INTEGRATED FAMILY HEALTH PROGRAM (IFHP) 2008-2016

FROM THE FIELD

SELECTED STORIES
Disclaimer
This publication is made possible by the generous support of the American people through
the United States Agency for International Development (USAID) with a central field support
mechanism to the Evidence to Action (E2A) project under a cooperative agreement number of AID-
OAA-A-11-00024. The contents are the sole responsibility of IFHP and do not necessarily reflect the
views of USAID or the United States Government.
Integrated Family Health Program 2016
INTEGRATED FAMILY HEALTH PROGRAM
(IFHP) 2008-2016

SELECTED STORIES
FROM THE FIELD

1
About IFHP
The Integrated Family Health Program (IFHP) is a USAID-funded program that is implemented by
Pathfinder International (PI) Ethiopia and John Snow, Inc. (JSI). IFHP supports USAID/ Ethiopias
strategic objective of investing in people with the overall goal of creating and consolidating
functional and effective network of well integrated family health services to communities
within the framework of the primary health care unit and more specifically the health extension
program. IFHP is implemented in Amhara, Oromia, SNNPR and Tigray and in selected zones of
Benshangul Gumuz and Somali regions
CONTENTS
Message from the Chief of Party .................................................................................................... ii
Building competence; transforming skills to save lives ................................................................. 1
Knowledge and Choice: Balancing family size with Resources in Rural Communities ................. 2
Breaking barriers to improve Skilled Birth Attendance: Experiences from Debaytilatgin Woreda ... 4
Saving Childrens Lives; Making Services Available at a Walking Distance .................................. 5
Verifying the Truth and Ensuring Quality through Integrated Supportive Supervision (ISS) .................. 7
Smashing Barriers; beating limitations ...................................................................................... 8
The story of Ethiopias Family Planning Success: Memoir from Dr. Mengistu ................................ 10
Availing health services within reach; protecting children from death and illness ............................. 11
Expanding options for family planning ........................................................................................ 12
Skilled delivery; a happy mother a healthy child .......................................................................... 13
Kima the Brave Woman A Fistula Survivor ................................................................................. 14
Expanding PMTCT Services within the Primary Health Care Units: The Case of Dera Health Center..... 16
A Life Dedicated to the Youth ..................................................................................................... 17
Availing services to meet demands for family planning ............................................................... 18
Protecting children from preventable illness .................................................................................. 20
Using performance data to make informed decisions:Making wise decisions for better service
quality and coverage ...................................................................................................................... 22
Reaching Pastoralist Communities with Long Acting Family Planning Services ................................. 23
Hard work pays off ......................................................................................................................... 24
A Path made easier .................................................................................................................... 25
Keeping the insect off: using ITNs and managing the environment to stay healthy ............................ 26
Telling the Truth ............................................................................................................................. 28
Serving My Peer, Serving My Community: using local Innovations to reach larger audience .............. 30
Ensuring Access to Contraception for Women Living with HIV: A One-Window Service Approach ..... 32
Reaching Young People with Youth Friendly Services ...................................................................... 34
Improving Child Nutrition ................................................................................................................ 35
Building Skills to save lives ............................................................................................................ 36
Transforming Lives from a Dark Past to a Luminous Future; Helping women lead life with dignity ....... 38
Integrating Family Planning Service in ART Clinics a promising practice to reduce pediatric HIV
infection ....................................................................................................................................... 40
Bringing Home Delivery to Nearly Zero: Experience of Soloda Kebele, Tigray- Northern Ethiopia ........ 41
Health Care at My Doorsteps ........................................................................................................... 42
Living Without Worries: Post-Partum IUCD (PPIUCD) Giving Rural Women Long Term Relief ............... 43
Improving the Cold Chain for Effective Immunization Services ......................................................... 44
Educating girls for a better future ................................................................................................ 45
The Health Extension Program: in the Eye of a Community Leader..................................................... 46
Working with local implementing partners to increase Family Planning service uptake ..................... 47
i
 Message
from the
Chief of Party

H
ealth programs are designed to bring sustainable change by benefiting
individuals, families and communities. Documenting stories related to
the changes in target beneficiaries that receive products, services and
information showcase how lives are positively impacted by programs. The benefit
of documenting stories is many folds; stories describe how donor funds are used to
change lives, create program accountability and transparency to stakeholders, help
qualitatively monitor program effectiveness beyond statistics and describes what
counts that is not necessarily countable.

In this regard, since IFHP started operation, many lives have been touched by the
program. Primary beneficiaries that received services are directly and positively
impacted by the program. Individuals, families and societies around them have also
been indirectly impacted in a ripple effect. The threat of unwanted pregnancies
have been prevented, children that would have suffered illnesses received treatment
and services, women whose lives were endangered by pregnancy and its undesired
outcomes were reached with lifesaving services, lives sidelined by families
and communities as a result of obstetric fistula were restored and successfully
rehabilitated, facilities that improved their management approaches and services
reached more people, knowledge sharing among health workers improved and use
of information for action helped deliver better services. This success story booklet
contains such stories from all regions where IFHP has been operating since 2008.

The stories included in the booklet represent the tip of the iceberg of the countless
women, men, children, young people and institutions that benefited from the
program. Efforts have been made to make the stories verifiable by providing
names and unique identifiers of locations and institutions through their consent
for whosoever would like to know more. To make reading the stories a fun, focus
has been given to use plain language and avoid jargons. Anybody with little or no
knowledge about health can read the stories and learn about the integrated family
health program and its work.

Having to see people witness how the program has changed their lives is rewarding
and encouraging. Such stories not only helped us rejuvenate our energy and move
forward but also helped our donors and stakeholders to realize how useful the
program is for people at the receiving end and sustain their support.

I take this opportunity to thank the Government of Ethiopia, IFHP staff, service
providers and program managers at different levels of the system, USAID and other
stakeholders who worked selflessly to bring a change in the lives of several people
including those whose stories are included in this booklet.

Mengistu Asnake (MD, MPH)

2
ii
Building
competence
transforming skills to save lives

E
ven though most maternal deaths stem
from manageable complications, myths
and misconceptions surrounding pregnancy
impede the uptake of lifesaving interventions.
Belaynesh Siraw, a 24 year old midwife, working
in Yifag Health Center of Libokemkem Woreda of
Amhara region has a story to tell. When a woman
becomes unconscious due to postpartum bleeding,
they believe it is Sirkegn or literally translated as
momentary blackout. Locals fire a gun to awake
the dying woman. Some kill chicken immediately
after the expulsion of the placenta with the belief Belaynesh Siraw, a mentor for BEmONC
to protect the mother and the newborn from evil
reducing time and resource needed to train
eyes. Belaynesh continues but now, thanks to
additional staff.
the Health Extension Program and partners such
as IFHP, such practices have changed. Women Belaynesh says, until recently, I did not
now seek services from skilled health workers at have the skill and the confidence to handle
health facilities. To dispel myths and to promote complicated deliveries. But now, following
skilled delivery service uptake, IFHP conducted the training, it is not only having the skill,
stakeholders meeting at the woreda level to but I also have the confidence to coach my
identify service barriers, facilitated action oriented fellow health workers.
kebele level sensitization meetings and carried out Belaynesh, as a mentor is able to coach nine
a series of community awareness sessions. of her fellow nurses in the woreda. Abebaw
To keep pace with the growing demand for skilled Kelkay, deputy head of South Gondar Zone
birth attendance, IFHP with technical and financial Health Department says, IFHPs BEmONC
support from USAID, trains health workers in Basic training came into our zone at the right
Emergency Obstetric and Newborn Care (BEmONC) moment. It is helping us a lot. The quality
for three weeks. To improve quality and ensure of services we provide has now improved
sustainability of skilled delivery services, BEmONC significantly. The training helped health
trainees undergo a three-day additional training in workers develop their confidence. You can
BEmONC mentoring. appreciate the difference between the
trained and the untrained health workers by
As BEmONC mentors, they are trained to observe
observing their level of confidence.
and coach untrained service providers during
deliveries. They also receive training to coach So far, IFHP has provided BEmONC
mentees during family planning, antenatal mentoring training to 1,416 health workers
and post-natal care service provision. This has in Tigray, Amhara, Oromia, and SNNP
facilitated on-the job knowledge and skill transfer, regions.

1
 Knowledge
and Choice
Balancing family size with Resources in Rural Communities
What will contraception do to my body? Will it make me smell or lose blood? Will it
mean I can never have children?
Without access to accurate information
about contraception, women like
Wezef Belay have little choice but to
believe these harmful misconceptions.
Wezef, a 30-year-old woman from the
rural Endaselassie village in the Tigray
Region of Ethiopia, had no access to
formal education. Despite feeling the
financial strain to meet the demands
of her four young daughters, Wezef
believed not to stop having children
until she give birth to a boy.
Since 2008, across six regions of
Ethiopia, the Integrated Family Health
Program (IFHP), with support from
USAID and in partnership with the
Ministry of Health, has trained a
sizable cadre of female providers to
reach underserved, rural communities.
In Tigray region alone, IFHP has
trained health extension workers
in many woredas, so that they can
mobilize communities to demand for
services.
Equipped with new interpersonal
communication and counseling
skills, health extension workers have
the capacity to address myths they
encounter during their meetings
with women like Wezef. That day
2
in her village, when Wezef and the
health extension worker discussed
contraception, it became clear to her
to limit the number of children she
has in the face of resource constraints
she was experiencing. Over time
with the providers gradual, constant,
and diligent communication and
counselingWezef decided and
changed her mind.
Many people received family planning
services in Tigray region. Wezef was
one of them. At first, Wezef chose to
use injectable contraceptives. Then,
after taking few rounds of injections,
she decided permanent method was
right for her. I cannot afford to have
more children with the meager income
I get from selling potatoes, onions, and
other food items, says Wezef, as she
shares her story. That is why I chose
the permanent method. she explains.
Wezef also advocates in her village,
so more women have access to
information to make an informed
choice. I advise my neighbors to
abandon their old and wrong beliefs
and decide on their family size, she
says.
Wezef near her house

3
 Breaking barriers
to improve
Skilled Birth
Attendance
Experiences from Debaytilatgin Woreda
D espite ever increasing uptake of skilled delivery
care, women in Ethiopia still deliver at home.
Debaytilatgin woreda of East Gojjam Zone in Amhara
region is not an exception to this. There has been a
long standing culture of home delivery in the woreda.
Lack of access to health facilities, particularly health
centers, and the unreliable skills of health workers
in handling obstetric complications were the most
mentioned reasons.
Even though residents in the Woreda believe that
giving birth at a health center is lifesaving, the practice
is to give birth at home where there is no trained
person and equipment says Ato Deres Dilnesa, head of
the Woreda Health Office (WorHO).
Having understood the challenge, IFHP with the fund
obtained from USAID started to implement Maternal
and Newborn Health (MNH) focused activities in
the woreda. In 2011, IFHP conducted a series of
sensitization workshops. The participants of the
workshop included woreda level stakeholders, HEWs
and community leaders. The findings that came out
from the workshops indicated lack of spiritual and
cultural sensitivity of health service providers towards
laboring mothers. This mainly was manifested by not
allowing the conduct of routine rituals like coffee
ceremonies and prayers to mothers in labor within
health facilities. Other reasons included; unavailability
of transport services and mothers reluctance to seek
care.
To address these problems, IFHP trained health service
providers in Basic Emergency Obstetric and Newborn
Care (BEmONC). The training enabled health providers
4
Deres Dilnesaw, Head of the Woreda Health Office
to manage obstetric complications and boost
their confidence. Supplies and materials
such as Ambu bags, thermometers and Blood
Pressure apparatuses were also provided
to each health centers in the woreda. To
create demand for the service that was made
available, HEWs did extensive community
mobilization and organized conferences for
pregnant women. During the conferences,
discussions were held on key danger signs,
birth preparedness and complication
readiness plans and the importance of
institutional delivery. Conducting coffee
ceremonies and attending prayers were also
allowed for families of laboring mothers
in health centers. Waiting rooms were
also arranged for near term mothers from
remote kebeles. Ambulance service was also
launched by the WorHO.
Following these measures, the skilled delivery
coverage of the woreda doubled from 250
mothers in the first six months of 2011 to
594 in the last six months of the same year.
Ato Deres said, Our achievement proves that
we are on the right track. We will continue
to improve and make health facilities more
comfortable to pregnant women. Inspired by
our successes, other adjacent woredas are
also considering doing the same.
Similarly, IFHP supports more than 400
health centers more than 60 woredas of
Amhara, Oromia, Tigray and SNNP regions.
Ayelech Kakebo recalls her past

