IFHP Success stories booklet 2008- 2016 , Produced by Tariku Nigatu and Abdusemed Mussa

INTEGRATED FAMILY HEALTH PROGRAM (IFHP) 2008-2016 

SELECTED STORIES 

FROM THE FIELD

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/ Ethiopia’s 

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 .................................................................................................... 

Building competence; transforming skills to save lives ................................................................. 

Knowledge and Choice: Balancing family size with Resources in Rural Communities ................. 

Breaking barriers to improve Skilled Birth Attendance: Experiences from Debaytilatgin Woreda ... 

Saving Children’s Lives; Making Services Available at a Walking Distance .................................. 

Verifying the Truth and Ensuring Quality through Integrated Supportive Supervision (ISS) .................. 

Smashing Barriers; beating limitations ...................................................................................... 

The story of Ethiopia’s Family Planning Success: Memoir from Dr. Mengistu ................................ 

Availing health services within reach; protecting children from death and illness ............................. 

Expanding options for family planning ........................................................................................ 

Skilled delivery; a happy mother a healthy child .......................................................................... 

Kima the Brave Woman – A Fistula Survivor ................................................................................. 

Expanding PMTCT Services within the Primary Health Care Units: The Case of Dera Health Center..... 

A Life Dedicated to the Youth ..................................................................................................... 

Availing services to meet demands for family planning ............................................................... 

Protecting children from preventable illness .................................................................................. 

Using performance data to make informed decisions:Making wise decisions for better service 

quality and coverage ...................................................................................................................... 

Reaching Pastoralist Communities with Long Acting Family Planning Services ................................. 

Hard work pays off ......................................................................................................................... 

A Path made easier .................................................................................................................... 

Keeping the insect off: using ITNs and managing the environment to stay healthy ............................ 

Telling the Truth ............................................................................................................................. 

Serving My Peer, Serving My Community: using local Innovations to reach larger audience .............. 

Ensuring Access to Contraception for Women Living with HIV: A “One-Window” Service Approach ..... 

Reaching Young People with Youth Friendly Services ...................................................................... 

Improving Child Nutrition ................................................................................................................ 

Building Skills to save lives ............................................................................................................ 

Transforming Lives from a Dark Past to a Luminous Future; Helping women lead life with dignity ....... 

Integrating Family Planning Service in ART Clinics – a promising practice to reduce pediatric HIV 

infection ....................................................................................................................................... 

Bringing Home Delivery to Nearly Zero: Experience of Soloda Kebele, Tigray- Northern Ethiopia ........ 

Health Care at My Doorsteps ........................................................................................................... 

Living Without Worries: Post-Partum IUCD (PPIUCD) Giving Rural Women Long Term Relief ............... 

Improving the Cold Chain for Effective Immunization Services ......................................................... 

Educating girls for a better future ................................................................................................ 

The Health Extension Program: in the Eye of a Community Leader..................................................... 

Working with local implementing partners to increase Family Planning service uptake ..................... 47 

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Health 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) 

Message 

from the 

Chief of Party 

2ii

Building 

competence 

transforming skills to save lives 

Even 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 

to protect the mother and the newborn from evil 

eyes.” Belaynesh continues ‘’…but now, thanks to 

the Health Extension Program and partners such 

as IFHP, such practices have changed. Women 

now seek services from skilled health workers at 

health facilities’’. To dispel myths and to promote 

skilled delivery service uptake, IFHP conducted 

stakeholders’ meeting at the woreda level to 

identify service barriers, facilitated action oriented 

kebele level sensitization meetings and carried out 

a series of community awareness sessions. 

To keep pace with the growing demand for skilled 

birth attendance, IFHP with technical and financial 

support from USAID, trains health workers in Basic 

Emergency Obstetric and Newborn Care (BEmONC) 

for three weeks. To improve quality and ensure 

sustainability of skilled delivery services, BEmONC 

trainees undergo a three-day additional training in 

BEmONC mentoring. 

