Combining long-lasting insecticidal nets and indoor residual spraying for malaria prevention in Ethiopia: study protocol for a cluster randomized controlled trial

Background: Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the main malaria prevention interventions in Ethiopia. There is conflicting evidence that the combined application of both interventions is better than either LLINs or IRS used alone. This trial aims to investigate whether the combination of LLINs (PermaNet 2.0, Vestergaard Frandsen, Lausanne, Switzerland) with IRS using propoxur will enhance the protective benefits and cost-effectiveness of the interventions against malaria and its effect on mosquito behavior, as compared to each intervention alone.

Methods/Design: This 2 x 2 factorial cluster randomized controlled trial is being carried out in the Adami Tullu district in south-central Ethiopia for about 116 weeks from September 2014 to December 2016. The trial is based on four arms: LLINs + IRS, LLINs alone, IRS alone and control. Villages (or clusters) will be the unit of randomization. The sample size includes 44 clusters per arm, with each cluster comprised of approximately 35 households (about 175 people). Prior to intervention, all households in the LLINs + IRS and LLINs alone arms will be provided with LLINs free of charge. HouseholdsintheLLINs+IRSandIRSalonearmswillbesprayedwithcarbamatepropoxuronceayearjust before the main malaria transmission season throughout th e investigation. The primary outcome of this trial will be a malaria incidence based on the results of the rapid diagnostic tests in patients with a fever or history of fever attending health posts by passive case detection. C ommunity-based surveys will be conducted each year to assess anemia among children 5 â?? 59 months old. In addition, community-b ased malaria prevalence surveys will be conducted each year on a representative sample of households during the main transmission season. The cost-effectiveness of the interventions and entomological studies will be simultaneously conducted. Analysis will be based on an intention-to-treat principle.

Discussion: This trial aims to provide evidence on the combined use of LLINs and IRS for malaria prevention by answering the following research questions: Can the co mbined use of LLINs and IRS significantly reduce the incidence of malaria compared with the use of either LLINs or IRS alone? And is the reduced incidence justifiable compared to the added costs? Will the combined use of LLINs and IRS reduce vector density, infection, longevity and the entomological inoculation rate? These data are crucial in order to maximize the impact of vector control interventions on the morbidity and mortality of malaria | 23-Dec-2016 13:01

Ethiopia’s effective climate diplomacy: lessons for other nations

Despite its Least Developed Country status, Ethiopia has played a leading role in climate diplomacy. This briefing explores the factors behind Ethiopia’s success in order to draw lessons for other nations. Meles Zenawi, the late former prime minister, has left a legacy of strong political will and leadership that has enabled Ethiopia to integrate climate into its development strategy, set ambitious national targets and successfully coordinate climate action across ministries. Ethiopian climate diplomats have also engaged effectively with their neighbours and the broader international community to mobilise support for stronger goals, supported by a growing evidence base gathered by the state. As nations — LDCs and others — work together to ratify and fully implement the Paris Agreement, the diplomatic efforts of proactive countries like Ethiopia will remain fundamental to the effort.

Policy pointers:

  • effective engagement requires strong political will and leadership at the highest level — national leaders are uniquely placed to push climate to the top of the agenda
  • strong regional climate diplomacy is needed to forge common positions in broader international negotiations and integrate climate concerns into strategic development planning
  • ambitious planning and domestic targets give climate diplomats the moral high ground they need to successfully lobby their peers to make bigger commitments
  • generating evidence to support climate advocacy provides diplomats with a firmer foundation for influencing international negotiations | 13-Dec-2016 11:41

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case-control study

Background: Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.

Methods: A case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.

Results: Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.

Conclusion: Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria. | 21-Nov-2016 04:21

Self-reported acute pesticide intoxications in Ethiopia

Background. Pesticide exposure is an important public health concern in Ethiopia, but there is limited information on pesticide intoxications. Residents may have an increased risk of pesticide exposure through proximity of their homes to farms using pesticides. Also the pesticide exposure might be related to employment at these farms. This study investigated the prevalence of acute pesticide intoxications (API) by residence proximity to a nearby flower farm and assessed if intoxications were related to working in these farms or not.

Methods. A cross-sectional survey involving 516 persons was conducted. Participants were grouped according to their residence proximity from a large flower farm; living within 5 kilometers and 5–12 kilometers away, respectively. In a structured interview, participants were asked if they had health symptoms within 48 h of pesticide exposure in the past year. Those who had experienced this, and reported two or more typical pesticide intoxication symptoms, were considered as having had API. Chi-square and independent t-tests were used to compare categorical and continuous variables, respectively. Confounding variables were adjusted by using binomial regression model.

Results. The prevalence of API in the past year among the residents in the study area was 26 %, and it was higher in the population living close to the flower farm (42 %) compared to those living far away (11 %), prevalence ratio (PR) = 3.2, 95 % CI: 2.2-4.8, adjusted for age, gender & education. A subgroup living close to the farm & working there had significantly more API (56 %) than those living close & didn’t work there (16 %), adjusted PR = 3.0, 95 % CI: 1.8-4.9. Flower farm workers reported more API (56 %) than those not working in the flower farm (13 %,), adjusted PR = 4.0, 95 % CI: 2.9-5.6.

Conclusion. Our study indicates a 26 % prevalence of self-reported symptoms attributable to API. The residents living closer than 5 kilometers to the flower farm reported significantly higher prevalence of self-reported API than those living 5–12 kilometers away. This increased risk of API was associated with work at the flower farm. | 21-Nov-2016 03:57

Spatial variations in child undernutrition in Ethiopia: Implications for intervention strategies (PhD theses)

Background: Ethiopia is one of the countries with the highest burden of undernutrition, with rates of stunting and underweight as high as 40% and 25%, respectively. National efforts are underway for an accelerated reduction of undernutrition by the year 2030. However, for this to occur, understanding the spatial variations in the distribution of undernutrition on a varying geographic scale, and its determinants will contribute a quite a bit to enhance planning and implementing nutrition intervention programmes.

Objectives: The aim of this thesis was to evaluate the large- and small-scale spatial variations in the distribution of undernutrition indicators, the underlying processes and the factors responsible for the observed spatial variations.

