S

ister Beliyu Shale is a nurse at Sagure Health Center in Arsi Zone of Oromia
region. She has been serving in the health center for more than ten years.
In the past four years, she has been providing family planning (FP) services
after she received training from USAIDs IFHP. The training she took focused on
intrauterine contraceptive device (IUCDs) which prevents pregnancy for up to 12
years. Before this training, no staff could provide IUCD when women demanded
the service at the health center. Sr.Beliyu says previously, none of us had the
skill to insert or remove IUCD. So, the contraceptives we provided were limited
to implanon, injectable, pills and condoms.

With the financial and technical support from USAID, IFHP trained at
least two staff at each health center in Digalo Tijo Woreda, one of which
is Sagure Health Center. The training helped health centers expand the
reach of FP beyond the health center. The trained health workers
are not limited to facility based services. They also give back up
support to health posts to reach women with contraceptives that
cant be provided by health extension workers. said Abayneh
Tesfaye, head of Digalo Tijo Woreda Health Office. .because
of the intensive backup support to health posts from health
centers, utilization of IUCD is improving steadily. Abayneh
added.

In the year 2010, only 57 clients were on IUCD, However,

last year alone, 1,431 women received IUCD services in
the woreda. Behind each woman that received the IUCD
service, there is a story, a unique story of change for the
better. One of these women is Constable Addis Ashime. She
received IUCD services from Sr.Beliyu. The 25 years old
policewoman said My job as a policewoman puts me on
duty during evenings and holidays. I already have a one year
old child. My husband, also a policeman, works in another
town, some 75 kilometers away from here. So taking care
of our child is a challenge leave alone having another baby.
So, I decided to take IUCD to delay my next pregnancy.

Similarly, IFHP has trained more than 1200 health

workers in IUCD insertion and removal in over 770
health centers across Tigray, Amhara, Oromia and
Southern Nations and Nationalities Region of
Ethiopia.
S
olomon Demiss was born and
brought up in Kuye, a tiny village near
Debaytilatgen Woreda of East Gojjam
Zone, Amhara region. He lost his mother when he
was one year old. His father, an illiterate peasant,
had a small plot of land to support his family. With
three brothers and a sister, Solomon, 24, is the second
from the last among his siblings. He is now a 4th year
student of Materials Engineering at Adama Science and
Technology University.

The tragedy that changed his life happened when he was

twelve years old. With only few days of illness, he found himself
paralyzed from the waist down. He lost strength in his legs and it
became difficult to walk. But after two years of treatment, he was
able to stand up and walk again with the support of a crutch. Since
then, he has been struggling with all the hardship in life to attend
and complete his education. My disability became the source of
my strength. When I was in secondary school, I won a recognition
award for my consecutive excellent school achievements from the
Zonal Education Office he recalls.