As BEmONC mentors, they are trained to observe 

and coach untrained service providers during 

deliveries. They also receive training to coach 

mentees during family planning, antenatal 

and post-natal care service provision. This has 

facilitated on-the job knowledge and skill transfer, 

Belaynesh Siraw, a mentor for BEmONC 

reducing time and resource needed to train 

additional staff. 

Belaynesh says, “…until recently, I did not 

have the skill and the confidence to handle 

complicated deliveries. But now, following 

the training, it is not only having the skill, 

but I also have the confidence to coach my 

fellow health workers”. 

Belaynesh, as a mentor is able to coach nine 

of her fellow nurses in the woreda. Abebaw 

Kelkay, deputy head of South Gondar Zone 

Health Department says, “IFHP’s BEmONC 

training came into our zone at the right 

moment. It is helping us a lot. The quality 

of services we provide has now improved 

significantly. The training helped health 

workers develop their confidence. You can 

appreciate the difference between the 

trained and the untrained health workers by 

observing their level of confidence”. 

So far, IFHP has provided BEmONC 

mentoring training to 1,416 health workers 

in Tigray, Amhara, Oromia, and SNNP 

regions. 

1

Knowledge 

andChoice 

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 

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 provider’s gradual, constant, 

and diligent communication and 

counseling—Wezef 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. 

2

Wezef near her house 

3

Breaking barriers 

to improve 

Skilled Birth 

Attendance 

Experiences from Debaytilatgin Woreda 

Despite 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 

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. 

4

Ayelech Kakebo recalls her past 

Saving Children’s Lives 

Making Services Available at a Walking Distance 

Ayelech 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 relative’s house for days 

until the child finished treatment. 

It was very hard and we usually 

didn’t 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 didn’t 

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 

couldn’t 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

Solomon 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. 

Solomon’s 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, Solomon’s 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 IFHP’s 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. I’m 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 

Ethiopia’s 

Family Planning 

Success 

Memoir from Dr. Mengistu 

When 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 age—15 

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 Ethiopia’s 

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 

high—contributing 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, we’ve 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 

women’s health, the government focused on mobilizing 

resources for community outreach—particularly in rural 

areas—through a network of health extension workers who 

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. 

10

Availing 

health services within reach 

protecting children from death and illness 

Mulu 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 couldn’t take 

them to the health center, they 

would buy and give them drugs 

without prescriptions or would 

try traditional medicine which 

usually worsened the illness’’ 

IFHP, with technical and financial 

support from USAID, collaborated 

with the ministry of health, in 

the training of HEWs, in the 

identification, classification 

and treatment of childhood 

illnesses. The training of HEWs 

is to enable them manage 

simple uncomplicated cases at 

health post level or otherwise 

refer complicated cases to 

health centers with first dose of 

antibiotics. The service is given 

for free in the community, by 

someone familiar, a HEW, in a 

known setting. In addition, IFHP 

gave drugs and consumables as a 

startup kit to initiate the service 

and supported the conduct of 

quarterly review meeting where 

HEWs discuss their performances, 

exchange experiences and get 

technical updates. Through 

integrated supportive supervision, 

the program also monitored the 

quality of services, the recording 

and reporting of activities and 

community service utilization. 

The woreda health office also 

used community networks to 

promote the availability of 

treatment services at the health 

post by HEWs. To ensure the 

continuity of services at the 

health post, health centers in the 

woreda buy and distribute drugs 

and consumables to health posts 

from the income they generate 

from the health care financing 

scheme. 

Since 2011, 649 cases were 

identified, classified and treated 

at Abaye Terra Health post, 

while 64 children were referred 

to Arbaya Health Center for 

further diagnosis and treatment. 

The commonest illnesses were 

diarrhea and malaria followed by 

pneumonia. The twin children 

of Mulu were among the cases 

that received service at the 

health post. She said, ‘’ Now the 

service is within reach, free and 

time saving’’ Manaley Mebrat, 

a HEW at the health post said 

‘’ since the treatment service 

started, parents come with their 

children seeking treatment at 

the health post. We treat the 

children using the chart booklet, 

a booklet containing algorithms 

for classification and treatment of 

cases. If the disease is severe, we 

refer them to the health center as 

per the direction on the booklet’’. 

