her area. She is the leader of a 1 to 5 health development network, where one woman is responsible for overseeing the health status of five households in her neighbourhood. The volunteer leader recommended Fentiya to visit the local health post for a pregnancy check up.

Fentiya received regular antenatal care support at the health post and participated in a monthly conference for pregnant women in her area. When Fentiya went into labour she was taken to a health facility where she delivered her baby with assistance from nurses. Although it was a safe delivery, her new-born son, Mulat Sahle, fell sick three weeks later prompting Fentiya to take him to Jabi Genet health post in Debre Elias woreda where health extension worker, Mulualem Wubliker, examined him.

Mulualem observed that he did not move unless he was touched and was suffering from severe chest constriction  rapid breathing and was running a high fever. Mulualem was worried by Mulat’s condition and gave him pre-referral medication before referring him to the health centre located six kilometres away. Fentiya took her son immediately to the health centre where her son was further referred to a hospital in  near-by town: Debre-Markos. Fentiya was desperate. “Although, my family insisted I take him to the health facility, I decided to take my baby home and let him die in peace,” says Fentiya. “I believed he would not survive the trip.”

The following day Mulualem visited Fentiya at her home and decided to treat the baby with injectable and oral antibiotics for seven days. The infant gradually showed signs of improvement and after one week was back to full health.

Mulualem follows up on Fentiya and her one month old son Mulat Sahle

© Abebe//2014/ Mulualem follows up on Fentiya and her one month old son Mulat Sahle

A Promise Renewed (APR) has helped galvanise a national response in Ethiopia to address existing challenges and disparities that threaten the lives of children. This global movement to accelerate action that safeguards the survival of maternal and new-born children has re-energised Ethiopia’s efforts to reach the most vulnerable and marginalised children with vital life-saving interventions. Ethiopia has scored tremendous gains in reducing child deaths and has achieved MDG 4 three years ahead of the 2015 deadline.

“In the case of Ethiopia, I’m delighted to report that we have made significant improvements in many of the health indicators, due in large part to a well-coordinated extensive effort and intensive investment by my government, partners and the community at large to strengthen and expand our primary health care”, declared Dr. Kesetebirhan Admasu Birhane, Ethiopia’s Minister of Health, during the A Promised Renewed meeting on 25 June 2014. “These successes are primarily due to political commitment and the introduction of our home grown innovative community health workers programme called the Health Extension Programme”, said Mr.Kesetebrihan.

However, over 205,000 children still do not reach their fifth birthday. Nearly 43 per cent (88,000) of the 205,000 children under-five are dying each year mostly from preventable or easily treatable diseases in their first 28 days.  Attaining the ambitious target of reducing Under Five Mortality Rate (U5MR) to below 20/1,000 live births and translating the APR ‘call to action’ into tangible results requires UNICEF and partners to act on reversing neo-natal deaths by addressing disparities and scaling up nutrition interventions.

Committed to achieving the goals of APR – Ethiopia has taken many measures since 2012. To attain universal access to and delivery of high impact interventions the government has launched several initiatives and integrated programmes to reflect a multisectoral approach to child survival and development that covers health, nutrition, water, sanitation and hygiene promotion, education and child protection as well as a commitment to deliver these services via facilities, communities and outreach. These key measures include: Community Based New-born Care (CBNC); the ONE WASH National Programme (OWNP); the National Nutrition Programme; and scaling up of the Community mobilisation initiative, a 1-5 network, to consolidate the gains with the roll out of a Health Extension Programme through a network of over three million female volunteers to engage the community in planning, implementation, monitoring and evaluation of health, nutrition, WASH and Education interventions at the community level .

One of the strategies launched in March 2013 delivered by Health Extension workers in rural communities to accelerate progress is the policy to save new-borns’ lives through Community Based New-Born Care (CBNC). Building on the Health Extension Programme and integrated Community Case Management (iCCM) platform- CBNC is a package of comprehensive new-born care which includes treatment of sepsis.

Ethiopia’s efforts in the past two years fall in line with the strategic shifts recommended in the APR Global Road map to accelerate progress for ending preventable child deaths.

