African solutions for Africa’s health challenges
AMREF health Africa is a noted non-governmental organization that has been operational in a number of nations, including in Ethiopia. Here, the CEO of Amref Health Africa, Githinji Gitahi (MD), reflects with Samuel Getachew of The Reporter on his own career, on the organization’s milestone in helping achieve better health in the continent, on the status of women health and on creating social safety net within Ethiopia. Excerpts:
The Reporter: You recently received the Moran of the Order of the Burning Spear for advocating and contributing to better health in Africa. What does this award signify for you and your work?
Githinji Gitahi (MD): Receiving the Moran of the Order of the Burning Spear from the President of Kenya, His Excellency Uhuru Kenyatta, is a great honour. I have dedicated the award to all health volunteers who, despite the challenges they face, continue to play a critical role in Kenya’s health care system. Receiving this commendation for promoting health signifies that governments in Africa, like Kenya, are recognizing the paramount importance of the right to health, and of having a healthy population which is a necessity for economic growth and development.
The chair of Amref Health Africa – in his congratulations to you – highlighted your effort for the right of health in the continent. How far are we, as an African society, from realising what universal health care as a right that is still seen as a farfetched dream for a majority of Africans?
The goal is Universal Health Coverage by 2030. It’s a very ambitious goal, particularly for a continent as large and diverse as Africa. We are seeing accelerating progress in many countries in Africa. For example, UHC is a priority of the Kenyan government, Rwanda, Tanzania and other countries are also on the road to UHC. Many countries are primed to take the leap to realize UHC.
Citizens now need to light the match and keep it lit, demanding accountability from their leaders to ensure everyone, everywhere has access to the health care they need to survive and thrive without suffering financial hardship. In our effort to continue advocating for UHC, Amref Health Africa is holding its Africa Health Agenda International Conference (AHAIC) this March in Kigali, Rwanda, convening policymakers, private sector leaders, researchers, advocates, journalists and young people to discuss how to achieve UHC.
Amref Health Africa celebrated its 60th anniversary in 2017 and it seems it has left much of its footprint in the region, as well as in Ethiopia. What have been the highlights of its work so far, in Ethiopia, Africa?
Amref Health Africa was founded in Kenya in 1957 so we are now going into our 62nd year as an African-led international non-governmental organization. When celebrating our 60th Anniversary, we took a look back at our impact and we found that during that time we had reached 110 million people through our health-focused projects and had trained 12 million health workers. Most importantly, we’ve done that by partnering with communities and working within Africa for solutions to Africa’s health challenges.
Amref Health Africa has been present in the Ethiopia since 2002. We started our partnership with the Federal Ministry of Health with a focus of strengthening community and health systems through existing government health structures. In line with our global mission, our interventions in Ethiopia bring lasting health changes targeting the wellbeing of communities with a focus on women, adolescent, youth and children. Currently, Amref Health Africa in Ethiopia is present in Addis Ababa, Afar, Amhara, Benishangul, Gambella, Somalia, Southern and Oromia. As a result of our work in the developing regions, our reach to remote areas of the country, and our focus on addressing community needs in urban slum areas, we strongly support the FMOH’s health sector transformation plan of addressing its equity agenda.
In 2018, we launched our global five year strategic plan under three pillars: focusing on human resources for health, innovative health service delivery and health care financing. Our Ethiopia program implementation aligns with these three pillars through a diverse portfolio in reproductive, maternal, newborn, adolescent and child health (RMNCAH), water, sanitation and hygiene (WASH), resilience oriented programs and human resources for health, and nationwide health systems strengthening interventions such as supporting the government health extension program. We also have crosscutting areas such as monitoring, evaluation and learning; and gender and social inclusion.
In 2017, our Ethiopia program was able to reach 2.4M people (51 percent women), 390 health facilities, 27 health science colleges. 11,861 mid-level health providers and 17,792 health extension workers and health development workers were trained. Our work also led to 47 improved water schemes and 80 improved sanitation schemes. Forty youth friendly centres and health institutions skill labs were constructed.