Ato Tigabu also said ‘’ after the 

initiation of the service at the 

health post, mothers take their 

sick children to the health post. 

They don’t try to self-treat them. 

As a result, the service improved 

the health seeking behavior of the 

community’’ 

IFHP has so far trained 17,575 

HEWs and HWs trained on 

integrated community case 

management of childhood 

illnesses (iCCM) in Amhara, 

Tigray, Oromia and SNNP regions 

of as a result of which close to 

a million children were correctly 

identified, classified and treated. 

11

Expanding options for 

family 

planning 

Mesenbet 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 

Amaru 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 

Amaru’s. 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, IFHP’s 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 

It was a rough drive up the hill to Kima’s 

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 wouldn’t leak. But that didn’t 

stop it. I couldn’t 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. We’d use the 

money they gave us to buy food and we’d 

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 I’ve been 

repaired and I’m 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 

16 

Dera 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 

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 USAID’s 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 

Wukro 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 

A Life 

Dedicated 

to the 

Youth 

within the health facilities. 

Wukro Health Center is 

one of the health facilities 

that benefited from IFHP’s 

support. 

Sr. Amakel, a nurse who 

took IFHP’s 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 we’ve 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 we’ve all passed through this stage. 

We have to think of our times as young 

people to understand them and be there 

for them. It’s 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. 

Availing family 

planning 

servece to meet 

demands 

Sister 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 

18

contraceptive methods that 

couldn’t 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”. 

Constable Addis Ashime, a satisfied client 

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 

In 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 

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. 

20

“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. “IFHP’s 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 

Soro 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 arm’s 

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 cliché 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 followup 

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. 

Keri Ayke with her youngest son discuss family planning options with a 

Community Health Extension Worker 

Reaching 

Pastoralist Communities 

with Long Acting Family 

Planning Services 

Keri Ayke is a mother of seven children at the age of 34. She 

lives in Besheda kebele of Hamer Woreda within Southern 

Nations, Nationalities and Peoples Region. She got married 

at 22 to Oyka Delo, the man that fathered her seven children. If a 

woman proves fertile and bears many children, the husband pays 

more goats to her relatives in return for her being prolific. That 

is why Keri gave birth to seven children within 12 years of her 

marriage. Especially, female children are taken as sources of wealth 

and prosperity in Hammer community as the girls future suitors will 

pay goats for dowry to parents in exchange for their daughters. 

‘’Now, life is becoming difficult’’ says Oyka, Keri’s husband. ‘’The 

land is being overgrazed and our cattle don’t have enough to eat,’’ 

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 

wellbeing of his family, Oyka convinced his wife to limit the number 

of their children after the sixth birth. Then, Keri started to take 

Injectable contraceptive from Besheda Health Post. After she took 

three doses however, the only health extension worker at the health 

post went off for maternity leave and the health post was closed 

temporarily. Consequently, Keri couldn’t get the fourth dose. She 

then became pregnant with the seventh child that both parents did 

not want. Keri regretfully says “If I were able to get the injectable 

at the health post on time, I would not have had my seventh child’’. 

”Almost all of them (the pastoralists in the area) are illiterate 

and don’t use modern ways of measuring time; as a result have 

difficulty of taking pills and injectables on the specified time’’ says 

Habtamu Wulayehu, Head of Hammer Woreda Health Office. He 

also says that some pastoralist women move from place to place 

with their cattle. Therefore, they may not come to health facilities 

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 

pastoralists. The ToT was then 

followed by a roll out training 

of 36 health extension workers. 

IFHP also provided initial startup 

logistic and material support to 

the health facilities from which 

the training participants were 

drawn. Community sensitization 

and mobilization sessions were 

also conducted using mobile vans 

to create demand for the service. 

Following the trainings and the 

support, 181 pastoralist women 

got Implanon (a long acting family 

planning method) within three 

months in the two woredas. 