Methods: We used nationally available climate and undernutrition data to evaluate the macro-scale spatial pattern of undernutrition and its determinants. We applied a panel study design, and evaluated the effect of growing seasonal rainfall and temperature variability on the macro-scale spatial variations (Paper I). We conducted a repeated cross- sectional survey to assess the performance of the Household Food Insecurity Access Scale (HFIAS) developed internationally to measure household food insecurity. The results from this validation work were used to modify the HFIAS items for subsequent papers (Papers III and IV). We conducted a census on six randomly selected kebeles to evaluate the spatial patterns of undernutrition on a smaller scale (Paper III). For Paper IV, we conducted a cross-sectional survey on a representative sample, and employed a Bayesian geo-statistical model to help identify the risk factors for stunting, thereby accounting for the spatial structure (spatial dependency) of the data.

Results: In Paper I, we demonstrated spatial variations in the distribution of stunting across administrative zones in the country, which could be explained in part by rainfall. However, the models poorly explained the variation in stunting within an administrative zone during the study period. We indicated that a single model for all agro-ecologic zones may not be appropriate. In Paper II, we showed that the internal consistency of the HFIAS' tools, as measured by Cronbach's alpha, was adequate. We observed a lack of reproducibility in HFIAS score among rural households. Therefore, we modified the HFAIS tool, and used it for subsequent surveys in this thesis (Papers III and IV). In Paper III, spatial clustering on a smaller scale (within a kebele) was found for wasting and severe wasting. Spatial clustering on a higher scale (inter-kebele) was found for stunting and severe stunting. Children found within the identified cluster were 1.5 times more at risk of stunting, and nearly five times more at risk of wasting, than children residing outside this cluster. In Paper IV, we found a significant spatial heterogeneity in the distribution of stunting in the district. Using both the local Anselin Moran's I (LISA) and the scan statistics, we identified statistically significant clusters of high value (hotspots) and a most likely significant cluster for stunting in the eastern part of the district. We found that the risk of stunting was higher among boys, children whose mother or guardian had no education and children who lived in a food-insecure household. We showed that including a spatial component (spatial structure of the data) into the Bayesian model improved the model fit compared with the model without this spatial component.

Conclusion: We demonstrated that stunting and wasting exhibited a spatial heterogeneity, both on a large and small scale, rather than being distributed randomly. We demonstrated that there is a tendency for undernourished cases (stunting and wasting) to occur near each other than to occur homogeneously. We demonstrated a micro-level spatial variation in risk and vulnerability to undernutrition in a district with a high burden of undernutrition. Identifying such areas where a population at risk lives is central in assisting a geographical targeting of intervention. We recommend further study, possibly using a trial design or implementation research approach, to help evaluate the feasibility and benefits of geographically targeting nutritional interventions. | 21-Nov-2016 03:37

How pro-poor are land rental markets in Ethiopia?

Land rental markets can potentially improve the access to land for land-poor households that possess complementary resources that can enable them to utilize land efficiently. Land rental markets can also enable landowners who are poor in non-land resources to rent out their land such that their land is utilized more efficiently and they themselves can get a better income and improved welfare from their land resource. This report assesses the land rental market that is dominated by a reverse tenancy system with relatively poorer landlords and less poor tenants. This market has largely developed informally in Ethiopia but has also been shaped by the changing land policies. We assess how pro-poor it is and whether interventions potentially can make it even more pro-poor and welfare enhancing or whether a “hands off” policy is preferable. If we can detect a significant market failure, there is room for intervention. However, there are also a number of current interventions in the market. We assess whether these achieve the intended outcomes or rather should be lifted or modified.

Population growth, economic growth, and structural transformation in agriculture may change the role of land from being the most important safety net and livelihood opportunity to become an important resource for agricultural transformation and development. The non-farm sector in Ethiopia has grown rapidly in recent years and provides new employment opportunities and this reduces the pressure on land as the only and main source of livelihood.

Our study of land rental markets in Ethiopia covers communities in Tigray, Oromia and SNNP regions focuses particularly on the period 2006 to 2012, but draws on data and research that goes back to 1998 in Tigray and utilizes information from landlords and tenants and other rural households with male and female representatives, local Land Administrative Committee (LAC) members and local conflict mediators with long experience in handling local land disputes.

In this report, we review the relevant literature and fill important gaps in this literature. These gaps include a) the stated reasons of landlords and tenants for partner choice and contract choice in the land rental market and their attitudes and preferences regarding regulation and formalization of land rental contracts; b) we investigate land access of youth in the land rental market; c) we assesses how joint certification of husbands and wives has affected participation in the land rental market; and d) how increasing population pressure and land scarcity affects land access and the land rental market over time. | 15-Nov-2016 03:21

Street based self-employment: a poverty trap or a stepping stone for migrant youth in Africa?

A significant percentage of youth in urban Africa is employed in the informal sector. The informal sector is more accessible than the formal sector for people with low human andfinancial capital, such as youth migrants from rural areas. But the sector is also generally considered to provide a subsistence livelihood. This study examines whether street based selfemployment in Africa offer a stepping stone towards a better livelihood or an urban poverty trap for youth migrants. The analysis is based on data from a survey of 445 street vendors in two urban areas in Ethiopia. We found that street based self-employment is indeed dominated by migrant youth; 96% of those engaged in the street based self-employment are youth and 98% are migrants from rural areas or smaller towns. Our analysis suggests that street based selfemployment can offer a viable transitional employment for migrant youth. We found that the average monthly earning of these self-employed youth is better than the minimum wage in the public sector and much higher than the official poverty line. We found that most of the youth consider this as a transitional employment and accumulate skill and capital with a view to establishing their own enterprise or accessing skilled employment. Young women are less likely than young men to seek exit out of street based self-employment but education increases their aspiration. Youth with better-off parents back home and those with larger network in their new residence are more likely to change their current occupation. The main risk for the livelihood of youth in this type of employment is lack of legal recognition to their activities and work place, which manifest itself in the form of arbitrary eviction and displacement from their work place. | 15-Nov-2016 02:57

Youth as environmental custodians: a potential tragedy or a sustainable business and livelihood model?