Saving Childrens Lives

Making Services Available at a Walking Distance

A
yelech Kakabo is a 40 years old woman living
in Walana village of Kachabirra Woreda. She
and many others in the village passed difficult
time. When a child got sick, the neighbors gathered
around, put the child on a locally made wooden cot
and carried on their shoulders all the way to the

5
 ''
health center. The health center is
a daylong distance from the village.
Ayelech recalls the situation as full
of hardships. When the children
got sick we travelled long distances
on foot, as long as 20 kms to reach
to Hosanna Health Center. As the
health facilities are very far, we had
to stay at relatives house for days
until the child finished treatment.
It was very hard and we usually
didnt prefer to go to the health
center. Instead, we tried to treat
them at home with what we learnt
from our forefathers
Degefech Ayana and Tigist Abuha
are health extension workers
(HEWs) at Walana Health Post.
They have been helping the
community for the last five years.
However, they were not able to help
many sick children as they didnt
have the training to treat cases
such as malaria and pneumonia.
It was embarrassing for us to be
considered as health extension
workers who can do nothing in front
of a desperate mother with a sick
child said Degefech. When we
couldnt help the sick child other
than referring to distant health
centers, the trust of the community
members on HEWs started to get
eroded.
Now, things have changed for the
better. A year ago, USAID funded
IFHP organized training for HEWs
in collaboration with Kembeta
Tembaro Zonal Health Department
6
it is because the service is close to my
home that things are easier now; had
it been like the old days, it could have
been very difficult and the outcome
could have been different.
and Woreda Health Offices in the Zone. During
the seven days training, the HEWs learned how
to identify, classify and treat sick children with
symptoms of Malaria, Pneumonia, Diarrhea and
Malnutrition. The Ministry of Health led the
process and IFHP partnered with the government
to support the initiative. IFHP did not only provide
training, it also conducted post training follow up,
mentored HEWs and supplied logistics.
Frenesh Meseret, 25, has two children, the
older Samuel is four years old and the younger
Eyerusalem is two years old. Two months ago,
Eyerusalem was very sick; she had fever and was
not eating anything. I took her to the health post;
the health extension worker checked everything
and told me it was malaria. She gave me
medicines and explained to me how to give the
medicine to my daughter. By the time I went for
the second appointment, my daughter has already
recovered from her illness. She was eating, playing
and laughing She continued it is because the
service is close to my home that things are easier
now; had it been like the old days, it could have
been very difficult and the outcome could have
been different.
So far, IFHP trained more than 17,575 HEWs
and other health workers to identify, classify
and treat pneumonia, malaria, diarrhea and
malnutrition in Amhara, Oromia, Tigray and SNNP
regions of Ethiopia.
Verifying the Truth
and Ensuring
Quality through
Integrated
Supportive
Supervision (ISS)
There are many examples where supportive
supervision has been used to improve health
workers performance. Kembata-Tembaro Zone
Health Department conducts its quarterly
Integrated Supportive Supervision (ISS) to follow
progresses, identify challenges, verify reports and
provide onsite technical support at woreda, health
center and health post levels.
We need to have an honest assessment of what
we have achieved. It is through the integrated
supportive supervision that we verify facts, identify
different bottlenecks and propose solutions said
Elias Mamo, head of Kembata -Tembaro Zone
Health Department.
Previously, some of the statistics that were
reported from woreda health offices to the
Zonal Health Department were exaggerated.
For example, a certain woreda reported 100%
achievement for first antenatal care visit. But
through ISS, we found it to be less than what was
reported he continued there was also a 100
% immunization coverage report from another
woreda. However, there was also epidemic report
from the same woreda. Through ISS, we also
identify reasons for such inconsistencies Said
Elias. These reports used to mislead the reader
to believe that more has been accomplished than
is actually the case. However, after the ISS was
started, things have changed a lot. However now,
the zonal ISS team spends enormous amount of
time trying to verify the accuracy, consistency and
timeliness of monthly reports that it receives from
all levels through various means including ISS.
The ISS team does not only check numbers
but also program qualities for example, during
supervision, we (supervisors) check whether the
insecticide treated nets distributed are actually
Ato Elias Mamo, head of Kembata Tembaro zonal health
department
utilized at household level. The majority of
households have at least one net. However, during
supervision we learnt that many of them were not
using it. The reason identified during our visit
was lack of awareness on how to properly use the
nets. Some nets were also torn and dirty. Thus, we
noted that we still need to work more on educating
communities to bring behavioral change and
replacing the nets that were rendered useless.
Moving from traditional and hierarchical
supervision systems to more supportive one
requires innovative thinking and time to change
attitudes, perceptions and practices at all levels.
IFHP, with the technical and financial support
from USAID, supports Kembata-Tembaro Zonal
Health Department in the training of health
workers and provision of financial, logistic and
material support to the conduct of ISS. IFHP is
one of our trusted partners. The program works
with us during the planning of ISS and also gives
us technical and material support. Thanks to IFHP
that our regular ISS is currently implemented
at all levels regularly. According to Ato Elias,
in the past, there had been talk of supportive
supervision, but enough had not been done in the
field in a structured and organized manner unlike
now.
Similarly, IFHP supports ISS in all its program
operation regions of Ethiopia with the aim of
improving the coverage and quality of health
services.
7
 Smashing
Barriers
beating limitations

Solomon Demiss looking for a bright future

8
S
olomon Demiss was born and
brought up in Kuye, a tiny village
near Debaytilatgen Woreda of
East Gojjam Zone, Amhara region.
He lost his mother when he was one year
old. His father, an illiterate peasant, had
a small plot of land to support his family.
With three brothers and a sister, Solomon,
24, is the second from the last among his
siblings. He is now a 4th year student of
Materials Engineering at Adama Science
and Technology University.
The tragedy that changed his life
happened when he was twelve years old.
With only few days of illness, he found
himself paralyzed from the waist down.
He lost strength in his legs and it became
difficult to walk. But after two years of
treatment, he was able to stand up and
walk again with the support of a crutch.
Since then, he has been struggling with all
the hardship in life to attend and complete
his education. My disability became
the source of my strength. When I was
in secondary school, I won a recognition
award for my consecutive excellent school
achievements from the Zonal Education
Office he recalls.
Solomons father, the only breadwinner
of the family, died and his last hope of
getting good education seemed gone.
The young boy, who was generally a good
student, did miserably in the first year of
college. He got low grades. My father was
the only support I had. Life became tough
and bitter. I lost support to continue my
education Solomon said. Fortunately, it
was when Solomon was in despair that he
was spotted by IFHP. He received support
as part of the initiative taken by voluntary
IFHP staff members to help needy
students at the University. He receives
monthly pocket money and clothing from
the staff contribution.
After sometime, Solomons grades started
to improve steadily and became one of the
top five students in his batch. Because
of this, the school has chosen him to
conduct his apprenticeship in a renowned
steel company in South Korea. Only
few students are given this opportunity
because of their high scores He claims
proudly. He has a passion to continue his
studies I will continue my education until
I reach PhD level. I am determined to be
like one of those famous researchers in the
field. I want to be a professor Solomon
shares his plan. Solomon gets short of
words to thank IFHPs staff. If it were
not for the fantastic people at IFHP, this
would have never happened. From the day
I started to receive the support, I made
better grades. I owe my success to the
wonderful people at IFHP Solomon says.
Solomon is also serving as a peer
educator for the Adolescents and Youth
Reproductive Health Project of IFHP. The
peer group training made a huge impact
on my life because it changed me quite a
lot, Solomon told us. Before the training,
I was not comfortable to go out and mix
with fellow students. But now, I have the
self-confidence. Im enjoying life I have
a good network of friends he reports
proudly.
Now, over 100 trained peer educators are
trained by IFHP at Adama Science and
Technology University.
9
The story of
Ethiopias
Family Planning
Success
Memoir from Dr. Mengistu
W
hen I first began work in community-based health
care in the 1990s, only three percent of married
women in Ethiopia used modern method of
contraceptive. Family planning was scarce, to say the least.
In 1990, on a visit to a rural community in eastern Ethiopia, I
discussed family planning issues with a group of women living
there. Most of the women were married at a young age15
years or younger and had an average of 7 or 8 children. They
believed that pregnancy had to occur every year in order to
prove their fertility to their husbands.
Almost every community member who I met had
misconceptions about modern contraceptive methods and very
little awareness about family planning. It was clear that women
in the country were in dire need of reproductive health and
family planning information and services. Because of the low
contraceptive prevalence rate, fertility was high and Ethiopias
maternal mortality rate was one of the highest in the world.
With un-spaced pregnancies, the chance of complications
occurring during pregnancy, labor, and delivery was very
highcontributing to high level of maternal mortality. Every
pregnancy a woman faced was like roulette, with her risk
of death increasing as she experienced more pregnancies.
In addition, families struggled to support large numbers of
children.
But in the last few years, weve seen a significant shift
.The 2011 Demographic and Health Survey shows that the
contraceptive prevalence rate in Ethiopia has doubled since
2005 and is now nearly 30 percent. The increase year after
year has, in many ways, been unprecedented. Ethiopia is one
of the three countries to see contraceptive prevalence rate
doubling in less than a decade. So the question is: how did
Ethiopia go from just three percent contraceptive prevalence
rate to nearly 30 percent in just 20 years?
Ten years ago, the government of Ethiopia made a commitment
to family planning. Following international pledges to improve
womens health, the government focused on mobilizing
resources for community outreachparticularly in rural
areasthrough a network of health extension workers who
10
Dr. Mengistu Asnake, Chief of Party of IFHP and Country
Representative of Pathfinder International
provide health information and services to
these areas.
In partnership with NGOs, the government
trains these health extension workers in the
provision of health services, including family
planning counseling and contraception. Great
success has been observed in particular with
access to short-acting contraceptive methods
including use of injectable contraceptives,
as well as long-acting family planning
methods such as implants. Findings from an
operational research show that the uptake
of Implanon, a one rod implant that health
extension workers have been trained to
provide, is particularly successful in these
rural, hard to reach areas for addressing the
unmet need for family planning.
In addition, the government invested
improving funding for contraceptive supplies.
Building over 15,000 health posts the
government increased the provision of basic
health services and provided a base from
which the health extension workers can reach
out to communities. Hence, with a steady
supply of family planning methods the health
extension workers were able to meet family
planning needs of clients.
Family planning saves lives. With improved
use of contraception in Ethiopia, maternal
mortality has declined and total fertility rate
has now reached 4.8 children per woman.
Today, with this increased level of awareness
at grassroots, especially as compared to the
1990s, communities are demanding better
access to quality family planning services.
Women, and indeed, all people, have the
right to family planning. But to realize that
right, we need stronger commitments and
investment in strategies that work.
 Availing
health services within reach
protecting children from death and illness
M
ulu Amha lives in Abaye
Terra kebele of Mirab
Belessa Woreda in North
Gondar Zone of the Amhara
Region. She and her husband,
Azanaw Tigab, have four children.
Their oldest child is nine years;
their youngest children are twins
and are aged 3 each. Before the
health extension workers (HEWs)
started providing treatment for
common childhood illnesses;
malaria, pneumonia, diarrhea and
malnutrition, at the health post,
the community in the Kebele
had to take sick children all the
way to Arbaya Health Center
for treatment. They had to walk
the rugged terrain under the
scorching sun for more than an
hour leaving household chores
and farming activities behind
to reach the health center. In
addition, they had to pay for
drugs and laboratory tests, which
made things worse on top of
abject poverty prevailing in the
area. Mulu recalls when my
children got sick, I had to take
them to Arbaya Health Center,
which took me a lot of time and
once I got there, I had to pay for
the medicine and that was very
difficult for poor people like me.
Ato Tigabu Melkam, Nutrition
and Child Service Officer at
the woreda health office said
previously, when children got sick
and their families couldnt take
them to the health center, they
would buy and give them drugs
without prescriptions or would
try traditional medicine which Since 2011, 649 cases were
usually worsened the illness identified, classified and treated
at Abaye Terra Health post,
IFHP, with technical and financial
while 64 children were referred
support from USAID, collaborated
to Arbaya Health Center for
with the ministry of health, in
further diagnosis and treatment.
the training of HEWs, in the
The commonest illnesses were
identification, classification
diarrhea and malaria followed by
and treatment of childhood
pneumonia. The twin children
illnesses. The training of HEWs
of Mulu were among the cases
is to enable them manage
that received service at the
simple uncomplicated cases at
health post. She said, Now the
health post level or otherwise
service is within reach, free and
refer complicated cases to
time saving Manaley Mebrat,
health centers with first dose of
a HEW at the health post said
antibiotics. The service is given
since the treatment service
for free in the community, by
started, parents come with their
someone familiar, a HEW, in a
children seeking treatment at
known setting. In addition, IFHP
the health post. We treat the
gave drugs and consumables as a
children using the chart booklet,
startup kit to initiate the service
a booklet containing algorithms
and supported the conduct of
for classification and treatment of
quarterly review meeting where
cases. If the disease is severe, we
HEWs discuss their performances,
refer them to the health center as
exchange experiences and get
per the direction on the booklet.
technical updates. Through
Ato Tigabu also said after the
integrated supportive supervision,
initiation of the service at the
the program also monitored the
health post, mothers take their
quality of services, the recording
sick children to the health post.
and reporting of activities and
They dont try to self-treat them.
community service utilization.
As a result, the service improved
The woreda health office also
the health seeking behavior of the
used community networks to
community
promote the availability of
treatment services at the health IFHP has so far trained 17,575
post by HEWs. To ensure the HEWs and HWs trained on
continuity of services at the integrated community case
health post, health centers in the management of childhood
woreda buy and distribute drugs illnesses (iCCM) in Amhara,
and consumables to health posts Tigray, Oromia and SNNP regions
from the income they generate of as a result of which close to
from the health care financing a million children were correctly
scheme. identified, classified and treated.
11
 Expanding options for
family
planning
M
esenbet Buzayehu, 28, is a clinical nurse
at Kuy Health Center, in East Gojjam Zone
of Amhara region. He has been trained
by USAID funded IFHP to provide long-acting
reversible postpartum intrauterine contraceptive
devices (PPIUCD). He was the first and the only
staff to take this training from the health center.
Previously, the health center did not provide
PPIUCD despite demands for the service. Women
received little or no counseling on the possibility of
receiving family planning (FP) service right at the
delivery couch.
In 2013, IFHP, with technical and financial support
from USAID, started to train health workers in
PPIUCD to initiate the service in selected health
centers in Tigray, Amhara, Oromia and SNNP
regions of Ethiopia. The program introduced the
service with the objective of providing women with
additional FP option to help them adequately space
or limit subsequent pregnancies, whichever is the
mothers choice. PPIUCD insertion is done in the
immediate postpartum period. The training is given
to midwives, nurses and other categories of health
professionals that regularly attend deliveries at the
health center level.
12
Mesenbet Buzayehu, Kuy health center, East
Gojjam
Having received the training,
Mesenbet provided the service
to 98 (28%) mothers out of 350
deliveries attended at Kuy Health
Center in 2015. He also counselled
all the mothers about FP including
PPIUCD. Birhanu Abate, Head of
Kuy Health Center says with the
introduction of the PPIUCD service,
mothers now access the service
soon after giving birth. This helped
space successive pregnancies
and reduce unnecessary maternal
deaths.
Amaw Zewdie, 39, is a mother
of six children. Her last two
pregnancies were unplanned I was
using injectable contraceptive and
kept forgetting my appointments
for my next shots. Having being
counseled at the health center,
I decided to use the service
right after I gave birth to my last
child. Here I am with great relief;
No worries about remembering
appointment dates!
IFHP has trained 192 health
workers trained on PPIUCD in 71
health centers in the regions where
it is currently operating.