Keri Ayke is one of the 181 

pastoralist women that benefited 

from USAID’s support. Because 

of the Implanon that she has 

now taken, she is protected from 

unintended pregnancy for the next 

three years. Keri says ’’ Now, I will 

not be hurt by bearing children 

one after the other. My body will 

get strong and I will only have 

to try to feed the children that I 

already have – I now want to lead 

a healthy and prosperous life with 

my children. Habtamu Wulayehu 

also says “ long acting family 

planning methods are becoming 

more acceptable by pastoralist 

communities. Therefore, we are 

now planning to scale up the 

service to reach more people.” 

23

Hard 

work 

24 

pays off 

For 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. 

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.

A Path made 

easier 

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, 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 depoprovera 

(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 longacting 

reversible contraception 

methods that were available only 

at the health facility that was a 

far distance from her home. Birke 

didn’t 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 Birke’s 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 hasn’t been the only beneficiary 

of IFHP’s 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 

Workiye 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 Workiye’s assessment 

‘’because we did intensive 

work on malaria prevention and 

control for years now, we don’t 

have malaria related death 

reports since last year’’. 

Similarly, IFHP supports 

malaria prevention and control 

activities in Amhara, Tigray, 

SNNP and Oromia regions of 

Ethiopia. 

Workie Mihiret and Tenaw near their 

ITN covered bed 

27

Telling 

the 

Truth 

Sheik 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 IFHP’s 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 Council’s 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 inschool 

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 school’s 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 don’t 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. USAID’s 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 

26-year-old woman from Debre Libanos 

district in the Oromia region of Ethiopia. “… 

when the nurse at the hospital told me I am 

HIV positive. I lost hope.” 

Six years earlier, Abebech married Tesfaye, 

a 32-year-old widower, whose wife had died 

just months before. Abebech and Tesfaye 

32 

did not get tested for HIV. Not long into their 

marriage, Tesfaye fell ill. 

“I started getting sick, but I thought I was 

bewitched,” recalls Tesfaye. “I visited 

different traditional healers…then went to 

Fiche hospital, where I found out I was HIV 

positive.” 

Tesfaye kept his HIV status from Abebech.

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.” 

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 Abebech’s home so 

she can get the services she needs in a way 

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 

Solomon 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 peereducators 

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 wouldn’t 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, “IFHP’s 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 

In 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 center’s 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 

Despite 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 baby’s 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. 

Tamire’s 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 

Tamire’s 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

North Gondar Zone of the Amhara 

region. At the tender age of 3, she 

was given for marriage, in a prearranged 

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. 

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 

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 

38

ed. I wept day and night. The whole world 

seemed against me. My mother wanted 

to caress me; I was bitter and wouldn’t 

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 woreda’s women children 

and youth affairs office’s 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 

positive living. 

Azeb Kassahun during her 

visit to the Health Center 

40

Bringing Home Delivery 

to Nearly Zero 

Experience of Soloda Kebele, Tigray- Northern Ethiopia 

Two 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 government’s 

strategy. 

41

Fatuma Yusuf (left) with her child 

Ekram and one of the Health extension 

workers at Health Post 

Health 

Care at My 

Doorsteps 

Like 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 

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. 

42

Living Without 

Worries 

Post-Partum IUCD (PPIUCD) Giving Rural 

Women Long Term Relief 

Meseret 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 didn’t 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 didn’t 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 IFHP’s 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 IFHP’s 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 Services 

“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 

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 

IFHP’s 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%.”

Ayalnesh Muhabe, a beneficiary of scholarship 

program of Dabat high school North Gonder 

Educating girls 

for a better future 

Ayalnesh 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 Ayalenesh’s, 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 o’clock 

in the evening, every family member would go to 

sleep except Ayalnesh. She would gather what 

little strength she had left from a hard day’s 

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 o’clock in the morning the next 

day and read again till 6:00 o’clock. 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. 

Besides all the burdens she bore which 

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 Ayalenesh’s 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, Ayalenesh’s parents began 

to sense the household burden on Ayalnesh 

and how she succeeded in her education 

despite the challenges. The financial support 

from Fisher’s 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, Ethiopia’s 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 Ethiopia’s 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 God’s 

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

IFHP Success stories booklet 2008- 2016 , Produced by Tariku Nigatu and Abdusemed Mussa

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