Youth unemployment and migration is a growing challenge that needs more political attention in many countries in the world, particularly countries with rapid population growth and economic transformation. Proactively mobilizing the youth as a resource in the creation of sustainable livelihoods can potentially be a win-win-win solution that Ethiopia is currently attempting with its new youth employment strategy and high ambitions to transform the country’s economy into a Green Economy. If it succeeds, it can set an example for other countries in the world to follow. This paper gives and overview of the youth program and the basic ideas and challenges. | 15-Nov-2016 02:42

Links between tenure security and food security in poor agrarian economies: causal linkages and policy implications

Population growth leads to growing land scarcity and landlessness in poor agrarian economies. Many of these also face severe climate risks that may increase in the future. Tenure security is important for food security in such countries and at the same time threatened by social instability that further accelerate rural-urban and international migration. Provision of secure property rights with low-cost methods that create investment incentives can lead to land use intensification and improved food security. Pro-active policies that engage youth in establishment of sustainable livelihoods hold promise. Social and political stability are essential for tenure security and food security. | 08-Nov-2016 04:49

Meeting the need, fulfilling the promise: youth and long-acting reversible contraceptives
The highest proportion of young people today - 89 percent - live in developing countries. In some sub-Saharan African countries, where fertility remains high, we can expect growing cohorts of children and youth, unless fertility needs can be met. Addressing the sexual and reproductive health of this large youth population is critical to support their universal right to health-including access to contraception-and to contribute to efforts to expand education, provide meaningful employment, and reduce poverty.
Fortunately, the importance of providing reproductive health information and services to youth is gaining worldwide attention. In 2015 the Global Consensus Statement on youth and long-acting reversible contraceptives (LARCs) was launched and more than 50 influential organizations and governments have signed on. The Consensus Statement says that ensuring young people’s access to LARCs will help to prevent unintended pregnancies, reduce maternal and infant morbidity and mortality, decrease unsafe abortions, and ensure full and informed contraceptive choice for youth.
This brief discusses the advantages and challenges of providing LARCs - specifically contraceptive implants and intrauterine devices (IUDs) - to youth, and provides case studies from Ethiopia and Madagascar. It also outlines actions for policymakers and donors to make youth access to LARCs a reality. | 04-Oct-2016 12:07

Environmental issues in Ethiopia and links to the Ethiopian economy
Ethiopia has a high-level strategy to pursue agriculture-based industrialisation with a goal of achieving middle income country status by 2025 with no net increase in carbon emissions. As an economy currently heavily dependent on agriculture and forest resources, and with a historical legacy of widespread, severe environmental degradation, environmental issues are a significant obstacle to the successful achievement of this goal. The historical and ongoing destruction and degradation of the soil and forest resources on which this development strategy depends represents a major policy and practical challenge. With the exception of climate change, the major environmental issues affecting Ethiopia are soil erosion and land degradation, deforestation and forest degradation, water scarcity, biodiversity loss, and various types of pollution. Whilst environmental issues are often considered separately, they are closely interlinked and studies increasingly attempt to consider them in an integrated manner, challenging as this is for researchers.
Analysis of the research literature demonstrates unequivocally that environmental degradation is widespread and severe in Ethiopia. In particular, the impacts of agriculture and deforestation - especially on soils - have been severe and increase the vulnerability of many people to food and water insecurity. A range of other environmental issues also present significant - and in many cases increasing - challenges for policy and management. These issues, their links to the Ethiopian economy, and their implications for economic growth, are the subject of this rapid, desk-based study. | 29-Sep-2016 11:38

Balancing school and work with new opportunities: changes in children’s gendered time use in Ethiopia (2006-2013)
Focusing on the relationship between children’s work and school attendance, this paper explores time use trends among boys and girls in Ethiopia. It does this by comparing the time use of two cohorts of children at the same age, 12 years, but interviewed at two different points in time, 2006 and 2013.

In assessing the pattern over this period the authors have taken four contributory factors into account; gendered norms and aspirations for children’s futures; local opportunities for both schooling and work; the characteristics of schools and different kinds of work; and intra-household dynamics.

Broad trends are identified through survey data and case studies of two rural communities that have experienced rapid economic and social transformation, with associated increases in gendered opportunities for work. 

The paper finds that overall there is a small reduction in the hours worked by 12-year-olds over the seven years.
However, this trend is mainly in urban areas. Rural boys are found to have increased their working hours. By examining two case-study communities that have experienced increasing economic development and gendered work opportunities the research finds that, contrary to expectations, the increased returns to work have lowered boys’ education aspirations and increased their school drop-out rates relative to girls’. | 29-Sep-2016 10:04

Between hope and a hard place: boys and young men negotiating gender, poverty and social worth in Ethiopia

In recent years, there has been an increasing focus on adolescence as a key transition to adulthood. Young people are navigating puberty and making life choices around schooling, work, and intimate and family relationships. However, much of the attention has been on girls. This has led to a lack of gendered analysis and has also meant that adolescent boys have been largely left out of the picture.

This paper uses Young Lives research in Ethiopia, carried out over multiple years, to look at boys and young men’s lives, their aspirations, and the obstacles they face as they grow into adults. It examines the diverse strategies they employ to overcome these challenges, and compares their experiences with those of girls and young women of the same age.

  • Education is seen by both parents and children as a route out of poverty.  95 per cent of Young Lives boys and girls were enrolled in school at the age of 12. By age 19, there was a growing ambivalence regarding education, particularly for young men who increasingly oriented their aspirations towards the world of work.
  • Rural/urban contrasts: Young people growing up in rural areas are often seen as having fewer life chances than those in towns. But the least optimistic young men were located in urban areas where they felt disconnected from development opportunities.
  • Livelihoods: Many of the young men had left school and were trying to find work, both as a response to poverty and a vital source of respect in the community. But because they found so few opportunities for gainful employment, some of them were left feeling stuck and hopeless.
  • Marriage Girls: see marriage as one way of improving their lives. But for young men, marriage was impossible until they had adequately paid work, and was therefore a way of entering into adulthood that they could not imagine in the near future.

The paper concludes by drawing out the policy implications of our findings. It calls for stronger gendered evidence on the relationship between gender inequality and childhood poverty, and an approach to gender justice that include boys and young men, as well as girls and young women, so that none are left trapped between hope and a hard place.

