Waking up at 6:00 am to travel to the health post and helping deliver a baby at 2:00 am the same night may seem like an impossible work day, but for Alemnesh Assefa, this is a common occurrence. Assefa is a 27-year-old Health Extension Worker (HEW) serving a rural village, or kebele, in the Amhara region of Ethiopia. During the day, Assefa provides mainly preventive, and to some degree therapeutic, health services. However, her work does not end when she leaves the health post at 5:00 pm; she often visits households on her way home. A mother in labor could call Assefa’s mobile phone at any time and she’d respond immediately.
HEWs operate nationwide in Ethiopia, providing a variety of services including antenatal and postnatal care, family planning, immunization, nutrition, sanitation and hygiene education, malaria testing and treatment, and more. HEWs serve in a kebele, in which the lowest health structure is called a health post, where two HEWs serve 5,000 people. HEWs are salaried government employees; they are required to have a 10th grade education and 10 months of training prior to beginning service.
Since Assefa was recruited to this region more than five years ago, the kebele has reported significant positive changes. In the beginning, it wasn’t easy for Assefa. Many households and community members initially resisted her health lessons. For example, some households refused to build latrines to stop open defecation and several community members rebuffed Assefa’s offers to visit to their homes and even put dogs by their gates to keep her out. However, with Assefa’s patience and determination she was able to make a difference in the kebele. Now, things have changed for the better. The community members value Assefa’s teachings and access roads have now even been built for ambulances to pick up laboring mothers and deliver them to a health facility. “I’ve always been proud to work with mothers,” says Assefa, “especially helping them during their delivery. I share in their pain and anxiety during their labor when I accompany the mothers to the health center.”
When asked about her biggest influence, Assefa cites her Kebele Administrator who taught her the importance of being patient and respectful of people’s privacy. “I once made the mistake of openly accusing a woman of getting pregnant every year when her husband informed me that she was not taking her family planning pills properly. This reached the ears of the Kebele Administrator, who advised me that, as an HEW, I had to maintain the dignity of every person. It was the biggest lesson in my life.”
Assefa’s goals do not end with her HEW certification. “I’ve gained so much in my 8 years as a HEW,” Assefa explains, “and I feel so rewarded by the changes that have happened. So if I could have any job now, I would choose nothing more than to be a midwife. Nothing would please me more than to help a woman deliver and share in her joy.”
The Last Ten Kilometers (L10K) works to strengthen the bridge between households and the primary health care unit (PHCU), Ethiopia’s basic health service delivery structure. The aim is to improve high impact maternal, neonatal and child health (MNCH) care practices among the rural households. L10K is a project implemented by JSI Research & Training Institute, Inc., with grants primarily from the Bill & Melinda Gates Foundation and additional funding from UNICEF and USAID, through the Advancing Partners & Communities Project.
Learn more about the The Last Ten Kilometers: What it Takes to Improve Health Outcomes in Rural Ethiopia Project.