© Abebe/2014 Fentiya’s healthy son, Mulat Shale at two months

© Abebe/2014 Fentiya’s healthy son, Mulat Shale at two months

Together with UNICEF’s implementing partner, JSI Research and Training Institute and L10K The Last 10 kilometres, CBNC was first implemented in East Gojjam zone, one of seven zones selected for initial implementation, in October 2013. East Gojjam is one of Ethiopia’s zones that benefits from UNICEF financial, technical and logistical support through CBNC implementation. Mulualem was trained as a Health Extension Worker in iCCM and more recently in CBNC, which she says has greatly enhanced her service delivery. “CBNC has given me the knowledge and skills to understand new-born health in detail. We have very close relations with the mothers because we visit them frequently”, she says. This makes the mothers happy because without having to travel the distance or worry about the extra time and cost they have to expend, the HEWs are right around the corner to follow up on their new-borns. “CBNC not only gave me more knowledge and confidence in handling new-born babies but also the chance to save lives – like the life of Fentiya’s son.”

The following results have been achieved:

  1. Community Based New-born Care included in the Health Extension Programme with over 38,000 Health Extension Workers (HEW) on government payroll – 2,250 health posts implementing CBNC in Ethiopia’s Amhara, Tigray, SNNPR and Oromia regions with over 4,460 HEWs equipped with CBNC skills and supplies to provide service . Expansion to more areas is underway with a plan to reach all health posts in the rural communities of the four regions by 2015.
  2. Introduction of Rota virus vaccine to the national immunisation programme;
  3. National Nutrition Programme mainly targeting a reduction of stunting by more than 14 per cent, wasting by over 6 per cent and chronic under nutrition in women of reproductive age by 8 per cent by 2015. The following ministries declared to work in coordination to implement the programme:  Agriculture, Water and Energy, Education, Trade and Industry, Finance and Economic Development Labour and Social Affairs Women, and Children and Youth Affairs ;
  4. The ONE WASH National Programme (OWNP) which covers the period from July 2013 to June 2020 is a shift from a small scale project based on funding to a broad-based sector wide and harmonised approach. It aims at increasing universal access to safe water supply, basic sanitation; improving hand washing practices and creating an open defecation free environment in Ethiopia. OWNP brings together different sectors and ministries including those working on Water Resources, Health, Education, and Finance & Economic Development to improve health and decrease  drop-out rates of children in schools, and make financing for Water Sanitation and Hygiene (WASH) more effective .
  5. MNCH Score card: Ethiopia adopted a national Maternal New-born and Child Health (MNCH) score card to be used by decision-makers, political leaders and administrators at all levels of government structures to monitor the implementation of MNCH intervention. It is a colour coded score card which is generated through software. The intention of introducing the scorecard to all levels of government administration is to: (1) Help national and subnational (district, zone) level planning; (2) Create competition for best performance between districts in a zone and between regions in the country; (3) Enhance viewing progress of targets; (4) Help decision-makers support low performing districts and encourage/scale up of best experience from high performing districts to the low performing; (5) Create accountability at all levels of management. The scorecard was started in 2012 and outputs are being generated quarterly using a software that coordinates all data from regions. Expansion to districts and zones is underway.

To ensure Ethiopia’s commitment to act on the call to ending preventable child and maternal mortalities in the coming years, Ethiopia’s Health Sector Transformation Plan will be multipronged and will revolve around: (1) The promotion of equitable service; (2) a commitment to deliver quality care with a seamless and timely referral system; (3) sustained and robust community engagement and empowerment; (4) a prudent and efficient use of resources; (5) embracing new innovation and use of appropriate technologies; (6) the purposeful utilisation of valid, reliable, timely and useful data for evidence-based decision-making, and, finally, (7) a nimbleness in the incorporation and responsiveness to the ever changing realities on the ground. “The scorecard as a tool to measure progress is important – all Ethiopia’s efforts and outcomes have to be systematically and purposefully measured and interval outcomes calibrated in a timely manner to ensure that we reach our goals”, underlines Dr. Kesetebirhan.

For additional information, please contact UNICEF Ethiopia:

Posted in: