Close the borders, curfew, state of emergency, and even containment... To counter the pandemic of Covid-19 and avoid at all costs due to the congestion of health facilities, african countries have multiplied their measures. The ethiopian government, which has declared a state of emergency since 8 April last, did also the bet of the prevention. To help it in its task, it can count on a support of size : an army of nearly 40,000 community health workers, majority of whom are women, ready to criss-cross the country. Their mission : to ensure that the information related to the coronaviruses are well known to all, even in the most remote villages.
Among the advice given, the essential "hand-washing" and "measures of social distancing," says Kesete Birhan Admasu, director of the roll back malaria Partnership to end malaria and former minister of ethiopia Health. "These agents are also a reliable source of information for the authorities, the doctor adds. In a country as vast as Ethiopia, confirm, or deny rumors of transmission proves to be very useful. "To help them in their task, the ministry of Health has put in place a training module which allows them then to ensure the prevention Covid-19.
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A winning strategy...
If the authorities are encouraging the initiative, it is that the work of community health workers has already been proven in the past. "Since 2003, the Ethiopia develops and deploys health extension workers at the national level in the framework of community-based health programs, reminds Emebet Getachew Abate, head of the Ethiopia within the organization Life & Peace Institute. The fight against maternal and infant mortality has been a success : the mortality rate of children under five years of age fell by 67% that of mothers, 71 %. It was also observed a reduction of 90 % of new HIV infections, a decrease from 73 % of malaria deaths and a decline of more than 50 % of the mortality due to tb between 1990 and 2015. "
impressive figures, which testify to the indispensable role played by community health workers in this country of 105 million people where access to care is not always assured and where "the intensive care units suffer from a critical shortage of professionals," says the weekly economic Addis Fortune. In this context, to appeal to these professionals is " the best bet you can do with Ethiopia."
An opinion that is shared by Boureima Sambo, representative of the world health Organization (WHO) in Addis Ababa. "In the midst of a pandemic of sars coronavirus, community engagement is fundamental, abounds there. When I go into certain districts, some villages, in suit and tie, nobody talks to me. But when someone speaks your language, lives the same reality as you, it is completely different. You're willing to listen and change your behavior, that sometimes, the authorities are struggling to enforce. "
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... also validated in other countries
A situation that is true also in other countries of the continent. "Today, more than usual, the NGOS must collaborate with community-based health workers, because these are people who have all the confidence of the people, ensures Adamu Isah, a doctor for the Save The Children organisation, based in Nigeria. This network is a key, if not the main, the resolution of the crisis. "
the Majority of these "brigades" community, "the women are in the front line in the fight against the Covid-19 in Ethiopia," says Emebet Getachew Abate. Students, mothers and occupational health, all commit on a daily basis to inform people, in collaboration with the religious leaders. "Women are a fundamental pillar of the community and have a decision-making power is very important," says Boureima Sambo. In societies such as ours, it is they who, most of the time, generate and manage the resources. With the traditional chiefs, they are the opinion leaders of the society. The scope of their message is great, and the results are palpable. "
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A health management which differs according to the regions ?
With the prevention work of these community health workers, the ethiopian government ensures that its messages are well heard and understood by all. But this dependence with these "small hands" of health care does it result not of an absence of the State in some parts of the country ? If for Boureima Sambo this mobilization proves, on the contrary, the liveliness of the messages of the State ", the former minister, Kesete Birhan Admasu recognizes him, that " the health extension workers are essential and represent a credible source of information on the health of populations in a country that has a Internet penetration rates, the lowest in Africa ". And where, therefore, the link between inhabitants and authorities is not always.
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For Laëtitia Bader, a researcher specialist of the Horn of Africa in Human Rights Watch, the Oromia region is particularly impacted. "The information about the Covid-19 struggled to find their way up there," she says. In question ? The cut-off of telecommunications recorded at the beginning of march, as the country confirmed its first cases. "The population of the region, therefore, could not hear the prevention message, which had replaced the phone ringing, each time you place a call," says the researcher, who explains : "This situation has all the same private information of nearly 3 million people. "Since that time, telecommunications have been restored in the region, for fear of spreading the coronavirus. But " the information that we have on the dissemination of knowledge, awareness and the distribution of material in this area remain unclear ", says Emebet Getachew Abate of the Life & Peace Institute. And to conclude : "The fight against the Covid-19 in this part of the country where the security situation remains precarious is a real challenge for the government. "