Taking community health groups to scale in Ethiopia

Women and Children First is supporting the Ethiopian government to establish community health groups.

These life-saving groups will support pregnant women and their children through their maternity journey.  They will be implemented and managed through the Ethiopian government’s community health system.

Working with government to save more lives

The community health group approach has been successful in saving and changing lives in Ethiopia in previous projects.

Embedding the methodology in the government health system is the best way to sustainably reach all communities that can benefit from it.

Running groups will become a standard practice for community health workers, who will be trained in the approach as part of their overall preparation for the role.

There is a large body of evidence behind the approach. Community health groups can halve maternal mortality and reduce newborn mortality by a third.

To be rolled out across the country, it requires the health system to establish thousands of community groups. Careful testing is required before a full scale-up is recommended.

This project is the first time this will be tried in Africa. This pilot initiative is a partnership between Women and Children First, JSI, Amref and the Government of Ethiopia. The work is part of a five-year project to improve primary health care delivery, funded by the Bill and Melinda Gates Foundation.

It will be implemented in rural areas where women do not have a health facility nearby that offers skilled birth attendants, such as midwives.

The groups have to be delivered in a cost-effective and feasible way for the government to manage them on an ongoing basis.

Ethiopia is committed to ensuring universal health coverage for all. As well as working to strengthen the primary healthcare system, it recognises the power of communities, and specifically, women, through community health workers.

Supporting Health System Improvement

Our work is designed to complement the work to improve the health-care system. Our health group approach empowers communities to take local action to overcome their biggest health challenges.  

The approach will support women and babies in agrarian and pastoralist communities, who have limited access to maternal and newborn healthcare services.

Agrarian communities are actively involved in agriculture, through farming and livestock. This is time-consuming, intensive work, which means they have less ability to be involved in the wider community and seek healthcare services.  

Pastoralist communities are more nomadic, moving around as people tend to their herds of cattle. This means they do not access health facilities as easily as communities that stay in one place.

1 in 8 Ethiopians are part of these pastoralist communities. Alongside this project there are new community health roles being introduced to support them.

For those that have difficulty reaching health centres for delivery, better home care practices are being encouraged. This includes using clean equipment, sterilised in boiled water, and keeping the baby warm after birth, reducing the risk of hypothermia.

The aim by the end of the project in 2025 is for the community health group approach to be recommended for embedding into the health system. This means every community health worker in Ethiopia would be able to have the tools needed to reduce maternal and newborn mortality.

Previous successes

This work has the potential to mirror a previous successful national scale-up work in India, conducted by Ekjut and UCL.

The largest ever community health participation intervention scaled up by government health workers and embedded in the public health system, this approach reduced neonatal mortality by 24%, and proved to be cost-effective.

Women and Children First so far has supported national stakeholders to design the approach to suit Ethiopia’s community health system and trained project and government representatives in the methodology.

We continue to work with project partners to support the roll out, monitor the intervention and learn lessons.  

Joanna Drazdzewska, Head of Programmes and Advocacy, says, “It is such an exciting opportunity to be working on this. This group approach is very powerful in mobilising communities to play an active role in their health.

“If it can be become a standard practice in Ethiopia, it would benefit many more communities than individual projects can. That ultimately has the potential to save the lives of more women during pregnancy and childbirth.”