[Summary from Younf Lives] | 29-Sep-2016 09:58

Norway’s role in supporting green growth in developing countries

This report discusses green growth in developing countries, and Norway's role supporting such a green development strategy. After defining green growth in the context of developing countries, the report discusses indicators of green growth, barriers, and prominent instruments to facilitate green growth. Two case studies are presented, the first on green bonds in Ethiopia, and the second on introducing a green growth credit mechanism. The report concludes with some general findings, and findings linked to the two case studies. | 20-Sep-2016 02:57

Becoming a climate-resilient green economy: planning for climate compatible development in Ethiopia
Ethiopia has emerged as one of Africa’s champions in responding to the implications of climate change. This is demonstrated by the strong commitment shown by the country’s political leadership on the issues. Much of this commitment has been driven by the impacts of climatic events in Ethiopia, mainly the drought episodes that have hit the country since the early 1970s. These experiences have contributed to the widespread understanding that climate change can have severe consequences, and has the potential to hold back economic progress and reverse the gains made in Ethiopia’s development.
This Working Paper documents Ethiopia’s lessons from the study ‘Lesson learning from national climate compatible development planning’, which aimed to capture and share institutional experiences of climate compatible development, and provide recommendations for the future. Kenya, Mozambique and Rwanda also participated.
Conclusions and lessons learned:

Establishing a climate-resilient green economy is a nationally owned process and a priority for Ethiopia. It is being driven domestically, with substantive investments – being made from national budgets, international climate finance, and multilateral and bilateral partners. As a result, there are several large-scale initiatives underway in a range of priority sectors, which will bring about substantial climate-resilience and low-carbon benefits.

Other decision-makers and development practitioners can learn from the Ethiopian experience, which includes the following lessons:
  • financing from international climate funds should be available to countries that pursue a holistic, ambitious and nationally driven development agenda that includes climate-related goals, such as zero growth in net carbon emissions or enhancing the adaptive capacity of communities. The opportunities presented by international climate funds set the tempo for Ethiopia to realign its strategic thinking in order to attract this financing for climate compatible development
  • engagement by political champions enhances the development and implementation of the governance and institutional arrangements, strategies and frameworks needed for climate compatible development
  • robust governance and institutional structures form a strong basis for establishing effective cross-government working relations. These are important for the development and implementation of climate compatible development interventions, which are inherently cross-cutting in nature
  • collaboration between the ministries responsible for finance and the environment creates a solid platform for the coordinated implementation and mainstreaming of climate compatible development into national development plans
  • commitment, ownership, nationally driven investments and the demonstration of results on the ground are critical for unlocking additional finance to implement climate compatible development programmes and projects
  • in planning and mainstreaming climate compatible development, decision-makers should give consideration to long-term technical and institutional capacity development, particularly in terms of the ongoing need to prepare fundable project and programme proposals and subsequently to implement these | 08-Aug-2016 05:22

Public spending on climate change in Africa: Experiences from Ethiopia, Ghana, Tanzania and Uganda

Public spending on climate change in Africa describes the extent to which public expenditure responds to national climate change policy and the institutional demands required to implement such policy. The four countries of the study: “ Ethiopia, Ghana, Tanzania and Uganda provide insights into the early mobilisation of climate change finance, as each country attempts to address the new challenges that climate change is bringing about. The report is divided into three parts. The first part introduces the concept of climate change finance and outlines the effectiveness framework used in each of the country studies. The methodological challenges associated with public expenditure reviews as applied to national climate change actions are also described. The second part provides in-depth country accounts for Ethiopia, Ghana, Tanzania and Uganda, on the level and nature of climate change-relevant public spending, set in the context of each country’s macroeconomic and public finance management systems. The final section concludes by drawing lessons for climate change policy development, institutional strengthening, local delivery of climate change finance and the monitoring of public finance, based on the insights gained from the country studies. | 27-Jun-2016 05:48

Gender matters: overcoming gender-related barriers to prevent new HIV infections among children and keep their mothers alive

Studies indicate that harmful gender norms and practices, cultural perceptions and beliefs surrounding pregnancy and childbirth, and a distrust of health-care services all can pose barriers to HIV prevention and treatment. In particular, women face difficulties related to unequal gender power relations and stigma.

This Joint United Nations Programme on HIV/AIDS (UNAIDS) document presents evidence that timely and continued access to antiretroviral medicines would reduce new infections in children and give HIV-infected women access to HIV treatment and care for their own health and well-being. Because 1) women's lack of autonomy, 2) mistrust of health services, particularly due to a lack of cultural sensitivity and confidentiality among health-service providers, and 3) fear of stigma and related abuse can affect women's access to treatment, key gender-related barriers stand in the way of preventing new HIV infections among children and keeping their mothers alive.

The following recommendations, based upon discussions in Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Uganda, are proposed to overcome gender-related and cultural barriers to services.

  • address stigma and discrimination against women living with HIV to increase utilization of and adherence to services", by, for example, building awareness and sensitivity in communities, including through the use of local media and local language(s), and engaging community leaders at all levels, including religious leaders, in dialogue on stigma
  • address violence against women as part of programmes to prevent new HIV infections among children and keep mothers alive and healthy", by integrating services for survivors of violence in all health-care settings and training health services to work in a non-judgmental manner with the complexities around violence against women and the underlying gender inequalities, using confidentiality and promoting the right to respect
  • support transformation of traditional gender roles related to maternal health, providing correct information on HIV by using culturally-appropriate, gender-sensitive and rights-based approaches" by, for example, creating opportunities for voluntary attendance, counselling, and testing for couples
  • address lack of awareness and mistrust of existing services to prevent new HIV infections among children and keep mothers alive and healthy", by, for example, reaching communities, beyond individual clients and healthcare providers, as part of "decentralized approaches and awareness campaigns. For consistency in messaging and the effective use of expertise, both women living with HIV and traditional birth attendants must be engaged in community mobilization efforts | 24-Jun-2016 14:30

Access, Services and Knowledge (ASK) Programme - essential packages manual

The Essential Packages Manual was produced as part of the "Access, Services and Knowledge" (ASK) programme of the Youth Empowerment Alliance, which seeks to improve the sexual and reproductive health rights (SRHR) of young people (15-24 years) by increasing their uptake of SRH services in Kenya, Uganda, Ethiopia, Ghana, Senegal, Pakistan, and Indonesia.

The manual is designed to help partners understand the main concepts, principles, and values of the ASK programme, and provides information and practical tools designed to assist partners to reach programme objectives. This includes information about SRHR and related services for young people, as well as guidance in creating an enabling environment and integrating SRHR, HIV/AIDS, and meaningful youth participation into programming.

The publication includes tools for self-assessment to help identify partners’ own progress and areas requiring support. It also includes roadmaps with practical steps to move towards desired project results, and outlines available tools, guidelines, protocols, and standards.

