Engaging the community for better health

Misrak Makonnen is the country director for Amref Heath Africa. She has a master’s degree in public health and in business administration and has worked in public health for the last 18 years. During those years she has held several program director positions and worked as head of different international organizations in Ethiopia. In particular, she has managed various projects on health—mainly in HIV and maternal and child health areas here in Ethiopia and other African countries. As country director, she oversees all the health portfolios. Heirete Yibaleh of The Reporter sat with Misrak to discuss issues regarding Amref’s projects, maternal and child health and other pertinent issues. Excerpts:

The Reporter: What is the main focus area of Amref Health Africa and what are you currently engaged in?

Misrak Makonnen: Our main focus is on maternal and child health. We have 21 health projects on maternal and child health, water and sanitation, communicable disease and non-communicable diseases; so my job is making sure that all the projects are carried out properly—both technically and financially. I am supported by a multidisciplinary staff to meet my responsibility of ensuring proper delivery and accomplishment of all the projects. I am accountable in meeting the expectations of our donors. I represent Amref with our government counterparts, partners and donors. I also work in business development, looking for new opportunities for the organization, in alignment with the country's health priorities. If you see the 21 projects that we have, the majority of them are on maternal and child health. The areas that we focus on are in developing regional states like Afar, Somali, Benishangul and Gambella. These are highly vulnerable regions and so we give them more focus. What makes Amref different from other similar organizations is the fact that it goes to very remote areas and supports the regional health bureaus in meeting the needs of its people. We also have smaller projects in Addis Ababa, Amhara and Oromia, but most are in the developing regional states where the need is more critical.

What sort of work do you do with the regional health bureaus?

All our projects are done in partnership with Ministry of Health and the regional health bureaus. Starting from the planning stage to the implementation, we make sure that our projects are aligned with the needs and demands of the health bureaus. We look at the needs of the regional health bureaus and we try to plan our projects starting from how to meet these needs. When we work on the implementation, we try to look at health bureaus even at the wereda level and use content from the wereda planning as guidance. When we go out on our field technical support, we go out with wereda or zone health staff because we are trying to build a sustainable system. We don't want all the work to be done by Amref since part of our mandate is to build the capacity of the health bureaus so that we can transfer technical knowledge and skills.

What is Amref's role in assessment?

We do assessments in collaboration with the health bureaus. That is how we make our baselines and reach our targets based on these baselines and the priorities set by the regional states.

What is the main problem with regards to maternal and child health and mortality here in Ethiopia?

I believe the first problem is the issue of access to basic health services and that is also what the government is focusing on. For instance, if we see the regions that we work on—like Afar, Gambella and the others—not every woman has access to the basic health services. The quality of health services is also another challenge. Qualities concerning the effectiveness of health trainers, health equipment etc are also some of the main issues. These issues are also the government’s priorities so access and quality are the main issues that need to be addressed.

What is Amref doing in trying to solve quality and access issues?

In order to improve quality, we have a lot of trainings and mentoring initiatives particularly with projects we work on in collaboration with the Ministry of Health and the regional health bureaus. Some of our projects provide financial support to train health extension workers, midwives, nurses and other health workers. We also directly provide trainings to health workers in collaboration with the regional health bureaus. So there is a huge capacity building work done by Amref. The other interesting thing that we do is clinical outreach services programs. This relates to Amref’s history of providing clinical outreach services to those in need in very rural areas. The Ethiopia clinical outreach service links specialized physicians with remote hospitals that lack such professionals. There is also a training component where the physicians, who do the clinical outreach, serve as trainers to the facility level junior health professionals and remain in contact as mentors. This intervention targets both access and quality. In terms of access, we do some level of community mobilization to help create awareness in the society the services that are provided. We have also supported mobile outreach services to the communities directly.

I’ve learned that you hold conferences with pregnant women. Can you tell me what the conferences are all about?

What we try to do in these conferences is support the government’s policy, which is dubbed ''Home Delivery Free Kebeles''. This policy basically tries to encourage women to deliver their babies at health facilities. Amref supports the health facilities to create a support group among pregnant women. This is an initiative where pregnant women and health providers gather in the clinic in an informal setting and be in a comfortable and friendly situation where they can discuss about the issues. Because all pregnancies are different, this platform gives them the chance to learn from each other on danger signs of pregnancies,  preparations needed to be made before delivery, the importance of breastfeeding and the like. It is a kind of setting where they can discuss about their issues openly and without difficulty. It is in a way awareness creating as well educating the pregnant women by health workers while bonding with one another.  It serves as a counseling and support group among friends while dealing with pregnancy, which is the happiest and in certain cases, the most difficult time in a woman's life because of the unknowns.

What are the awareness creation works that Amref is doing?

We have a health communication group that is working with the weredas to support the community mobilization work of the health extension workers. Based on our health communication strategy, we have various approaches for transmitting the key message, which are print, mass media, group conversations and the like. And since we are an organization that works with the community, we have programs like community conversation conferences that we use to transmit messages to the community with different entertaining and educational materials. For example, when working with the youth on sexual reproductive health, we use creative awareness creation modalities by sending messages to the mobile phones of the youth willing to participate and discuss critical issues regarding their health. We also use interactive software that help students learn about sexual health education in their schools especially for pre-college and university students where they get the knowledge that they need in 16 weeks. There is also a call center that we support that helps in educating students on sexual health free of charge.

What is your partnership with Liya Kebede?

Liya Kebede has been an advocate for the World Health Organization for many years on maternal and child health issues. Since she is a very well-known African public figure, we asked her to be a partner of Amref Health Africa. When she was in the country, we visited Amref’s sexual and reproductive health project in Debre Berhan. We went to two health centers supported by the project. We observed the pregnant mothers conference that was going on at one of the health centers to give Liya an idea of the purpose of these women support groups, which we believe are very important. This gave Liya an opportunity to see first-hand the exchanges among the pregnant women and share their stories. The content is close to her heart since she has been supporting maternal and child health initiatives for a long time. Hence, that is why we are engaging her.

What are the future plans of Amref?

Our future plan is to strengthen our work and grow with the demands and priorities of the Government of Ethiopia. We also want to strengthen the work we are doing in the developing regional states that most NGOs do not go to, and since we have a lot of experience there we want to strengthen that. We especially want to work more on maternal and child health since it is also the priority of the government. We want to support communities in health service delivery. This is part of our strategic business plan. Even though our main focus is on maternal and child health we also work on non-communicable diseases. We also work on diseases like cancer that comes with the development of the country; we support the Ministry of Health by providing trainings on cancer screening, clinical mentoring and we are in the process of getting equipment for hospitals identified by the Ministry of Health. We will also push in expanding our efforts to improved access to and use of sanitation and hygiene facilities at the community level.

Amref Health Africa has been working in Ethiopia since 1998 working in close partnership with the Ministry of Health and regional health bureaus, as well as other sectors such as water and education. We would like to continue to strengthen this relationship and contribute to the implementation of the ministry’s Health Sector Transformation Plan.