Shewareged a midwife at Fetal Health Center during ANC service
Skilled delivery
a happy mother a healthy child
A
maru Ketema is a 22 year old woman who lives in one
of the remote kebeles of Yayagulele woreda of Oromia
region. When she was nine months pregnant and started
to have contractions, she told her husband, Abraham Girma, to
take her to Fetal Health Center.
Abraham took no time when he called his neighbors and
carried her to the health center on a traditional ambulance,
a wooden bed with leather strap having four handles at each
corner to help carry on the shoulder. Weary of the long journey
through a difficult terrain, they eventually arrived after three
hours. Shewarega, a midwife working at the health center,
welcomed Amaru and the people accompanying her, took her
in to a curtained examination coach, did an assessment and
confirmed that she was having a labor.
However, as the labor was early, Amaru had to wait at the
health center for extra hours so did some of the people
accompanying her. As part of the effort to make delivery
services women friendly, the health center has a special
maternity waiting room. In this room, families are allowed to do
rituals for laboring woman in accordance with their customs.
The health center provides the woman and her family with
flour to make porridge after delivery as is the practice in the
area. Family members and neighbors are allowed to cater
for their own food. They are provided with firewood, kitchen
space and some necessary utensils.
They also conduct coffee ceremonies.
All of these support to make them
feel at home. When the labor was
progressing, Amaru was transferred to
the delivery room for close monitoring.
Because the labor was a bit delayed,
Amaru had to give birth with the help
of a vacuum extractor, a cup like
device attached to a vacuum extractor
to help expel the baby in such cases.
Shewarega assisted the delivery. He
has been behind most of the deliveries
at the Health Center after he received
training on Basic Emergency Obstetric
and Newborn Care (BEmONC)
organized by USAID funded IFHP. He
explains that the training has helped
him build his knowledge and skills to
respond appropriately to situations like
Amarus. The BEmONC training is a
practical hands-on training to manage
normal births as well as complications
of pregnancy, childbirth and the
newborn.
Due to the commitment of the
government, the staff and the
continued support from partners such
as USAID funded IFHP, skilled birth
attendance in Yaya Gulele woreda has
significantly improved from less than
20% in 2012 to 87% in 2015 said
Yirga Tessema deputy head of Yaya
Gulele woreda health office.
Mesfin Nigussie, IFHPs Regional
Program Manager for Oromia also
says; Previously, health centers
were staffed with health workers with
minimal midwifery training, totally on
their own without adequate medical
equipment, supplies and supervision.
IFHP has trained he 1,416 health
workers on BEmONC in Amhara,
Oromia, SNNP and Tigray regions.
Birke Assefa dreams for her daughters
to be doctors, and with the freedom
she now has to decide when and how
many children to have.
13
 Kima
the Brave
Woman A Fistula Survivor

I
t was a rough drive up the hill to Kimas
house. Part of the way to her home,
we had to make it on foot. Panting
heavily we made our way through a narrow
footpath and finally walked out in a field of
corn. The serenity and cool breeze caught
us off guard and for a minute we stopped
in our tracks with awe. A lonely house
stood with a huge crowd gathered around
it. With warm smiles and hugs, we were
greeted by the neighbors and friends of
Kima. The tough drive and the steep walk
up, was worth it all.

Kima Hassen Adem lives in Meta Woreda

of East Hararghe Zone, Oromia Region.
She was once lived with obstetric fistula
and suffered the consequences of stigma
and discrimination. She tells us her story
and we listen captivated by her expressive
narration. I married at the age of 15 and
immediately became pregnant. When I
gave birth to my first child, I was in labor
for three days and I could not get any
medical help. I got weak each day and by
the time I gave birth, the child died and I
got fistula.

When I had fistula, I would refuse to eat

so that I wouldnt leak. But that didnt
stop it. I couldnt work, so my husband
was the bread-winner in our home. He
spent all what he earned and sold most
of what we had, including our cattle, in
search of treatment for me. But the money
we earned from the sale of our cattle was
stolen and we had to beg. We got broke Kima, a mother with obstetric fistula

14
and had little means to live on. Friends
would help us out at times. Wed use the
money they gave us to buy food and wed
eat that for as long as it would last. I lost a
lot of weight.
Then one day I left my home. Everyone
hated me, even my husband. Though he
never told me to leave, I could see his
reaction and could no longer stand it.
When I got to the city, I could not work as
a house maid because of the incontinence.
I lived on the streets for six years. One day
the Woreda Administrator found me and
let me stay in his backyard for a couple of
days. Then, he sent me back home and
told my husband that he should take care
of me till death do us part. I feared my
husband was not happy with this yet he
also feared that I might commit suicide.
But we continued to live together for the
next 12 years.
I visited several places in search of
treatment. I went to traditional healers
and religious leaders but no one could
help me. Everyone discriminated me.
People would insult me and call me all
kinds of demeaning names because of
the smell. I got fed up of seeking help
that was unavailable and I planned to
commit suicide. But then I met this
girl Masresha [a Voluntary Community
Health Worker]. Masresha came over to my
home and told me that I could be sent to
Addis Ababa for treatment and she could
facilitate my travel. I refused. She tried
hard to convince me and she came to my
home three times. I refused to go because
I had completely lost hope that I could be
treated. I did not believe Masresha could
help me. But she was persistent and the
fourth time she came, I decided to give it
a try. I was sent to Addis Ababa Fistula
Hospital with all my expenses covered
by IFHP. I was doubtful and scared of
raising my hopes for what could possibly
fail. I was then treated and I stayed
at the hospital for 15 days. I got my
meals and a bed and I was happy. I
felt very well during that time but after
some time I asked to be returned home.
Again all my costs were covered, by
the hospital, I was provided with new
clothes and shoes and they put me in
a car which took me all the way back
home.
When I got home, I told everyone about
my treatment. Today, I tell women that
there is treatment for such conditions.
I encourage them to seek assistance if
they suffer from fistula.
For 19 years, I did not know that what
I had was called fistula until I went for
treatment. I thought it was a condition
unique to me. It was only when I got
to Addis Ababa Fistula Hospital that I
realized that there were so many women
suffering in the same way.
Ten months now since Ive been
repaired and Im in good health and
my life has completely changed. I am
now able to go about my social affairs
[weddings and funerals] without fear or
shame.
IFHP has been supporting the
identification, referral of women with
obstetric fistula to treatment facilities
and their reintegration back in to their
families and communities. Since 2008,
with the support of the program 6,738
women with fistula were identified and
referred in Amhara , Oromia, Tigray and
SNNP regions of Ethiopia.
15
 Expanding PMTCT Services
within the Primary
Health Care Units
The Case of Dera Health Center
D
era Health Center provides
comprehensive primary health
services to a population of
over 30,000 people. It is found
in Tigray region and was upgraded
from a clinic to a health center level
recently.
Dera kebele was previously
characterized as a highly populated
area where HIV prevalence was
relatively high. The health center
did not have staff trained on PMTCT
services. Thus, HIV-positive mothers
were referred to another facility
which would mean more hours
and distance for them to reach the
service.
With the fund obtained from USAID,
IFHP undertook a facility assessment
with the Woreda Health office. This
was followed by training of the
health center staff on the provision
of PMTCT services. Health Extension
Workers within the catchment of the
health center were also trained to
counsel mothers and schedule them
for testing appointments at their
respective health posts. Then, the
trained health providers at the health
center go to the health posts on the
date of appointment and provide
PMTCT services to the pregnant
women at the health posts through
the back up support: a mechanism
by which trained providers based at
health centers regularly visit health
16
posts to provide health services
including PMTCT.
After IFHP supported the launching
of the PMTCT services at Dera
Health Center, 840 mothers have
been reached with the service, 562
(66%) of them were addressed at
the health posts through the back
up support provided by the health
center team as of 2013. Of the
total number of mothers tested, only
17 were identified as HIV positive
and linked to treatment. When they
reached term, all of them gave
birth and their infants received ARV
prophylaxis and follow-up. Seven
received Dried Blood Spots (DBS)
testing at six weeks of age and the
remaining ten are waiting to receive
this testing service.
In addition to focused antenatal
follow up, mothers are greatly
relieved to receive such crucial
services in their localities. This
is now evident by the increasing
number of clients arriving at the
health center and health posts in
search of PMTCT services and none
of them decline HIV testing.
With USAIDs support, 212,609
pregnant women tested for HIV
during ANC in Amhara, Tigray,
SNNP and Oromia Regions of
Ethiopia.
S/r Amakelech with youth peer educators
W A Life
ukro Health Center
is usually busy with
a continuous flow of
young people between 10-
24 years. This is because
the health center has now
established a separate
corner that provides tailored
youth friendly health
services to this segment of the population.
The Youth Friendly Service at the health
center provides young people with access
to information and services on HIV and
AIDS, family planning, antenatal care,
post abortion care, sexually transmitted
infections and pregnancy tests in addition
to other medical services. Conscious of
the health needs of young people, IFHP
with a fund obtained from USAID provided
Training of Trainers course to health
professionals on the provision of Youth
Friendly Health Services and supported
the establishment of separate units
within the health facilities.
Wukro Health Center is
Dedicated one of the health facilities
that benefited from IFHPs
to the support.
Youth Sr. Amakel, a nurse who
took IFHPs training at
Wukro Health Center
says, Previously, young people had
to receive health services in the same
room with other clients. This made them
uncomfortable as the health system was
not responsive to their age and health
needs. Therefore, they were discouraged
and even stopped using the services.
After the establishment of the youth
friendly services at Wukro Health center,
Sr. Amakel started to reach young people
through 10 peer educators and 15
volunteers. When she first started the
job, the greatest challenge was to win the
trust and confidence of the youth. It was
17
''
Young people could be
difficult because they are
explorative. This is only
natural and weve all passed
through this stage...
a gradual process filled with several trials
and frustrations. After four years however,
the number of young people coming to the
facility started to grow. Most of them came
with personal problems trusting that Sr.
Amakel would help.
The Youth Friendly Service which started
small has now grown to become a second
home for most of the youth where they
get comfort and relief from their worries.
For Sr. Amakel, it is no longer a job but a
life commitment that knows no limit. With
a simple shrug of her shoulder she said,
Young people could be difficult because
they are explorative. This is only natural
and weve all passed through this stage.
We have to think of our times as young
people to understand them and be there
for them. Its not that difficult as we think
it is to work with young people.
Young people in Wukro town are now
comfortable to go to the health center and
receive services tailored to their individual
needs. They have very good source of
information and can get services easily.
Sr. Amakel by working as their friend and
mentor closely follows them and has made
the service friendly to access.
Today, through USAID and a matching
fund from KOICA, 248 health centers
have integrated similar youth friendly
services in Amhara, Oromia, SNNP, Tigray,
Beneshangul Gumuz and Somali regions of
Ethiopia.
18
Availing family
planning
servece to meet
demands
S
ister Beliyu Shale is a nurse
at Sagure Health Center
in Arsi Zone of Oromia
region. She has been serving in
the health center for more than
ten years. In the past four years,
she has been providing family
planning (FP) services after she
received training from USAID
funded IFHP. The training she took
focused on providing additional
skills on intrauterine contraceptive
device (IUCDs) which prevents
pregnancy for up to 12 years.
Before this training, no staff
could provide IUCD when women
demanded the service at the
health center. Sr.Beliyu says
previously, none of us had the skill
to insert or remove IUCD. So, the
contraceptives we provided were
limited to implanon, injectable,
pills and condoms.
With the financial and technical
support from USAID, IFHP trained
at least two staff at each health
center in Digalo Tijo Woreda of
Arsi Zone, one of which is Sagure
Health Center. The training helped
health centers expand the reach
of FP beyond the health center.
The trained health workers are not
limited to facility based services.
They also give back up support to
health posts to reach women with