The manual includes the following contents, organised around key result areas:

  • Values and Principles
  • Result area 1: Direct SRHR information for young people
  • Result area 2 & 3: SRH services for young people
  • Result area 4: Creating an enabling environment
  • Cross-Cutting Strategies: Integrating SRHR and HIV, meaningful youth participation
The manual is available to download in PDF format in English, French and Bahasa. | 23-Jun-2016 13:53

Empowering each other: young people who sell sex in Ethiopia

This 12-page case study discusses the experience of a peer education project in Ethiopia, which trained young people who sell sex to reach out to their peers and lead sexual and reproductive health and rights sessions, supported by trained nurses and a referral system for services. The project was led by the Organisation for Support Services for AIDS (OSSA) as part of Link Up, a five-country programme working to improve the sexual and reproductive health and rights (SRHR) of one million young people most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda. The Ethiopian initiative was created to fill both knowledge and service gaps to ensure that young people who sell sex have access to both adequate information and services about their SRHR in order to stay healthy.

The case study outlines a number of challenges faced by the peer educators and nurse counsellors. This includes group dynamics in which some groups did not bond and in other cases group members did not always respect their peer educator. Group members also sometimes requested additional refreshments (beyond the coffee and bread already provided) to come to sessions. In addition, the priorities of young people who sell sex are often not SRHR-related, but rather the need to provide housing, food, and clothing for themselves and their families, plus the need to attend school or start a business.

The case study offers a number of lessons learned:

  • Role of peer educators -“ Peer educators speak the same language as their peers, are good at facilitating conversation, can answer questions clearly, and talk openly about sensitive issues. They play an important role in identifying session participants as well as setting appropriate times and locations for sessions. They are often seen as role models by their peers"
  • Role of nurse counsellors - "The nurse counsellors are critical to this intervention. They provide peer educators with support, enhance their knowledge and instil confidence in them. Nurse counsellors provide a critical service by assisting young people who sell sex to health facilities"
  • Locations and times of peer education sessions - “It is important to hold sessions at times convenient to, and agreed by, group members otherwise this may become a barrier to participation"
  • SRHR and HIV must be integrated - “During the project, a significant number of young people who sell sex reported experiences of unplanned pregnancy and STIs as well as living with HIV. These stories remind us of the importance of integrating SRHR and HIV information and services. This means addressing a range of SRHR and HIV issues in the peer education sessions and ensuring that information, education and communication materials speak about dual protection and the use of condoms for protecting against both pregnancy and HIV and other STIs. It also means ensuring young people who sell sex know they can access a range of services at health facilities"
  • Recognising the priorities of young people who sell sex - “It is important to recognise that young people who sell sex may share a range of experiences and needs during peer education sessions including the need for housing, food, employment opportunities and education plus psychosocial support to respond to violence, stigma, discrimination and other issues"
  • Promoting good experiences - "When young people who sell sex have experienced sensitised and supportive health providers, it is useful to encourage them to share their experience with their peers in order to dispel the fears others may have around accessing care in health facilities and as a way to respond to questions about which services” | 23-Jun-2016 13:31

Building the assets to thrive: addressing the HIV-related vulnerabilities of adolescent girls in Ethiopia

When HIV prevention programs are shaped by evidence and designed for replication and scale-up, they can reach large numbers of the girls and young women at greatest risk and increase their ability to avoid infection.

In Eastern and Southern Africa, HIV is the leading cause of death among girls aged 15–19. Despite decades of investment and substantial progress against HIV, adolescent girls remain at disproportionate risk of infection.

Few programs have sought to take a “whole girl” approach to addressing the multiple vulnerabilities to HIV infection—social isolation, economic insecurity, lack of access to services, and sexual and gender-based violence—experienced by the most marginalized adolescent girls in the poorest communities in Africa.

Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia is a comprehensive review of three programs implemented and evaluated by the Population Council and the Ethiopian government beginning in 2007: Biruh Tesfa, Meseret Hiwott, and Addis Birhan. These
programs seek to reduce Ethiopian girls’ HIV risk by using similar methods to engage girls—and, in the case of one program, the males who play a role in their health and well-being.

This policy brief summarizes Building the Assets to Thrive to provide policymakers and program planners with a road map for creating and supporting evidence-based, locally responsive, simple, effective, scalable, and sustainable programs that produce positive outcomes for girls and their communities. | 23-Jun-2016 04:51

Status report on nationally appropriate mitigation actions (NAMAs) 2016

Nationally Appropriate Mitigation Actions (NAMAs) have continued to show steady growth in proposals over the past six months, while financing remains limited and implementation lags behind. This is one of the findings of the NAMA Status Report mid-year update which has been launched at the Bonn UN Climate Conference.

The update, written by Ecofys and ECN under the Mitigation Momentum project, takes a look at the role of NAMAs in light of the Paris Agreement, provides a snapshot of the current state of play and includes opinion pieces from government representatives of countries in Africa, Asia, and South America on NAMAs in the new climate landscape. While they state that NAMA development will continue after Paris, some new challenges for NAMAs are also associated with the Paris Agreement. 

The Mitigation Momentum project is part of the International Climate Initiative by the German Ministry for the Environment, Nature Conservation, Building and Nuclear Safety. | 24-May-2016 07:04

Ethiopians’ views of democratic government: fear, ignorance, or unique understanding of democracy?

Five rounds of Afrobarometer surveys in up to 35 African countries show that ordinary African citizens tend to reach the same conclusions about the extent of democracy in their country as international expert rating systems. But the 2013 survey in Ethiopia produces a puzzling anomaly: While no expert assessment comes close to calling Ethiopia a democracy, 81% of Ethiopians consider their country either a complete democracy or a democracy with only minor problems. The best explanation for this anomaly is Ethiopians’ highly positive assessment of political and economic developments in their country. However, these opinions are marked by a syndrome of “uncritical citizenship” and a distinctively instrumental and paternalistic understanding of “democracy.”

Other contributing factors include the country’s low level of development, especially with respect to education and communications; its long-standing one-party dominance and low levels of political freedom; and significant political fear and suspicion of the interview environment. Because of the idiosyncratic way in which Ethiopians understand democracy, extreme caution must be exercised in attempting to compare any responses to democracy questions from Ethiopia with those from other African countries. Analysts are advised to use the Ethiopia data set only in a stand-alone setting or to limit their comparative analysis to items that do not use the “d-word.” | 17-May-2016 14:45

Do dreams come true? Aspirations and educational attainments of Ethiopian boys and girls

Most economic decisions that individuals take are forward-looking and are therefore shaped by the desire or ambition to achieve a goal. And yet, little is known about how aspirations shape decision-making. This paper partially addresses this gap using a rich longitudinal dataset following a cohort of children in Ethiopia for over a decade between the age of 8 and 19. We investigate the role of early aspirations for human capital investments in a context of poverty, traditional social expectations and gender roles. More specifically, the focus is on three related questions. First, the author investigates the relation between aspirations and boys’ and girls’ educational attainment, as an indicator of cumulative investments in education. Second, the paper look at how parents and children form their aspirations and at the transmission of aspirations from one generation to the other. Third, the paper explores the gender-based bias in aspirations and we investigate whether an initial pro-boys aspiration bias might constitute a source of gender inequality perpetuation particularly in a context of extreme poverty.

