Health extension worker Fantaye Yenehu, featured in the BBC’s Survivor’s Guide, tells her story

A foot soldier in a health service revolution

“I am a health extension worker in a remote community in northern Ethiopia. Through the simple things that I teach the people in the community where I work, and the vaccines and other services that I provide, we have seen great improvement in the health of both children and adults. This week, a documentary about the work that I do together with my colleague Zewde Getahun will be shown on BBC World as part of the Survivor's Guide series.

“In the last two years, more than 24,000 health extension workers like myself have been trained and deployed in Ethiopia. By the end of the year there will be 30,000 of us providing health services to people who previously either didn’t have any services or who would have to travel very far to get them.

“ I have always wanted to work with health and to help my community. When I was growing up, we didn’t have any services here, and we didn’t understand how people get sick. For example, we had a disease called ankayis, which is measles. I had it as a child, and many other children had it too, but we didn’t know what to do with it. Our parents would try to cure us through making coffee. Now that I have had the health training, I can teach people that it is possible to prevent diseases such as measles and also how to do it. Now we vaccinate the children against measles and we don’t see it any more.

“After I completed 10th grade, there wasn’t much for me to do, but then I heard of the opportunity to train as a health extension worker. I competed, and was very happy to pass and be selected. Like the other health extension workers, I received twelve months of training in the different interventions that we provide. Then I was deployed here in the community together with my co-worker Zewde. We provide sixteen different kinds of interventions or packages in the community. Some are related to environmental health and hygiene, like teaching people how to build and use latrines, how to dispose of liquid and solid waste, to separate people and livestock, and how to take care of their personal hygiene. We teach people to build and use smokeless stoves, which is particularly important for women who now cook over open fires and get respiratory infections. We provide immunisation against eight different diseases to children and against tetanus for women. If we had malaria here we would provide treatment for it, and we also have oral rehydration salts to give to people who have diarrhea. We also inform them about and provide family planning services and HIV prevention, and we assist when women give birth.

“People that have benefited from our services talk about how they see improvements already. They say things like ‘now, my children cough less and they have less diarrhea’, ‘when the children are healthy, we don’t need to spend the little money we have on medical bills, instead we can spend it on food or clothes or schoolbooks’, ‘we don’t see as many sick children any more’, ‘cooking is much more pleasant now that there is no smoke, and I cough less’, ‘our compound is more pleasant and smells better now that we dispose of the waste, and that makes us happy’.

“In doing our work, Zewde and I are supported by many different partners. We work with twenty volunteers, who are members of the community and who help in many ways, by collecting vaccines from the nearest clinic on vaccination days, or by spreading information to community members. The community contributed the building that we work from. The government pays our salaries, which makes us very proud because we are actually civil servants. UNICEF, WHO, the GAVI Alliance, NGOs and others support in different ways, for example by providing training or parts of the cold chain for the vaccines.

“Both Zewde and I come from this area, and it makes us very happy to be able to help the community members to be healthier. Since we are women, and most of our work is with mothers, they feel comfortable sharing their problems and their secrets with us, and we are very happy that we can be there for the women. We can already see that our work is making a difference, and we are very pleased because we know that it is because the health post is here and we are working in it.

“Through the construction of the health post and the training and hiring of health extension workers like us, we get a chance to have education and a satisfying job. For young people from this community, there are almost no opportunities. If we had not gotten in to this programme, maybe we would have to work as servants in houses or on farms, or we would just sit at home with nothing to do and feel useless, like many people we know. So this programme has given us a really great opportunity. For the future, we will work hard so that we can qualify for further training and be upgraded to work maybe in the administration of the programme or on other parts of the health system.”

As told to Indrias Getachew, UNICEF Ethiopia, and Bjorg Sandkjaer, GAVI Alliance