Constable Addis Ashime, a satisfied client
contraceptive methods that
couldnt get the service from
health extension workers. said
Abayneh Tesfaye, head of Digalo
Tijo Woreda Health Office.
.because of the intensive
backup support to health posts
from health centers, utilization
of IUCD is improving steadily.
Abayneh added. In the year
2010, only 57 clients were
on IUCD, However, last year
alone (2015), 1,431 women
received IUCD services in the
woreda. Behind each woman
that received the IUCD service,
there is a story, a unique story
of change for the better. One of
these women is Constable Addis
Ashime. She received IUCD
services from Sr.Beliyu. The 25
years old policewoman said My
job as a policewoman puts me
on duty during evenings and
holidays. I already have a one
year old child. My husband, also
a policeman, works in another
town, some 75 kilometers away
from here. So taking care of
our child is a challenge leave
alone having another baby. So,
I decided to take IUCD to delay
my next pregnancy.
Similarly, IFHP has trained more
than 1,585 health workers in
IUCD insertion and removal
in over 770 health centers
across Tigray, Amhara, Oromia
and Southern Nations and
Nationalities Region of Ethiopia.
19
Protecting children from
preventable illness
I
n the morning of Thursday in the
month of August, in a small open space
outside of the immunization room of
Sagure Health Center, a group of women
sat under a tree shed with their babies
on their laps waiting for vaccination. Sr.
Adanech Gizaw, a nurse at the health
center, checked the vaccination status of
each baby on the yellow cards the women
carried with them. She wrote the vaccines
each baby was eligible for the day on
the card and gave injections and polio
droplets to the babies. Before the mothers
left, she explained possible side effects
and the appointment dates for the next
immunization.

Amidst the crowd of women was Jamila

Nemo, a 19 year old mother, with her
nine month old baby. Jamila came
for the final vaccination for her baby
after which she would be awarded an
Immunization Diploma. Jamila has known
the importance of immunization for her
baby and made her baby receive all the
vaccinations before its first birth day.

Jamila explains, Health extension

workers in my kebele have taught me
that immunization protects children
from many diseases. Children who are
vaccinated are healthier than those who
are not. IFHP in collaboration with
the Regional Health Bureau of Oromia
trained Sr. Adanech and her colleagues on
Expanded Program of Immunization (EPI)
and Integrated Management of Newborn
and Childhood Illnesses (IMNCI). Health
20
Jemila with her nine months old child at Sagure
Health Center
Extension Workers have also
been trained in EPI as well as
Integrated Community Case
management (ICCM) which has
enabled them provide vaccination
as well as treatment services for
sick children, respectively.
Seeing the deaths among unimmunized children
during outbreaks and knowing those who survived
had been immunized, the local community has now
recognized the importance of immunization, says
Abayneh Tesfaye, head of Digalo Tijo Woreda Health
Office. IFHPs technical support and training of the
health center staff and health extension workers has
greatly contributed to these changes
Abayneh concludes.
Since the inception of the program,
IFHP has trained 7,172 people
trained on EPI in Amhara, Oromia,
Tigray and SNNPR.
21
Using performance
data to make
informed decisions
Making wise decisions for
better service quality and
coverage

S
oro is one of the 11 woredas in Hadiya Zone of
Southern Nations, Nationalities and Peoples
Region Ethiopia. With a population of more
than 132,000, the woreda has 46 rural and 3 urban
kebeles. Two years ago, we were the least performing
woreda in the zone recalls Ebenezer Bekele, head
of the woreda health office. The training we received
on how to use our performance data to make decision
and take action was an eye opener. We knew very little
about using our own data to identify our own gaps and
propose solutions. Our decisions were usually arbitrary
and based on anecdote.
Use of data for decision making refers to the
collection and analysis of various types of data,
including input, process, and output data to guide
a range of decisions to help improve the success
of the health sector. Health systems require quality
data from health information systems to plan
for and ensure that the workforce is fully funded
and equipped with the necessary commodities,
infrastructure, resources, and policies to deliver
services.
Now, we are completely data-driven Ebenezer
proclaims. Every side of the wall in his office is
filled with graphs and tables, reflecting plans and
achievements of the woreda health office (WorHO).
Ebenezer continues we get information at arms
length for our day to day decisions and visitors also
learn what is going in the woreda very quickly. In
recent times, Soro Woreda health office has witnessed
a growing interest in the use of performance data
for decision making, making it a clich in the hearts
and minds of health workers and managers in the
woreda. One of the major challenges to use data for
decision-making was its lack of timeliness, accuracy,
consistency and completeness. Currently, the WorHO
has successfully managed to improve all these
challenges. The improvement in this woreda is due to
frequent supportive supervision and follow-ups at all
levels Ebenezer confirms.
Abenezer Bekele, Head of Soro Woreda Health Office
Data handling has improved; this is due to
standardized supervision practices they utilize
supervisory checklists. Supervision has been
conducted on a regular schedule with written and oral
feedbacks given to supervisees. Performance data
are collected, monitored and reviewed regularly. The
reports are sent timely and there is continuous follow-
up and performance audit of facilities at woreda level
and this has positive effect on data quality.
The Health Centers and the Health Posts in the
woreda have now started to use performance data for
decision making, We started to realize our mistakes
in the past said Tigabu Abera, head of Kosha Health
Center in the woreda. Now, we collect reports timely,
check for accuracy, completeness and consistency,
and conduct supervisions regularly. The management
of the health center also analyzes the data and uses it
for decision making
Ebenezer is thankful for the training on data for
decision making provided by IFHP with the technical
and financial support of USAID. It is a great help for
us. It helped us change in many ways. This year we
have won recognition award from the regional health
bureau for our outstanding performance, now we are
on the top of the list
So far, IFHP has trained nearly 15,000 health workers
and health managers in the use of data for decision
making in Amhara, Oromia, Tigray and SNNP regions
of Ethiopia. The program also provides technical and
materials support to encourage data use for decision
making in all regions.

22
 to refill for their next pills and
injectables on time.
In July 2011, USAID funded
IFHP provided Training of Trainers
(ToT) to 12 health center staff
and health extension supervisors
on Implanon insertion as part of
expanding Long Acting Family
Planning (LAFP) services in
Hammer and Benatsemay woredas
of South Omo Zone. The woredas
are predominantly inhabited by
Keri Ayke with her youngest son discuss family planning options with a pastoralists. The ToT was then
Community Health Extension Worker
followed by a roll out training
Reaching of 36 health extension workers.
IFHP also provided initial startup
Pastoralist Communities logistic and material support to
with Long Acting Family the health facilities from which
the training participants were
Planning Services drawn. Community sensitization

K
eri Ayke is a mother of seven children at the age of 34. She and mobilization sessions were
lives in Besheda kebele of Hamer Woreda within Southern also conducted using mobile vans
Nations, Nationalities and Peoples Region. She got married to create demand for the service.
at 22 to Oyka Delo, the man that fathered her seven children. If a Following the trainings and the
woman proves fertile and bears many children, the husband pays support, 181 pastoralist women
more goats to her relatives in return for her being prolific. That got Implanon (a long acting family
is why Keri gave birth to seven children within 12 years of her planning method) within three
marriage. Especially, female children are taken as sources of wealth months in the two woredas.
and prosperity in Hammer community as the girls future suitors will
pay goats for dowry to parents in exchange for their daughters. Keri Ayke is one of the 181
pastoralist women that benefited
Now, life is becoming difficult says Oyka, Keris husband. The
from USAIDs support. Because
land is being overgrazed and our cattle dont have enough to eat,
of the Implanon that she has
he adds. Let alone paying dowry, the food we have is not enough
to feed our family. Realizing the impact of large family size on the now taken, she is protected from
wellbeing of his family, Oyka convinced his wife to limit the number unintended pregnancy for the next
of their children after the sixth birth. Then, Keri started to take three years. Keri says Now, I will
Injectable contraceptive from Besheda Health Post. After she took not be hurt by bearing children
three doses however, the only health extension worker at the health one after the other. My body will
post went off for maternity leave and the health post was closed get strong and I will only have
temporarily. Consequently, Keri couldnt get the fourth dose. She to try to feed the children that I
then became pregnant with the seventh child that both parents did already have I now want to lead
not want. Keri regretfully says If I were able to get the injectable a healthy and prosperous life with
at the health post on time, I would not have had my seventh child. my children. Habtamu Wulayehu
Almost all of them (the pastoralists in the area) are illiterate also says long acting family
and dont use modern ways of measuring time; as a result have planning methods are becoming
difficulty of taking pills and injectables on the specified time says more acceptable by pastoralist
Habtamu Wulayehu, Head of Hammer Woreda Health Office. He communities. Therefore, we are
also says that some pastoralist women move from place to place now planning to scale up the
with their cattle. Therefore, they may not come to health facilities service to reach more people.