The author finds that:

  • aspirations have a strong predictive power for later educational attainment particularly for boys, who are more likely to drop out of school after the age of 15
  • there is a substantial gender gap in aspirations and steep gradient in aspirations across wealth
  • parents ground their aspirations on the expectations they have about their children’s future when they are 12 years old
  • children’s aspirations mirror parental aspirations
  • initial low aspirations might be a mechanism of perpetration of gender inequality among the poorest segment of the population
  • parents and children revise their aspirations over time adapting to external circumstance and social expectations, so that after the age of 15 the pro-boys gender bias in aspirations is reverted. | 22-Apr-2016 06:26

China and Brazil in African Agriculture: World Development Special Issue | Vol 81, Pgs 1-92, (May 2016)

Open Access Special Issue of World Development based on work on the changing role of China and Brazil in Africa’s agriculture from China and Brazil in African Agriculture’ project  of the Future Agricultures Consortium (FAC).

Articles include:

  • A new politics of development cooperation? Chinese and Brazilian engagements in African agriculture
  • South-South cooperation, agribusiness and African agricultural development: Brazil and China in Ghana and Mozambique
  • Chinese state capitalism? Rethinking the role of the state and business in Chinese development cooperation in Africa
  • Imagining agricultural development in South-South Cooperation: the contestation and transformation of ProSAVANA Lídia Cabral, Arilson Favareto, Langton Mukwereza and Kojo Amanor
  • Brazil’s agricultural politics in Africa: More Food International and the disputed meanings of ‘family farming’
  • Chinese migrants in Africa: Facts and fictions from the agri-food sector in Ethiopia and Ghana
  • Chinese agricultural training courses for African officials: between power and partnerships
  • Science, technology and the politics of knowledge: the case of China’s Agricultural Technology Demonstration Centres in Africa | 08-Apr-2016 13:31

Chinese migrants in Africa: facts and fictions from the agri-food sector in Ethiopia and Ghana

The role of Chinese migrants in Africa—when viewed from the perspective of the agri-food sector—is poorly researched and understood. A micro-level view suggests, however, that it does not fit neatly into Western media stereotypes (land grabbing, empire building) or Chinese government discourses (South–South cooperation and technology transfer). This is not a state-driven phenomenon, but rather a story of individuals.

This paper makes an empirical and ethnographic contribution to the literature on Chinese migrants in Africa by using five case studies to explore their role in the agri-food sector in Ethiopia and Ghana. The authors find that the realities of Chinese migrants in this sector matches neither popular media stereotypes of empire building and land grabbing, nor Chinese government narratives of South–South cooperation, technology transfer, and agricultural development. Far from being a “silent army” promoting larger Chinese state objectives, they operate independently and serve no agenda other than their own. Many migrants have little if any contact with the Chinese Embassy or other official Chinese presence in Africa. While none of the informants have received support from the Chinese government, they are nonetheless affected by government regulatory frameworks in African countries and their activities are shaped accordingly.

The regulatory policy environment is very different in the two countries, and this has implications for the livelihood strategies of Chinese migrants. While the impacts of their presence on local development are modest overall, these impacts do appear to be positive in the sense that they are creating economic opportunities, both for themselves and for local people. | 08-Apr-2016 11:55

Rapid fragility and migration assessment for Ethiopia

This report is based on 24 days of desk-based research and provides a short synthesis of the literature on fragility and migration in relation to Ethiopia.

It is difficult to obtain an accurate picture of the migration situation in Ethiopia today. Limitations with the migration data include the use of varying definitions for different categories of migrants, and the lack of documentation of irregular migration.

This rapid review has found a fairly large development practitioner and academic literature on the sources of fragility in Ethiopia. While migration statistics are unreliable, there is reasonably credible information about the routes and migrant profiles. This literature is more focused on those travelling to the Middle East, with a strong focus on young women in a number of reports. As much of the migration is irregular, this presents challenges for documentation.

Key evidence gaps include :

  • up to date information on migrant profiles, motivations and routes, taking into account the impact of the new global migration context (most survey data is from 2011 – 2013)
  • migrant journeys along the north/west and south routes
  • information on internal displacement
  • the impact of hos ting a l arge refugee population
  • the role development aid has played in relation to migration pressures | 07-Apr-2016 10:56

Women’s economic empowerment and care: evidence for influencing

Care responsibilities is being increasingly identified as a factor restricting women’s empowerment outcomes, yet there is limited evidence on determinants of long hours or gender inequality in care work. To gain a clearer understanding of care work and pathways of change to promote more equitable care provision, Oxfam conducted a Household Care Survey in communities of rural Colombia, Ethiopia, the Philippines, Uganda and Zimbabwe.

Results highlight that gender inequality exists in all measures of care work, with women and girls doing significantly more primary and secondary care activities, and supervision of dependants, than men and boys. Key findings are presented in time use and work hours, and determinants of patterns of care work. In all countries, the research found that women have longer total hours of work than men, men spend more time on paid work than women, and women have longer hours of care work. The determinants of care are context-specific. Education and relative household wealth are less relevant as determinants of length, intensity or inequality in care hours than might be expected. Women’s paid/productive activities and access to labour-saving stoves and improved water systems are sometimes associated with decreases in women’s hours of care work. 

Adapted from authors’ summary. | 21-Mar-2016 14:26

Energy dialogues in Africa: is the Grand Ethiopian Renaissance Dam transforming Ethiopia’s regional role?

Major hydropower projects, such as the Grand Ethiopian Renaissance Dam (GERD) in Ethiopia, invite enquiry into the potential to increase the generation, transmission and distribution of power, how best to finance these infrastructures and how to balance them with the call for a sustainable development approach. Analyses of these projects make little reference, however, to the potential for interregional co-operation that goes beyond the construction of the dam and a focus on power pooling.