There is a perception that the poverty and lack of social safety net in health and employment and that of the challenges of the continent are uniform like. What in your opinion are the challenges of Ethiopia, compared to that of other African nations where Amref Health Africa does its vital services?
Ethiopia, being the second most populous country of our continent, has a current demographic structure that needs to be given high attention. 60 percent of the country’s population are under 25 years and with it comes major implications related to the country’s ability and readiness of harvesting the demographic dividend.
The high unemployment rate, particularly focusing in urban areas, is a critical issue with the necessity for creating work opportunities to address such challenges, including the development of the private sector. As you know, youth unemployment may lead to substance abuse, sexual and reproduction health problems and threat to political instabilities.
Re-emerging communicable diseases, such as HIV, after a decade of highly resourced intensive nationwide interventions is a concern and we need to better understand what happened as it highly affects the youth, particularly young girls.
Our health interventions in Ethiopia try to address such issues through our focus area in SRH/Adolescent and youth health supporting the FMOH adolescent and youth health strategy (2017 – 2020). We try to create health programming that embeds youth empowerment through income generating activities (training in entrepreneurship; links with microfinances in communities we work in); we also design health interventions that build in business models - for example, while we support communities and kebeles to build communal latrines and shower facilities, we build in youth engagement and empowerment by training them on managing a small business so that they can run these latrines and shower facilities, while selling hygiene commodities on the side.
We are also addressing harmful traditional practices such as female genital mutilation/cutting and early child marriage by working through the communities and their communications structures. We provide life skill development training for youth using client-centered, gender-sensitive, interactive, and participatory methodologies. We work with youth to build their assertiveness, confidence, decision-making and relationship-building skills, enhance women’s and girls’ abilities to make healthier choices, cope with peer pressure and avoid risky behaviour. Some of our projects in Ethiopia provide seed funds to youth who have undergone basic entrepreneurial training to start-up small businesses. In partnership with youth led organizations, we also try to create safe spaces for the youth and engage them through advisory platforms for our programs.
Another approach of engaging youth is creating opportunities for women in developing regions through pre-service midwifery training, including providing minimal incentive packages (purchase of books & scholarships) in consultation with communities and government. This approach becomes also part of retention of the health workforce in these regions. We design and implement all these youth centered interventions with consultation and support of our regional health bureau counterparts which have given high emphasis on the wellbeing of the youth.
How is Amref Health Africa helping on the rights of girls and women on health care services and health rights?
The health rights of women and girls have been central to Amref Health Africa’s work since our founding in 1957 because, in most communities we partner with, women and girls are the most vulnerable and most marginalized leading to the still unacceptably high rates of maternal deaths in Africa. Some Statistics are, the risk of a woman dying from a pregnancy-related cause during her lifetime is about 23 times higher in Africa than it is for a woman living in a developed country. Africa accounts for 200,000 of the 289,000 mothers who die every year from pregnancy or childbirth-related complications. Teenage childbearing remains high in sub-Saharan Africa at 116 births per 1,000 adolescent girls in 2015, which is more than double the world’s average.
Sexual and reproductive health and rights and ending harmful practices such as female genital mutilation/cutting and child marriage are part and parcel of Amref Health Africa’s day-to-day work. That being said, we can do better when it comes to designing our projects from the ground up with the health and human rights of women and girls in mind. It’s something we are committed to improving across all of our projects as we learn and grow as an organization and understand better the societal and cultural norms that heavily influence the daily health of many girls and women in communities in Africa.
For example, something as essential as whether or not a pregnant woman attends antenatal care can be determined by the social norms under which she lives. It’s often not enough to talk only to women about the value of antenatal because it may be social norms that are preventing them from seeking care. That’s why community-wide dialogue around the health and human rights of women and girls that includes everyone – men, religious/cultural leaders, women etc – is so critical to efforts to reduce maternal mortality and morbidity.