23
Hard
work
pays off
F
or those living in the villages of
Goro Gutu Woreda, West Hararghe
Zone of Oromia region, the rocky
terrain keeps healthy people fit but
very difficult for the sick. Surrounded
by many hills, streams and a vast
area covered with plantations, it was
difficult for local residents, specially
mothers and children, to reach health
facilities for treatment of illnesses
such as malaria. Those who manage to
reach health centers arrive in serious
conditions.
Of the 30 kebeles in the woreda, 23
of them are malarious. In 2003, there
were numerous malaria cases in the
woreda. To make matters worse, the
problem coincided with draught that
resulted in food insecurity. We had
a very difficult time. Mothers were
unable to feed their sick children.
Elderlies died before reaching health
centers recalls Abdul Aziz Ibrahim,
head of Goro Gutu woreda health
office.
24
Abdulaziz Ibrahim, Head of Goro Gutu woreda health office
In 2010, the zonal health department with
support from USAID funded IFHP, organized
trainings on epidemic management and malaria
treatment for health managers and other health
workers, respectively. Health extension workers
(HEWs) were trained to treat uncomplicated
cases of malaria at the community level. In
addition, they worked hand in glove with the
community in malaria prevention. The HEWs
taught the community about malaria prevention
that included draining of water pockets, use of
bed nets and in case of a fever, the need to seek
immediate medical care. Each household in the
community also received up to three bed nets.
All these efforts paid off says Abdul Aziz,
now, through the collaborative work of the woreda
health office and the community, the number of
malaria cases has declined sharply. If you look at
the malaria statistics in the woreda, the number
of new cases reported four years ago was 350
per year but in the just ended fiscal year, only 10
malaria cases were reported to the woreda health
office he added. IFHP provides similar supports
to malarious woredas in Amhara, Tigray, Oromia
and SNNP regions of Ethiopia.
 made
A Path
easier
B
irke Assefa dreams for her
daughters to be doctors,
and with the freedom she
now has to decide when and how
many children to have, she has
more hope than ever for their
future. At 26, Birke has not had
an easy life; abandoned by her
first husband after the birth of her
first daughter, she returned to her
parents home to be supported by
her father while working as a daily
laborer. There she met her second
husband and became pregnant
with her second daughter after
discontinuing her use of depo-
provera (a contraceptive method
that is injected into the arm and
is effective for three months) due
to side effects and the challenges
of having to remember a quarterly
appointment.
Like many women in rural Ethiopia,
Birke had limited knowledge of the
available choices of contraception,
and limited access to long-
acting reversible contraception
methods that were available only
at the health facility that was a
far distance from her home. Birke
didnt know that she had other
options I am poor. I do not have
enough income to give a decent
meal to my two children, let alone
having another child.
Her knowledge and access
increased when she met Tsehay
and Banchi. Tsehay and Banchi
are just two of more than 38,000
health extension workers (HEWs) Birke Assefa LAFP client Sheno Health Center

25
working throughout Ethiopia to
improve the quality and availability
of primary health care by teaching
communities about family planning,
maternal newborn and child health,
malaria prevention, nutrition, hygiene,
sanitation, and more. For Birke, and
the 3,000 members of Sojole Village,
Tshey and Banchi are the primary
source of health information and basic
health services. And now, thanks to
the training the HEWs received from
USAID funded IFHP, they are able to
provide family planning counseling
and service provision at their health
post. When Birke came to the health
post for one of her antenatal care
visits, I explained to her that there are
other choices including Postpartum
Intrauterine Contraceptive Device
Tsehay said.
On the day Birkes labor started, she
was accompanied the 10km distance
from her village by Tsehay and
Banchi to the Sheno Health Center
of North Shoa Zone, Oromia Region
where they linked her with Sister
Amelework. Like other midwives at the
health center, Sister Amelework had
received training from IFHP on Basic
Emergency Obstetric and Newborn
Care (BEmONC) and Postpartum
Intrauterine Contraceptive Device
services, so she was able to provide
Birke all of the services she wanted,
including contraception. Now, I do not
have to worry about my appointment
days and the discomforts have gone
for good Birke said with gratitude.
Birke hasnt been the only beneficiary
of IFHPs work in her community.
The total number of intrauterine
contraceptive device clients in the
Woreda was only 60 in the year 2013,
but now (2015) it has grown to 363
thanks to the technical, material, and
capacity building support of the
Sister Amelework concluded.
26
Keeping the
insect off
using ITNs and managing the
environment to stay healthy
W
orkiye Mihiret and Tenaw
Teshome are young married
couples in Abaye Terra Kebele of
Mirab Belessa Woreda in Amhara region.
Just as a recently wed couple, they have
a plan to have children. The couples
use long lasting insecticide treated net
(LLITN) at home to prevent themselves
from the deadly insect bite that causes
illness and death: malaria. Many people
were ill or died in the past due to malaria
in their kebele. Workiye herself survived
repeated episodes of malaria When I
had fever, I used to go to Arbaya Health
Center or Abaye Terra Health Post for
treatment she recalls. Ato Tigabu
Melkam, Nutrition and Child Health
Service Officer and former head of the
woreda health office said for many
years, malaria was the number one killer
in our woreda. We (the woreda health
office) distributed over 140,000 LLITNs
since 2009. In addition, indoor residual
spray (IRS) was used and water pockets
were drained in the malarious kebeles in
the woreda to reduce the burden of the
disease.
IFHP, with technical and financial
support from USAID, the Carter Center
and the MoH trained health extension
workers (HEWs) and health center staff
in the woreda on how to test malaria
and treat positive cases accordingly.
IFHP trained HEWs on the prevention
and management of malaria as part
of the training on case management
of childhood diseases. The program
provided logistics that included
anti-malaria drugs and
consumables, as startup kit,
to initiate services right away
following the trainings. The
program also trained health
workers on malaria cases
management. During follow
up, IFHP monitored utilization
of LLITNs at household level.
In some cases, the program
provided transportation
service for LLITN distribution.
Further, IFHP supported the
conduct of review meetings
among HEWs where they
discuss issues like case
management of malaria, ITN
utilization, and environmental
management of mosquito
breeding sites. They also share
their best experiences among
themselves.
Looking at the malaria
monitoring chart on the walls
of the woreda health office
tells the story. One can observe
a progressive decline in the
number of malaria cases for
years. Workiye said Since I
started to use ITN, I neither
had illness due to malaria nor
heard a person die of the same
cause. Ato Tigabu also agrees
with Workiyes assessment
because we did intensive
work on malaria prevention and
control for years now, we dont
have malaria related death
reports since last year.
Similarly, IFHP supports
malaria prevention and control
activities in Amhara, Tigray,
SNNP and Oromia regions of Workie Mihiret and Tenaw near their
Ethiopia. ITN covered bed

27
Telling
the
Truth
S
heik Fuad is a well-respected
imam--an Islamic religious
leader--in the rural area of
Adele, a predominantly Muslim
community which is located near
Harar town of Eastern Ethiopia. Like
his father Sheik Abdulkadir, who
was also an Imam, he believes that
much is expected from him in terms
of serving his community and giving
guidance in all aspects of life to
followers of the religion.

For him, as with many other

religious leaders, family planning,
reproductive health, and basic
education about health issues were
not topics worth discussing with
the congregation. However, with
high rates of fertility and maternal
and child deaths, he recognized the
dangers to the overall health and
well-being of the people in his area.

Recently, Imam Fuad attended

a seven days training workshop
organized by IFHP and its
implementing partner, the Ethiopian
Muslim Development Agency
(EMDA). He learned about the
importance of reproductive health
and family planning, and how
certain practices like birth spacing
can improve the health of mothers
and children. He also learned other
health issues, including malaria and
HIV, and how to help his community
address these challenges. Sheik Fuad, near his rural village mosque

28
He has also been given a very
important eye opener (the Fatwa
document) which was sent for
him from the National Council
of Ulammas of the Ethiopian
Islamic Affairs Supreme
Council. The fatwa document
(religious decree) approves use
of modern family planning with
the exception of permanent
methods. The document
discusses important issues
pertinent to family health and
gender equity within the context
of Islam. It is a compendium of
scholarly works by intellectuals
of the religion. I never knew
we had such rich resource in
this regard he recalls.
Imam Fuad emerged from the
workshop with an energetic
desire to spread the crucial
health information to as many
people as possible. He organizes
a session before every Friday
sermon for the entire village
in which he explains that
Islam accepts birth spacing
and urged villagers to visit
community health posts for
these services. The Imam
also warned discrimination
against people living with HIV,
explaining that HIV is like all
other health issues, and advised
his audience to care for those
who are HIV positive.
He has a very good relation with
the Health Extension Worker
in the Village. Whenever
community members discuss
the issue with me, I give them
my advice and blessing so that
they feel free to visit the health
post. I started this with my own
family because I am convinced
of the health benefits of family
planning, says the Imam. My
daughter is married and is 20 years
old. She and her husband have two
children in their two and half years
of marriage. I advised the couple to
use family planning and space the
births for the future he continues
I keep telling this as an example to
every village member who asks me
about this issue.
It is true that Islam teaches about
the health of mothers and children.
I will keep on telling the truth
His influential words and actions
are already making a difference.
Mesret, the HEW from the local
health post remarks that before
the interventions of these religious
leaders, many were ashamed of
asking for the service for fear of
rejection by community members.
However, after hearing their
messages and following their
example, they have noticed an
increase in the number of people
who visit the health post.
Ethiopian Muslims Development
Agency (EMDA) is one of IFHPs 13
Implementing Partner Organizations.
One of the objectives of the two
year (20xx-20xx) bilateral project
agreement between IFHP and EMDA
is to assist Ethiopian Islamic Affairs
Supreme Councils National Council
of Ulammas, the most influential
group of Muslim religious scholars
and leaders in the country, to issue
a national fatwa on reproductive
health and family planning.
29
 Serving My
Peer, Serving My
Community
using local Innovations to reach larger audience

Few of the peer educators at Wondo high school

30
Hey!!!!!!!!!! This is FM 105.2
and I am your host Mikias from
your mobile studio said a soft
voice of Mikias, one of the peer
educators in Wondo Secondary
and Preparatory school of
Aleta Wondo town in Southern
Ethiopia. Then, it was followed
by a stream of sweet local
music. Mikias is one of the 15
peer educators (PEs) trained by
the IFHP in the school of more
than 3000 students.
The PEs at the school use
morning and afternoon
breaks at the school to pass
health messages through in-
school FM radio invented by
Tsegazeab, an enthusiastic PE
trained by IFHP. The FM radio
transmits different programs
live covering a wide array of
topics including reproductive
health. The students and the
local community tune in to the
program using mobile phones
and radios. The producers also
use the schools megaphone to
reach students without mobile
phones.
Tsegazeab who is the inventor
of the radio gadget says; Most
students in the school have
limited knowledge on sexual
and reproductive health issues.
There are also misconceptions
concerning pregnancy and HIV/
AIDS. As a peer educator, this
is worrisome. He continues
so one day, I asked myself,
why dont we (PEs) have a
radio program to help us
reach students with health
information? The answer was
not easy. However, I started
to refer different sources
to know better about FM
transmission and finally came
up with this small device.
I made it from scraps and
secondhand radio parts He
said proudly. Although the
FM program is not legally
registered to transmit radio
programs, his efforts won
him recognition award during
Young Students Scientific
Innovation Contest by the
regional education bureau.
The main role of the PEs
in the school is to educate
and counsel fellow students
and young people in the
community on a variety
of sexual reproductive
health issues. They (PEs)
also refer their colleagues
to receive youth friendly
health services at a nearby
health center. USAIDs IFHP
provides five days basic
training on peer education,
follows their performances
and provide them refresher
trainings once in a year for
three days. The PEs cover
topics like family planning,
unwanted pregnancy,
sexually transmitted infection
including HIV and substance
abuse among others. They
also distribute condoms and
behavior change materials to
their peers. Tsegazeab says,
The training helped me a lot
to improve my confidence to
make public speeches and
develop self-esteem.
Bruk, an 11th grade
student also said The
information I received from
the local FM radio helped
me protect myself and
my friends from different
unhealthy practices such
as use of substances. The
PEs use various methods
to pass health messages.
Every Friday we have
a question and answer
contest. We give small
prizes such as pen and
exercise books to winners
of the contest said Mikias.
Serving my peers gives
me great satisfaction. Our
number is not enough;
we are trying to include
new members, as we are
about to complete high
school and join universities
next year Tsegazeab
explained We need to
have successors. The peer
education activities should
not be discontinued he
added. In addition to the
training and follow up,
IFHP gives the necessary
support and ascertain the
continuity of the service in
all respects.
Similarly, IFHP has
trained nearly 23,000
peer educators trained in
Amhara, Tigray, Oromia,
SNNP, Benshangul Gumuz
and Somali regions of
Ethiopia to increase access
to health service for young
people.
31
Abebech and Tesfaye near the Health Center