Concentrating on the GERD, this paper identifies several challenges to energy co-operation between Ethiopia and regional stakeholders. It argues that Ethiopia’s ownership of the GERD, the recent trade agreement between SADC, the Common Market for Eastern and Southern Africa and the East African Community, and growing interest in regional power pooling have created a timely opportunity for greater energy co-operation. Such cooperation will be sustained by an increase in power supply in these regions, but also by shifting national perspectives on regional prospects. | 18-Mar-2016 15:54

Promotion of micro and small scale enterprises sector and improvement of Addis Ababa city transportation system

2011 KSP with Ethiopia was initiated in November 2010 when the Ministry of Finance and Economic Development (MOFED) of the Government of the Federal Democratic Republic of Ethiopia (GOE) submitted a written Demand Survey Form. The form was officially channeled through the Embassy of the Republic of Korea in the Federal Democratic Republic of Ethiopia and the Ministry of Strategy and Finance (MOSF). The requested topics were: (1) Capacity Building on Economic Policy and Economic Crisis Management; (2) Improving of Addis Ababa City Transportation Facilities; and (3) Transforming of Micro and Small Scale Industries into Exportable Industries.

Based on the topics submitted by the partner country, the MOSF and the Korea Development Institute (KDI) reviewed the form to judge if the topic would be suitable within the scope of Korea’s necessary expertise and experiences for sharing with Ethiopia, and decided to carry out the topic under the KSP (the “project”). MOSF and KDI pre-screened out transforming selected micro and small scale industries into exportable industries and improving Addis Ababa City transportation system project ideas to be addressed in the 2011 KSP. Korea Expert Consulting Group (KECG) was selected and requested to undertake the project in view of its expertise and consulting capacity. | 11-Mar-2016 13:43

Sustainable cities: local solutions in the global south

As the combined problems of urbanization, environmental degradation, and poverty become increasingly urgent, understanding the links between sustainability and poverty reduction is imperative. A sustainable urban future for all requires raising the quality of life of the most vulnerable.

Existing at the margins of urban life, low-income residents of cities in the global South are subject to numerous environmental burdens and are too often excluded from mainstream development and planning. In the face of these challenges, communities have proven to be remarkably resilient and innovative, with tremendous potential both to improve the quality of their own habitat and to contribute to the development of healthy and productive cities. The research presented in this book attempts to show how this potential can be harnessed, by showcasing sustainable solutions developed by the urban poor themselves.

The book’s case studies were conducted in the growing urban and peri-urban areas of Peru, Senegal, Bangladesh, Ethiopia, the Philippines, Thailand, and the Democratic Republic of Congo. They outline concrete strategies for sustainable urban living and design, developed in partnership with low-income city dwellers. The book offers insights into both theory and practice, which will be useful and inspiring to students, researchers, development practitioners, and policymakers alike. | 10-Mar-2016 16:39

Strategy for the implementation of e-Government and the development and promotion of the leather and footwear industry of Ethiopia

The 2012 Knowledge Sharing Program (KSP) with Ethiopia was conducted by the Korea Development Institute (KDI), supervising agency of the project, which had prepared for the project in 2011.

The focus of the 2012 KSP with Ethiopia was diverted into two directions, as covered by this report:

  • establishment of strategy for the introduction of e-Government and ICT technology in the field of public service
  • policy advice for the main stream trend of R&D in the leather/footwear industry. | 07-Mar-2016 13:20

El Niño in Ethiopia: Programme observations on the impact of the Ethiopia drought and recommendations for action

Ethiopia is in the middle of one of the worst droughts for 50 years according to the December 2015 FEWS report, a drought which has left many poor and vulnerable families with nothing

As a result Ethiopia is facing a massive food insecurity crisis. The impact of failed rains and droughts have been worsened by the 2015 El Niño, which itself has been supercharged by climate change. Urgent humanitarian action is needed to support millions of people who have lost food, water and livelihoods. And long-term investment is needed so that communities can become more resilient and reduce their vulnerability to weather events in the future.

[adapted from source] | 25-Feb-2016 15:00

Enhancing urban resilience: Addis Ababa, Ethiopia

Addis Ababa is urbanizing and growing at a rapid pace. The city faces potential shocks and stresses that could hinder it from achieving its development goals. These include urban flooding, fire, earthquakes, rapid urbanization, water scarcity, unemployment, and social vulnerability.

In February 2015, Addis Ababa invited a team of specialists from the World Bank Group to implement the CityStrength Diagnostic in close collaboration with local officials, technical staff, and stakeholders.

The objective of this publication is to share the findings of the diagnostic and the priority actions and investments agreed with local leaders. Designed to be accessible to a broad audience, this publication presents the most relevant and actionable information that emerged from the diagnostic process.

Although the implementation of CityStrength in Addis Ababa leveraged a substantial collection of studies, research, and plans prepared by multiple development partners, this publication does not go into detail on each. Where applicable, those studies are highlighted within this text and readers are invited to seek out the original files for more in-depth information (see Resources on Addis Ababa at the end of this publication).

CityStrength is an interview-based methodology; as such, a significant portion of the findings captured in this publication are based on statements made by local officials, experts, and stakeholders during the launch workshop, individual and group interviews, and field visits.

[adapted from source] | 24-Feb-2016 15:17

Industrial policy in Ethiopia

This report assesses industrial policy in Ethiopia. Industrial policy is a contested issue, especially for low-income countries. Proactive policies are required to make the transition from low-productivity resourced-based societies with large informal sectors to more productive, knowledge-based and formalised patterns of productive organisation. However, channelling resources into preferential activities may reduce allocative efficiency. This can create perverse incentives for stakeholders including investors and bureaucrats. This problem is exacerbated in low income settings, where political checks and balances may be weak.

The Ethiopian government has created the preconditions for a market-based and socially inclusive industrial transformation. It has demonstrated commitment to investing in technological learning in order to build new competitive advantages through programmes to strengthen the technical and vocational education system. Universities and specialised supporting institutions have been established. Diversification and industrial development are the objectives. Agricultural demand-led industrialisation and export promotion are central in its strategy. For the last ten years, the Ethiopian economy has grown at 11 per cent annually, mainly due to favourable agro-climatic conditions, high coffee prices, considerable inflows of aid and remittances, and a boom in construction. However, the economic structure has not changed much and competitiveness has not increased. This study focuses on the policymaking process in the leather/leather products and the cut flower industries. | 08-Feb-2016 13:19

Negotiating new relationships: how the Ethiopian state is involving China and Brazil in agriculture and rural development

This article provides an overview of Brazilian and Chinese agricultural development cooperation activities in Ethiopia.

