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Health and paradoxes in Ethiopia

It was early evening by the time I arrived in Semera, the capital of the Afar region, on 7 April. With me was an assessment team from the London School of Hygiene and Tropical Medicine. They’ve come to Ethiopia for a week to assess our upcoming maternal and child health project in one of the pastoralist districts in this region. The weather was hot, dry and windy but pleasant, and the setting sun made a peculiar scene of the Afar desert.  

The next day we started speaking to selected key people in the area. About 92% of Afar people are pastoralist, so make their living from livestock.

Witness to change

Fortunately most of the people we spoke to said they’d seen significant progress in the general health services in the region and in maternal and child health services in particular over the last five years. There is a growing number of health facilities and a growing number and diversity of health work forces and other infrastructure.

Certainly, I am one of the living witnesses in this regard as I’ve known the region since 2002. However, I do strongly feel that there is a very long way ahead before we realise the ambition that every Afar pastoralist is able to get basic healthcare, with no barriers to stop them fully using the services available.  

No water, no school, no future?

Health is a human right.  But it’s not uncommon to see children waving their hand to ask for water while you drive through any part of the region because water shortage is their very crucial problem. I don’t think they could even imagine the 15-20 litres per day, per person, amounts being preached globally (for drinking, cooking and washing). With a dearth of access to water (even unclean water), the tendency to acquire waterborne diseases repeatedly is high. And with repeated infections the likelihood of children being absent or even dropping out of school is very high too.  The effect on their growth and development will be serious. Water shortage can kill a generation.

With advances in information technology, people have started getting information from any part of the globe within a fraction of a second. This is very recent, and in its infancy in developing countries. Afar pastoralists have their own way of exchanging information — an age-old tradition called a ‘Dagu’ system, through which information can be exchanged even at a rate faster than the world’s latest technology. To my surprise though, there is still limited knowledge among them about where and when to seek modern health services. This is a real paradox: they can pass information on so fast and yet they might not have been informed with the right basic health messages at the beginning.

Must do better for children

Ethiopia’s children and mothers suffer some of the worst health problems in the world, and health in Afar is also the poorest compared to other regions of Ethiopia. Still, fewer than 20 health NGOs, together with the Afar Regional Health Bureau, are supporting the 1.5million people in the region. Even then, most operate in the relatively better-served places along the major road, leaving out the remote and marginalised communities. So, while real progress is being made, the question remains: with only four years left to achieve the Millennium Development Goals, and 33 years that have passed since primary healthcare was declared, where is the equity? and where is the real access?

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