Ensuring
Access to Contraception for
Women Living with HIV
A One-Window Service Approach
I was shocked, says Abebech Reta, a did not get tested for HIV. Not long into their
26-year-old woman from Debre Libanos marriage, Tesfaye fell ill.
district in the Oromia region of Ethiopia.
I started getting sick, but I thought I was
when the nurse at the hospital told me I am bewitched, recalls Tesfaye. I visited
HIV positive. I lost hope. different traditional healersthen went to
Fiche hospital, where I found out I was HIV
Six years earlier, Abebech married Tesfaye,
positive.
a 32-year-old widower, whose wife had died
just months before. Abebech and Tesfaye Tesfaye kept his HIV status from Abebech.

32

It was only after she, too, became sick and
visited the hospital that she learned the
truth. Within an instant, her hopes for the
future began to fade.
Even though I had a strong desire to have
a baby, says Abebech, the nurse told me
that my health status was not good enough
to become pregnant. She advised me to
delay the pregnancy until I get my health
back. Abebech began HIV treatment at the
hospital.
Then, a nurse counseled and referred her for
further treatment at the Debretsigie Health
Center, which is closer to Abebechs home so
she can get the services she needs in a way
that is more convenient, confidential, and
effective.
In 2009, IFHP with support from USAID and
in partnership with the Ethiopian Federal
Ministry of Health initiated the provision
of HIV and FP integrated services, under
one roof. By providing these one window
services, IFHP is empowering women
living with the virus to prevent unintended
pregnancy and prevent mother-to-child
transmission of HIV.
While her health improved, Abebech chose
to use injectable contraceptive and condom.
Then, with support from facility staff, she
was able to proceed with her plans for
pregnancy. Today, as she shares her story,
Abebech is the proud mother of a healthy
18-month-old boy, who is free from HIV.
I am happy to have a child, says Abebech.
For Abebech and her husband, one child is
enough for now. We do not plan to have any
more children for the time being. I am using
injectable contraceptive and condoms to
delay my next pregnancy, as I did before the
first one.
IFHP continues to ensure that women like
Abebech have access to a range of sexual
and reproductive health services during their
visits, and that the health system is ready
to use this opportunity to deliver equitable,
efficient, stigma-free, and sustainable
healthcare.
We have benefited from this very important
intervention by IFHP. Our health providers
received training; our health center has also
received job aids and FP commodities. We
are now able to provide FP and HIV/AIDS
services together for our HIV-positive clients
says Shemelis, Head of Debretsigie Health
Centre.
To date, IFHP has trained 1,630 health
workers trained on FP/HIV integration in
Amhara, SNNPR, Tigray, and Oromia regions
of Ethiopia.
33
Reaching
Young People
with Youth
Friendly Services
S
olomon and Hirut are loved by most
young people residing in the rural
town of Kombolcha, located in East
Hararghe Zone of Oromia Region about
548 km East of Addis Ababa and just 16
km away from the ancient city of Harar. Both
of them are nurses at Melka Fura Health
Center. With a population close to 62,446,
like many towns in Ethiopia, Kombolcha is
predominantly inhabited by young people.
Talking about sex is considered a taboo in
this community. Specially, old people and
parents deliberately shun discussing the
topic in front of young people. Thus, young
people have to explore and learn about
it on their own. Unfortunately, they may
have exposed themselves to substantial
risks of unwanted pregnancies and sexually
transmitted infections including HIV before
they acquire the right information.
With the newly established youth friendly
service (YFS) unit at Melka Fura Health
Center, Solomon and Hirut provide sexual
and reproductive health (SRH) and other
health information and services to young
people in the community. They also recruit,
train and deploy young people as peer-
educators and counselors. This has helped
in improving the SRH awareness of young
people in the area. One day, before the YFS
was established, a 16 year old girl burst into
my office to avoid public eyes and whispered
into my ears that she wanted to talk to me
in private. I took her to the backyard of the
building. She kept quiet for a while. Afraid
of how to start her story, she finally said I
am pregnant. She pleaded for termination.
34
Sr Hirut - a YFS provider
If I wouldnt help her, she said, I will
commit suicide. Because I had to confirm
her pregnancy first, I ordered a pregnancy
test. Luckily, the laboratory test was
negative-she was not pregnant!! I counselled
her, gave her contraceptive and saw her off.
These days, after the YFS is established,
young people come straight to the YFS and
get the services they want without fear. They
also get adequate information concerning
the services available at the YFS from peer
educators says Hirut, one of the health
service providers trained by the project.
Most health facilities did not have YFS
units to provide youth friendly services to
young people. They did not have trained
staff either. Young people were treated like
adults and services were not sensitive to
their needs. As a result, young people faced
various health problems.
Unless you handle young clients in a
friendly manner and with assurance of
confidentiality, you cannot give them the
service and tackle their problems says
Nurse Solomon, YFS provider at Melka Fura
Health Center, IFHPs training has helped
me a lot in this regard he added.
In collaboration with the public health
system and with technical and financial
support from USAID and KOICA, IFHP has
established 248 YFS facilities and trained
several youth friendly service providers in
Amhara, Tigray, Oromia, SNNP, Benshangul
and Somali Regions of Ethiopia. This
has increased access to SRH services for
millions of young Ethiopians.
Improving
Child
Nutrition
I
n Dilla Zuria Woreda of
SNNPR, children below two
years of age suffered from
malnutrition due to lack of family
awareness on optimal nutrition
for newborns and infants.
Mothers did not select food for
their babies carefully and most
initiated solid food for their
babies at less than six months
of age. Instead of feeding food
that was produced to children,
families also took most of the
food items they produced to
sell in the market. Andualem
Mamo, Head of Chichu Health
Center in Dilla , describes
the problem: On average, 15
children were admitted to our
health center per quarter for
intensive care and rehabilitation
due to malnutrition. According
to Andualem, there was a
critical need to increase health
providers skills and increasing
community awareness around
nutrition.
Recognizing this need, the
woreda collaborated with IFHP
to train health care providers
including health extension
workers in essential nutrition
vegetable garden demonstration in the premise of Dilla Zuria
woreda health center
actions. Following the training, the
health center organized regular
health education sessions to educate
mothers on proper positioning and
attachment during breastfeeding
and demonstrated preparation of
complementary food for babies
above six months. These sessions
are combined with immunization
days to minimize travels for
families. The live demonstration of
complementary food preparation is
intended to illustrate to mothers that
nutritious meals can be prepared
with locally available food items.
Health professionals at the health
center take turns educating mothers
through role plays and actual
preparation of food.
At the end of the session, families
are invited to see a vegetable garden
in the health centers back yard to
indicate that most vegetables can
be grown at home. Andualem adds,
What we teach at the health center
is reinforced by health extension
workers. Health development
armies play a critical role in helping
mothers prepare complementary
food at home to make sure the
practice is continued at homes.
35
Building Skills to
save lives

D
espite the long distance and her
near term pregnancy, Tamire Gizat,
34 and a mother of six children had
to travel in a wooden stretcher carried on
the shoulders of four men from her small
village, Shina Girbish in Fogera Woreda
of South Gondar Zone, to Quihar Michael
Health Center. Under the scorching sun in
the rugged terrain, and accompanied by
her husband and neighbors, she arrived at
the Health Center very weak and soaked
with sweat.

Tamire had already three antenatal care

checkups for the current pregnancy.
She learned the importance of antenatal
care and skilled birth attendance from
the village health extension worker. This
morning, she had lower abdominal pain
which she thought could be the onset
of labor. Up on her arrival at the health
center, she was examined. It was clear that
the babys head was firmly engaged. Few
minutes later, her water broke. She was
carried to the delivery room, where within
few hours; she safely delivered a 3.8 kg
healthy baby boy. The health center was
filled with the sound of ululation of her
female neighbors and relatives, a way of
expressing happiness over safe delivery
according to the custom in the area.

Tamires labor was attended by Emebet

Meressa, a midwife at the health center.
Emebet has been assisting most of the
deliveries at Quihar Michael Health
Center that has a catchment population
of over 35,000 people. She is one of the
participants of the three weeks training on
BEmONC (Basic Emergency Obstetric and
Newborn Care) organized by the . Emebet Nurse Embet Meressa with a happy husband

36
explains that the BEmONC
training has helped her build
her knowledge, skill and
confidence to deal with normal
and complicated deliveries.
She beamed with pride as she
recounted the situation If
you take for instance the case
of Tamire, despite presenting
with normal labor, she
began bleeding immediately
after delivery. Having been
trained and mentored on
how to manage postpartum
hemorrhage, I was fast to act. I
quickly performed the required
procedure effectively stopping
the bleeding and saving
Tamires life she continues,
With the training given to me,
I am so happy to be able save
lives which would have been
lost otherwise. She puts in.
Skilled delivery attendance has
dramatically increased from
merely 3.7% two years ago to
50% at Quihar Michael Health
Center. This is as a result of
the service improvement at the
center due to the skill training
combined with intensive
community mobilization
and commitment of all
stakeholders. Moreover, IFHP
supported essential supplies
and equipment to enable the
health center provide skilled
maternity services. As a result,
not only has the number
of women delivering at the
health center increased but
also number of referrals to
Debretabor hospital dropped
significantly.
37