In the context of a highly aid-dependent country, the Government of Ethiopia (GoE) has developed an effective way of balancing donor inputs, both regionally and sectorally. Development cooperation is carefully managed and coordinated, in line with the national 'growth and transformation plan'. The government promotes harmonisation and an alignment process of western donor support through the Ethiopian High Level Forum, with five subsidiary sector-specific working groups.

Brazil and China are currently not engaged in these coordination platforms working instead on a bilateral basis. Core activities include experience sharing in public governance, technical cooperation, and the attraction of private and public investments. In the case of Brazil, the cooperation focuses on renewable energy sector development mainly related to biofuels derived from sugarcane production, whilst in the case of China, cooperation is more focused on infrastructure, agricultural technology and skill transfer. The approach adopted by Ethiopia reflects a commitment to a 'developmental state' approach. This seems to be delivering results in the agricultural sector, and beyond. | 05-Feb-2016 14:03

'One hand can't clap by itself': Engagement of boys and men in KMG's intervention to eliminate FGM-C in Kembatta zone, Ethiopia, EMERGE Story of Change 3

This story of change pulls out the key findings and messages from EMERGE case study 3, which focuses on the work of Kembatti Mentti Gezzimma (KMG) in Kembatta Zone, Ethiopia. KMG works with men, boys, women and girls as part of its efforts to eliminate female genital mutilation-cutting. | 03-Feb-2016 17:28

Reforming higher education: access, equity, and financing in Botswana, Ethiopia, Kenya, South Africa, and Tunisia

This chapter in the 2011 Africa Competitiveness Report analyses systems of higher education in Africa using five African countries— Botswana, Ethiopia, Kenya, South Africa, and Tunisia— as case studies. Specifically, the chapter analyzes current enrolment 
trends, accessibility and equity, governance, quality and relevance, financing, university-industry linkages (UILs),
and entrepreneurship education in tertiary education curricula. The idea is to look at what works well and
 what does not, to consider what challenges need to be confronted, and to discuss lessons learned and the way
forward for reforming tertiary education in Africa.

The chapter argues that the major challenges identified as facing tertiary education in African countries are how to expand access and at the same time improve quality and relevance, how to make it more equitable, and how to provide adequate financial resources. Overcoming these challenges will involve a massive expansion and restructuring of tertiary educational systems in particular, and education generally. Based on the evidence from the five countries, this should be based on three pillars: quantity and equity, quality and relevance, and financing. | 01-Feb-2016 14:27

Chronic poverty in rural Ethiopia through the lens of life histories

Studying chronic poverty using retrospective qualitative data (life histories) in conjunction with longitudinal panel data is now widely recognised to provide deeper and more reliable insights (Davis and Baulch, 2009).

This paper uses three rounds of panel data and life histories collected by Young Lives, a longitudinal study of childhood poverty, to identify factors that contribute to households becoming or remaining poor in rural Ethiopia, with related effects on the children within those households. It combines a case-centred and a variable-centred approach (Ragin, 1987), analysing and comparing the experiences of individual households on the basis of qualitative and quantitative techniques and interrogating these findings by looking at attributes of households (variables) across a larger sample. The substantive findings on poverty ‘drivers’ and ‘maintainers’ (Baulch, 2011) support those of previous studies: rainfall, illness, debt, exclusion from the main form of social protection. But by mixing different types of data and analysis, the paper was able to show that combinations of factors rather than single events drive households into poverty, and that household characteristics can play an important factor.

The primary contribution of the paper is methodological as it presents a novel method of using life histories to investigate chronic poverty in rural Ethiopia by generating or testing hypotheses/findings on poverty drivers and maintainers. . | 26-Jan-2016 12:52

“We are dying while giving life”: Gender and the role of Health Extension Workers in rural Ethiopia
The health sector is a key priority sector for addressing women’s needs and priorities in Ethiopia. Under the Health Sector Development Program (HSDP), the Health Extension Program (HEP) aims to improve equitable access to essential health services through neighborhood (kebele) based services with a strong focus on sustained preventive health actions and increased health awareness. The HEP includes 16 health intervention packages that are delivered by two government-salaried Health Extension Workers (HEWs) who are assigned to each rural kebele of around 5,000 people. HEWs spend much of their time on community outreach programs to households, especially to mothers and children. Women are selected for the HEW role because of their key role in improving the health of mothers and newborns at the community level.

Within this document, the authors wanted to understand gender dimensions of the HEWs’ role and experiences of serving in that role in the HEP; issues of HEWs’ performance and satisfaction; and to identify possible gaps and come up with recommendations for improvement. They specifically wanted to give voice to the HEWs; to critique some of the assumptions underlying the gender aspects of the HEP; and, to make recommendations for considering gender issues/mainstreaming gender and HEWs empowerment in the HEP. Job opportunity and desire to help the community were the main reasons for HEWs joining the HEP.

The things that make them HEWs happy are helping mothers and children, ensuring they are vaccinated and that women attend Antenatal Care (ANC) and are referred to health centers for skilled attendance during delivery—things that coincide with the goals of the HEP. However, a recurring theme among HEWs’ responses is that they struggle with excessive workload including unpaid overtime in fulfilling their responsibilities. This is exacerbated by their gendered household duties, which have not diminished with their taking up of paid work in the HEW role. Other constraints in their duties include trying to manage day-to-day with a shortage of medical and other equipment and lack of transport.

Many HEWs spoke of feeling unhappy with the lack of career path or opportunities to move into positions with more or different responsibilities and better conditions. While there are some limited opportunities to upgrade training, few HEWs believe there is much opportunity for them to better themselves or move beyond the HEW role. For some, the lack of opportunity for advancement impacts on their enjoyment of being a HEW. The lack of opportunity to transfer was raised repeatedly by HEWs and appears to have been a source of considerable dissatisfaction and practical inconvenience, or worse, for many HEWs. Under HEP policy, HEWs have been unable to transfer from one location to another because they have been recruited from their own kebeles on the understanding that they will return to them after training and serve in their own community. The no-transfer policy means that some HEWs who have worked for many years in one place and have married and had children are unable to live with their husband and children. The authors examined the findings in the data through a ‘gender lens,’ using a number of established gender analysis conceptual frameworks. A key conclusion is that the health system, and the HEP specifically, are in some ways gender blind in that they fail to look at the gender of the health workers who are responsible for delivering the health services to women. | 21-Jan-2016 11:24

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