Neges Mesfin a mother with obstetric fistula
Transforming Lives
from a Dark Past
to a Luminous
Future
Helping women lead life with dignity
The furrows and the sunken eyes on her beautiful
face tell the story. A story of pain and sorrow
endured for years. Neges Mesfin, 49, lives in
Tsion Serguage Keble of Maksegnit Woreda in
38
North Gondar Zone of the Amhara
region. At the tender age of 3, she
was given for marriage, in a pre-
arranged marriage deal between
her parents and the parents of her
present husband, Asnakew Dagnew,
in accordance with the long
standing culture in the area. When
she grew up, her parents started to
persuade her to act womanly; to
get married and become prolific.
However, she insisted to finish
school and make the decision later
on her own.
Her rebellion was viewed as
infringement and disrespect to
the long held belief in the area.
Her parents started mistreating
her. Beating became her daily
encounter, eventually, I was
not able to resist the plight and
discontinued my education and
submitted to their will remembers
Neges. At the age of 15, she
married Asnakew and became
pregnant right away. When the
pregnancy was due, the labor lasted
for three days. I was laboring at
home for three days and finally I
lost energy to push down further
she continues the pain was so
intense and finally the baby came
tearing me off all its way down. I
felt like every bit of bones in my
body crushing in to pieces as the
baby passed down. Even though
I delivered a healthy baby, I lost
control of myself and did not know
what happened next. Later, when I
woke up with pain, I noticed that I
was leaking something unpleasant
through my birth canal. She said,
tears filling the brink of her eyes as
if she would burst at any moment.
Sick and debilitated, I lay in my
bed. I wept day and night. The whole world
seemed against me. My mother wanted
to caress me; I was bitter and wouldnt
let her. My mother and my father were
wretched when they saw what happened to
my body. Only my parents and my husband
knew about the problem and all of us
thought it as a curse. My mother said I
was demon possessed and tried all sorts of
spiritual healings with no avail.
At first, I totally excluded myself from
social life. Some people spread rumor in
the village saying she stays in bed most of
the time and pees on her bed like a baby.
I started to use clothe pads to absorb the
fluid and feces leaking through my private
parts. Somehow, I started partaking in
social life. Her fair skinned face reddened
and the tone of her voice changed like she
was weeping. I lived with this problem
for twenty eight years until one fine day
I heard the life changing news. I saw
a film in our kebele about women who
had problems exactly like mine. I was
happy to see women like me and above
all the availability of treatment for the
problem. I also knew that the problem is
called fistula. Soon enough, I contacted
the organizers in the kebele and got
the opportunity for treatment at Gondar
Referral Hospital.
The Integrated Family Health Program
(IFHP), based on the financial and
technical support from USAID, trained
the staff at the woredas women children
and youth affairs offices and organized
workshop for religious leaders on gender
and harmful traditional practices with
particular focus on fistula identification
and referral. Health workers at health
centers were given training on fistula
screening. Health extension workers
were also given orientation about it
to do identify and refer cases to the
health center for further diagnosis. In
addition, the program provides education
materials for community mobilization.
When suspected obstetric fistula cases
are identified in the community, IFHP
covers transportation costs to take the
women to fistula repair centers. The
program also provides sanitary materials
and clothes to the victim. In addition, per
diem and transportation is paid to the
person accompanying the fistula victim to
treatment centers. After successful repair,
the program gives life skill trainings to help
fistula survivors reintegrate back in to their
communities and lead a normal life. Some
of them become fistula ambassadors
and join the struggle to put an end to the
problem. In addition to identifying and
referring fistula cases, the ambassadors
also promote institutional delivery in the
community.
Neges, was one of the women identified
during community campaign against
fistula organized by IFHP trained kebele
and religious leaders. After she was
successfully repaired, she has become
a fistula ambassador, educating women
in her kebele and beyond about fistula
and its treatment that changed her life
for the better. She proudly said so far,
I have identified and accompanied eight
suspected fistula cases to Gondar Referral
Hospital. Five of them were diagnosed as
fistula and successfully repaired. Now, I
have identified four additional women that
I will take to the hospital. She continues
I thank my husband who has been with
me during those trying times. He equally
suffered the pain that I went through. He
really is my soul mate. It has now been
four years since I got my problem got
solved and I consider as If I am reborn
she says breaking a broad smile that
spreads through her wrinkled forehead.
39
Integrating Family
Planning Service in ART
Clinics
a promising practice to reduce pediatric HIV
infection
Preventing unintended pregnancy in HIV positive women
is one of the cornerstones for effective PMTCT services.
Meeting the contraceptive needs of these women not only
avoids unintended pregnancy but also reduces unsafe
abortions, the number of HIV-positive births as well as
HIV-related infant and child deaths.
HIV positive mothers should focus more on taking care
of themselves rather than bearing a child and causing
the suffering of another being, says Azeb Kassahun,
27, married and HIV positive mother of twins of age four
each. She first tested positive for HIV at eight months of
her pregnancy in Oct.2007 at Koladiba Health Center of
Amhara region. Weeks after she knew her HIV status, she
delivered her twin babies at Gondar Hospital, as advised
by health professionals.
With the twin babies, Azeb lived in denial for a year and
began to worry her kids could also have HIV. To escape
from the anguish and frustration, she hid herself at home
and spent most of her time watching TV. However, when
she learnt about HIV, its treatment and available services
from the media, she got convinced, accepted her status
and decided to go public. She also made up her mind and
went to Koladiba Health Center to get her children tested
for HIV. Fortunately, both of them were negative.
In January 2011, IFHP supported the integration
of Family Planning services in to the ART clinic at
Koladiba Health Center through the fund obtained from
USAID. The support included the provision of technical
assistance, training of health professionals and logistic
support such as continuous supply of contraceptives, Job
aids and IEC materials. Azeb says the integration enables
mothers to get a one stop service under the same roof at a
time. It also encourages more couples to seek the services
because the services are given in one room by one service
provider and most couples trust and find it easier to talk
to one provider.
Currently, Azeb is able to prevent another pregnancy
by using Condom and Injectable from the ART clinic
at Koladiba Health Center. She also joined the mother
support group, a group of HIV positive women volunteers,
at the health facility where she counsels HIV positive
women on family planning, safer pregnancy and on Azeb Kassahun during her
positive living. visit to the Health Center

40
Bringing Home Delivery
to Nearly Zero
Experience of Soloda Kebele, Tigray- Northern Ethiopia
T
wo years ago, the
number of mothers
who accessed skilled
birth attendance in Soloda
Kebele of Adwa Woreda
(district) was low. As a result
of this, pregnant women
were exposed for many risks.
This was a big concern for
Adwa Woreda administration
compelling it to take
immediate action to increase
skilled birth attendance.
Everyone knew that this
required the concerted
efforts of all stakeholders
in the Kebele (village). It
also required community
participation.
The Health Extension Workers
(HEWs) in Soloda Health
Post began community
mobilization activities in
collaboration with the Adwa
Woreda administration.
Together with health center
staff and the woreda health
office, they organized
repeated community
sensitization meetings to
provide information to the
community on maternal and
newborn health, the dangers
of unskilled delivery, and the
services provided at health
centers. The information
was provided through a
series of meetings in the
community and all women in
the reproductive age group
were organized in teams of
women development armies.
The youth participated
by coordinating local
transportation system
commonly known by the
communities as Bahlawi
ambulance literally
translated as traditional
ambulance.
To create opportunity for
pregnant mothers to learn
from one another, a monthly
meeting of pregnant women
locally known as Malti
Birhan which means Bright
day in the local language
was initiated. These meetings
helped women to understand
more about pregnancy and
to ensure their participation
throughout pregnancy, delivery
and postnatal period.
HEWs and women
development armies arranged
transportation for women in
labor and they accompanied
them to health facilities.
The HEWs provide postnatal
care through home visits.
The local kebele provided
administrative assistance to
the HEWs and the women
development armies. The
woreda ensured that the
referral linkage between the
health center and the hospital
was strong and responsive to
needs of laboring mothers.
Consequently, for all women
referred to Adwa Hospital for
delivery, the hospital sent
feedback on their status to
the referring health center.
Finally, all of these efforts
paid off. In Soloda Kebele, all
women of child bearing age
are now aware of maternal
and newborn health services
including the importance of
institutional delivery. The
proportion of mothers who
delivered in a health center
reached 95% by the end of
the 2004 Ethiopian fiscal
year (2011-2012). During
July to December 2012,
34 pregnant women in the
kebele were identified for
follow up and all of them
received antenatal care
services and their deliveries
were assisted by skilled birth
attendants. This confirms
that the Tigray Regional
Government is heading in the
right direction in achieving
their motto of No mother
should deliver at home!
The Integrated Family
Health Program (IFHP) has
been providing overall and
comprehensive support to
accelerate improvements in
maternal and newborn health
in line with the governments
strategy.
41

Fatuma Yusuf (left) with her child
Ekram and one of the Health extension
workers at Health Post
Health
Care at My
Doorsteps
L
ike some of the rural villages of Ethiopia, Chafi
Banti of West Hararghe zone is far from the
nearest health center by more than ten kilometers.
Pneumonia, diarrhea and malaria account for most of
the mortality and/ or morbidity of children aged 6 to 59
months.
The village was known by its high prevalence of
Malaria. There is also a scarcity of potable water.
Children of the village suffer from the frequent
occurrence of acute diarrhea and malaria. The Health
Extension Workers did not have enough skill to treat
sick children. Thus, families in Chafe Banti Kebele will
be forced to travel for three hours on foot just to find
a trained health worker at the nearest health facility.
Only few lucky ones who can carry on the sick child all
42
the way to the health center or those who
can pay for transport get there before the
problem gets worse. Some even die before
getting treatment.
Gone are the days now; treatment of a child
is not far any more. The Health Extension
Workers (HEWs) at the Health post (HP)
were trained on Integrated Community Case
Management (ICCM). ICCM is a skill training
that enables Health Extension Workers
(HEWs) to provide life-saving interventions
to address common childhood illnesses. It is
a proven intervention that reduces under-5
mortality.
The two health extension workers at Chafe
Banti Health Post have attended the training
provided by the USAID funded IFHP in
collaboration with West Hararghe Zonal
Health Department. Now, villagers know
about the service at the health post.
Fatuma Yusuf is a mother of two. She is a
resident of Chafe Banti. Her 18 months old
daughter Ekram suffered from diarrhea for
three days. After the treatment at the Health
Post , she become well. Thanks to the
government; we do not have to travel long
distances or pay for transportation to get the
service. We do not pay for treatment and
medicine. It is free says Fatuma.
Similarly, IFHP has expanded the ICCM
service in all its program operation regions
training 17,575 HEWs and health workers to
provide the service.
Living Without
Worries
Post-Partum IUCD (PPIUCD) Giving Rural
Women Long Term Relief
M
eseret Hussein is a 20-year-old mother of two
children. She is a hard working woman who lives
in a small village in rural Aleta Chuko Woreda
of SNNPR. Her first born son is 4 years old and the
second child is only eight months. After the birth of her
first child, Meseret and her husband did not want to
have another child until they get economically better.
She started to take pills and later shifted to injectable
contraceptive. After I started taking the first shot
of injectable; I forgot to take the second shot. Then,
came the second pregnancy she recalls. When her
menstruation stopped, she didnt suspect pregnancy. She
thought it could be because of the injectable. However,
after few weeks, her belly started to grow bigger. I went
to Chuko Health Center to learn that I was pregnant.
It was frustrating moment. I didnt know what to say.
Her husband, a cobbler, was not happy either. There
was frequent quarrel between them. He blamed me for
not being careful about my appointment and persuaded
me to abort it she remembers the situation sorrowfully.
Despite the pressure from my husband, I insisted on
continuing the pregnancy. I also started to visit the
health center for pregnancy follow up.
Tigist, a midwife nurse, who received IFHPs training
in FP, met Meseret during her antenatal care visits at
Chuko Health Center She (Meseret) told me the entire
story about her second pregnancy. I comforted her and
counseled her on the available family planning methods
including IUCD. Tigist said. When she came for
delivery at the health center, I counseled her again and
she finally decided to take IUCD immediately after her
second birth even before she was discharged.
It is not uncommon for a rural woman to forget
appointment dates and face unwanted pregnancy Tigist
continues, the women in the woreda are always busy.
They look after their babies, fetch water and firewood
and do all other household chores-- washing, cleaning,
cooking etc. They also work in the field and support their
husbands. She added. Availing contraceptives like
IUCD, that would prevent unwanted pregnancy as long
as 12 years, gives relief for women like Meseret Tigist
concludes. She also thanks IFHP for the training she
Messeret Hussein, a satisfied family planning client
received in IUCD, In addition to the skill
in IUCD insertion and removal, I have also
learned how to communicate, convince and
win the trust of my clients.
With a population of over 46, 000, much of
the surrounding villages of Aleta Chuko are
rural. IFHP has provided in-service training
to health workers from six health centers
in SNNPR including Aleta Chuko Health
Center. So far, about 35 health professionals
received the training. After IFHPs training,
impressive achievements have been recorded
so far said Mr. Mareg Mekuria head of
Chuko Health Center. We were able to serve
95 clients with post-partum IUCD since we
started the service 9 months ago, of which,
45 clients were served in the last three
months.
After eight months with IUCD, Meseret
speaks out with a great sign of relief, Now I
am relieved. I have nothing to forget and get
unplanned pregnancy. When things get better
for my family, I will have the IUCD removed
and get pregnant right away. Meseret has
also planned to start a small business to
support her husband who brings home the
bacon. I have shared my experience to my
friends in the neighborhood and many of
them are planning to do the same and get
free of worries she says happily.
43
Improving the Cold Chain for
Effective Immunization
Cold chain is the heart beat of the
immunization program, describes Ato Emiru
Gabisa, Family Health Team Leader at Oromia
Regional Health Bureau (RHB). According to
Ato Emiru, many vaccine refrigerators were
stacked at the corridors of health facilities
and the inventory conducted by the RHB
revealed that 42% of these fridges needed
minor repairs to function. Health workers
lacked the skills to complete the minor
repairs on such fridges and discarded them
as useless items. The facilities almost always
requested replacements of non-functional
fridges. In turn, immunization services were
frequently interrupted, and children in some
cases were denied the protection they needed
from vaccine-preventable diseases.
The Oromia RHB discussed the issue and
made a decision that the problem with the
non-functioning fridges should be identified
and repair of fridges should be given priority
rather than replacing the fridges without
examining their situation thoroughly.
The strategy followed was to: 1) to build
the capacity of cold chain technicians;
2) undertake preventive maintenance at
facilities to ensure the proper functioning
of the fridges, and 3) conduct minor repairs
at the facilities when fridges stop working.
On top of this, the region held a cold chain
maintenance campaign by pulling medical
equipment technicians from the Zonal Health
Offices and by collaborating with partners.
IFHP had the opportunity to contribute to
the cold chain campaign by identifying
the fridges needing repair; by training the
health workers on the expanded program
44
Services
on immunization (EPI) and cold chain;
and by deploying its own support staff
in the activity. In IFHP areas alone, 427
fridges were repaired with the leadership
of the program. Most of the repairs cost
500- 1000 birr, whereas replacing a
refrigerator costs 50,000 birr. In addition
to cost savings, the cold chain campaign
has resulted in improved storage capacity
of vaccine fridges at zonal health offices.
Service interruption is greatly minimized
which improves immunization coverage and
by implication decreases child morbidity
and mortality. The ORHB appreciates
IFHPs innovation in engaging its support
staff in the repair of refrigerators. It is a
cost-effective approach in that the drivers
use their time efficiently during field trips
while technical assistance is being given
by officers. The ORHB is looking to scale
up this approach of engaging more support
staff in the cold chain maintenance activity.
The RHB also appreciates that IFHP has
supported the renovation and organization
of cold rooms and provision of power
regulators in different zones. The zonal
cold rooms are now strengthened and have
the capacity to store three months supply
of vaccines which in turn has minimized
the transportation cost and the need for
frequent trip to the regional cold room to
collect vaccines. Ato Emiru concludes
by remarking, We intend to conduct this
activity continuously and our vision is to
reach every child with potent vaccines and
make vaccination coverage 100%.
 Educating girls
for a better future

A
yalnesh Muhabe is a 16-year-old girl and a
tenth grade student. She comes from a poor
family that earns a living from subsistence
farming in Dabat Zuria Kebele of Dabat Woreda,
North Gondar zone, Amhara Region. She is the
eighth child in a family of 12 children. Large
family size, such as Ayaleneshs, is considered
as an asset in rural families of Ethiopia. This is
because families with larger number of children
are more acceptable by the society than those
with smaller number of children. The thinking
is that girls will bring bride price (Dowry) to the
family and thereby increase social ties when
they get married and boys would turn out to be
a source of respect and support when they are
grown-ups. Therefore, many rural women bear an
average of between five and six children in their
reproductive years. In addition, traditional gender
norms often result in poor treatment of girls as
compared to boys. Ayalnesh is one of those girls
who have experienced such practices. Despite her
interest in going to school, she was often absent
because she had to help her mother with the
housework. She never had enough time to study.
The way my parents see it is that school is my
time to do school work and home is for household
chores. She explains. When it was eight oclock
in the evening, every family member would go to
sleep except Ayalnesh. She would gather what
little strength she had left from a hard days
work and try to concentrate on her studies until
midnight. She would use a flashlight to read as
there is no electricity in her village. She would
wake up at four oclock in the morning the next
day and read again till 6:00 oclock. Then, she
would go fetch water, clean the house and do
other household chores as usual before she left
for school. This, she says, affected her results
because she did not have enough time to study
and stood third in her class, unlike previous
years where she always stood first despite all the
challenges.

Ayalnesh Muhabe, a beneficiary of scholarship Besides all the burdens she bore which
program of Dabat high school North Gonder undermined her schoolwork, her parents also

45
tried to marry her at the age of twelve to a man
in his early twenties. But I told my teacher,
who helped me get the marriage cancelled,
Ayalnesh remembers. If I was married at that
time, I would have become a mother early and
might have suffered fistula, she adds. My
parents are uneducated and do not believe
that any good can come out of sending girls to
school. The only future for a girl, they believe,
is to marry her off so that she may have as
many children as possible.
Realizing Ayaleneshs academic performance
and her great interest in education, her teacher
helped her win a scholarship from a program
supported by the Fisher Family Foundation
through Pathfinder International Ethiopia. The
program provides financial support to young
girls, especially those in rural areas, to cover
some school expenses. The USAID funded
Integrated Family Health Program (IFHP),
implemented by Pathfinder International
and John Snow Inc. (JSI) in partnership
with Consortium of Reproductive Health
associations of (CORHA) carried out extensive
community sensitization on the importance
of educating girls and the empowerment of
women. As a result, Ayaleneshs parents began
to sense the household burden on Ayalnesh
and how she succeeded in her education
despite the challenges. The financial support
from Fishers Family Foundation also helped
her buy everything she needs for school. She
receives Birr 100.00 (US$ 6.00) every month.
With this money, she covers her school related
expenses such as school uniforms, exercise
It would have been difficult for me to take my
child to the distant health center for treatment,
let alone the frequent follow up. But now that
the health post is at my doorstep and my child
could get treatment and medicine, I came on
all the appointment days so that the HEWs will
examine my child and tell me the progress
Fatuma explained.
IFHP has been working with regional health
bureaus to strengthen the capacity of the
HEWs and build their confidence to be able to
serve millions of mothers and children.
46
The Health
Extension
Program
in the Eye of a
Community Leader
Before the Health Extension Program
began, we did not know about family
health, recalls Ato Idris Gemedu, 67, a
resident of Gere Negeya Kebele in Oromia
Region. We lived an unhealthy life and our
family, especially the children, often got
sick. Our women did not know about family
planning or good nutrition for the children.
We spent a lot of money in travel to transport
our sick family members to health facilities.
Back then, we had to go to Goba Hospital,
90 km from our kebele. Transportation was
not always available and was expensive when
we could get it. We also paid for health
services. I had to sell my cattle whenever my
family members got ill in order to get them
to the hospital.
According to Ado, Ethiopias Health
Extension Program has brought measurable
improvements to his community. Things
have changed dramatically. The Government
established a health post in our kebele and
assigned two women, Wubit Emiru and
Alemtsehay Geleta, whom we consider as our
own family members, to help us and serve
as health extension workers (HEWs). The
two HEWs began working hard to change our
situation and taught us day and night about
our health. They said we needed to dig our
own latrine in our backyard and start using
it. At first we thought having a pit latrine
was a shameful thing and we had to go to
the woods to relieve ourselves. The extension
workers told us that we often got sick
because of the unclean environment around
us. We took the advice and began cleaning
our compound and our fields. I dug a pit
latrine for my family with my own hands even
though I am an old man. The two HEWs also
taught our women about preparation of good
food for their children. They advised them
to get the children vaccinated and to use
family planning for themselves. Health in our
community has improved dramatically. I am
very happy that our community is clean and
we are healthy. The children of this time are
very different from children we raised in the
past. The children today receive vaccination.
They are well fed and they look healthy.
I often say to myself, if only the health
extension program began 15 years ago. We
would have enjoyed all the benefit early on.
I envy the children of today when I see how
healthy and radiant they are compared to the
children most of us raised in the past who
had big heads, swollen abdomen and very
slim legs because of malnutrition. I would
also have saved a lot of money and my cattle
that I had to sell to pay for health services
and on transportation for me and my family.
I would have been at least a middle income
farmer with a better life style. Today, we get
health service free of charge and the health
extension workers come to our houses to
teach us.
Ato Idris has no formal education but he has
made his own analysis of the situation and
highlights the benefits of the HEP. Idris goes
on by saying, We recognize the effort of
Government and the partners who helped us
change our way of life. We as a community
have benefited a lot and have become more
productive.
47
Working with
local implementing
partners to increase
Family Planning
service uptake
Adna Gobeze is a resident of Zarota
village. She is a 30 years old mother
of two. Adna regretfully recalls her
past I gave birth to my first child
and became pregnant again in just
nine months. The first child had
not started eating food by the time
I became pregnant with my second
child. My breasts could no longer
produce enough milk and it was so
painful to me when my first child
sucked my empty, tender nipples.
It was depressing. I felt guilty and
become frustrated for being unable
to feed my baby
Many mothers in Zarota village,
Northern Ethiopias Waghemra
zone of Amhara region, complained
of unintended pregnancies. The
village is known for its high birth
rates. Villagers have lived with
the misconception that having
many children is a sign of wealth
and respect. To make matters
worse, using modern family
planning method was considered
as a transgression of Gods
Commandments. The suffering
of women due to continuous
delivery was not understood by
the community. It was not even
noticed as a reason for the high
maternal and child deaths. Since
2003, efforts were made to
introduce the use of modern family
planning in the village by a local
NGO called Ethiopian Evangelical
Church Mekaneyesus/North Central
Ethiopia Synod (EECMY/ NCES),
with the support obtained from
Pathfinder International Ethiopia.
Since 2008, IFHP through its local
IPO, (EECMY/NCES), has been
supporting the implementation of
the health extension program in
Waghemra zone. EECMY/NCES
48
works on community mobilization
Etenesh Alemu(left), a health extension worker, discussing with her
client Adna Gobeze during home visit
to raise the awareness of the
community on family planning and
other reproductive health issues.
It also works on training of health
extension workers and health
service providers in the zone on the
provision of long and short acting
family planning methods and on
communication, counseling and
mobilization skills.
IFHP through EECMY/NCES also
provided uninterrupted supply of
family planning commodities to
health facilities. Equipped with
essential knowledge and trainings
from the program, the health
extension workers devote their time
to mobilize and give relevant health
information to women 15-49 in
Zarota village, about 346 (42%)
are using modern family planning
methods as compared to 86
(10.4%) in 2008.
I have learned from my past
mistakes and already started using
contraceptives while my second
baby was four months old. Now, I
am healthy and have time to take
care of my children. I will continue
to use contraceptives until my two
kids finish elementary school.
Said Adna
Nowadays, people in Zarota village
have understood the benefits
of family planning. More and
more mothers are coming to the
health post in the village seeking
counseling and family planning
service. As a result, the number of
family planning users is increasing
from time to time.
Equipped with essential knowledge
and trainings from the program,
the health extension workers devote
their time to mobilize and give
relevant health information to their
communities during different events
including house to house visits and
religious festivals in order to increase
awareness. Community conversation
sessions were the most important
tools where the advantage of family
planning was deeply discussed.
Additionally, school health club
members have acquired knowledge
through training and are playing
great role in raising the awareness.
The suffering of mothers has gone for
good now. After the unlimited effort
of the health extension workers,
voluntary community health workers
and support from local IPOs such
as EECMY, community members
are gaining behavior change and
their attitudes towards the use of
family planning has improved a
lot. Currently, from 823 women of
child bearing aged (15-49) in Zarota
village, about 346 (42%) are using
modern family planning methods
as compared to 86 (10.4%) in
2008. I have learned from my past
mistakes and already started using
contraceptives while my second
baby was four months old. Now, I
am healthy and have time to take
care of my children. I will continue
to use contraceptives until my two
kids finish elementary school. Said
Adna Nowadays, people in Zarota
village have understood the benefits
of family planning. More and more
mothers are coming to the health
post in the village seeking counseling
and family planning service. As a
result, the number of family planning
users is increasing from time to time.
Address
Integrated Family Health Program
Tel. +251 11 320 3501
P.O. Box 12655
Nefas Silk Lafto Sub City
Woreda 05, Hadid Building
Around Del Gebeya Area
Addis Ababa, Ethiopia

Prepared by: Tariku Nigatu

Abdusemed Mussa
Designed & Printed by
Master Print +251 111 557 788