Solomons father, the only breadwinner of the family, died and his
last hope of getting good education seemed gone. The young boy, who
was generally a good student, did miserably in the first year of college.
He got low grades. My father was the only support I had. Life became
tough and bitter. I lost support to continue my education Solomon said.
Fortunately, it was when Solomon was in despair that he was spotted
by IFHP. He received support as part of the initiative taken by voluntary
IFHP staff members to help needy students at the University. He receives
monthly pocket money and clothing from the staff
contribution.
After sometime, Solomons grades started to improve
steadily and became one of the top five students in
his batch. Because of this, the school has chosen him
to conduct his apprenticeship in a renowned steel
company in South Korea. Only few students are
given this opportunity because of their high scores
He claims proudly. He has a passion to continue
his studies I will continue my education until I
reach PhD level. I am determined to be like one of
those famous researchers in the field. I want to be a
professor Solomon shares his plan.
Solomon gets short of words to thank IFHPs staff.
If it were not for the fantastic people at IFHP, this
would have never happened. From the day I started to
receive the support, I made better grades. I owe
my success to the wonderful people at IFHP
Solomon says.
Solomon is also serving as a peer educator for
the Adolescents and Youth Reproductive Health
Project of IFHP. The peer group training made
a huge impact on my life because it changed
me quite a lot, Solomon told us. Before the
training, I was not comfortable to go out and mix
with fellow students. But now, I have the self-
confidence. Im enjoying life I have a good
network of friends he reports proudly.
Currently, IFHP has over 100 trained peer
educators in Adama Science and Technology
University.
F
or those living in the villages of Goro Gutu
Woreda, West Hararghe Zone of Oromia region,
the rocky terrain keeps healthy people fit but
very difficult for the sick. Surrounded by many hills,
streams and a vast area covered with plantations, it
was difficult for local residents, specially mothers
and children, to reach health facilities for treatment
of illnesses such as malaria. Those who manage to
reach health centers arrive in serious conditions.
Of the 30 kebeles in the woreda, 23 of them are
malarious. In 2003, there were numerous malaria
cases in the woreda. To make matters worse, the
problem coincided with draught that resulted in food
insecurity. We had a very difficult time. Mothers
were unable to feed their sick children. Elderlies died
before reaching health centers recalls Abdul Aziz
Ibrahim, head of Goro Gutu woreda health office.
In 2010, the zonal health department with support
from USAIDs IFHP, organized trainings on
epidemic management and malaria treatment for
health managers and other health workers, respectively.
Health extension workers (HEWs) were trained to treat
uncomplicated cases of malaria at the community level. In
addition, they worked hand in glove with the community in
malaria prevention. The HEWs taught the community about
malaria prevention that included draining of water pockets,
use of bednets and in case of a fever, the need to seek
immediate medical care. Each household in the community
also received up to three bednets.
All these efforts paid off says Abdul Aziz, now,
through the collaborative work of the woreda health office
and the community, the number of malaria cases has declined
sharply. If you look at the malaria statistics in the woreda,
the number of new cases reported four years ago was 350
but in the just ended fiscal year, only 10 malaria cases were
reported to the woreda health office he added.
IFHP provides similar supports to malarious woredas in
Amhara, Tigray, Oromia and SNNP regions of Ethiopia.
I
n the morning of Thursday in the month of
August, in a small open space outside of the
immunization room of Sagure Health Center,
a group of women sat under a tree shed with their
babies on their laps waiting for vaccination. Sr.
Adanech Gizaw, a nurse at the health center, checked
the vaccination status of each baby on the yellow
cards the women carried with them. She wrote
the vaccines each baby was eligible for the day on
the card and gave injections and polio droplets to
the babies. Before the mothers left, she explained
possible side effects and the appointment dates for
the next immunization.
Amidst the crowd of women was Jamila Nemo, a
19 year old mother, with her nine month old baby.
Jamila came for the final vaccination for her baby
after which she would be awarded an Immunization
Diploma. Jamila has known the importance of
immunization for her baby and made her baby
receive all the vaccinations before its first birth day.
Jamila explains, Health extension workers in my
kebele have taught me that immunization protects
children from many diseases. Children who are
vaccinated are healthier than those who are not.
IFHP in collaboration with the Regional Health
Bureau of Oromia trained Sr. Adanech and her
colleagues on Expanded Program of Immunization
(EPI) and Integrated Management of Newborn and
Childhood Illnesses (IMNCI). Healths Extension
Workers have also been trained in EPI as well as
Integrated Community Case management (ICCM)
which has enabled them provide vaccination as well
as treatment services for sick children, respectively.
Seeing the deaths among unimmunized children
during outbreaks and knowing those who survived
had been immunized, the local community has now
recognized the importance of immunization, says
Abayneh Tesfaye, head of Digalo Tijo Woreda Health
Office. IFHPs technical support and training of
the health center staff and health extension workers
has greatly contributed to these changes Abayneh
concludes.
So far, IFHP has trained 6,121 health workers and
HEWs in EPI, IMNCI and ICCM in Amhara,
Oromia, Tigray and SNNPR.
A
maru Ketema is a 22 year old
woman who lives in one of the
remote kebeles of Yayagulele
woreda of Oromia region. When she was
nine months pregnant and started to have
contractions, she told her husband, Abraham
Girma, to take her to Fetal Health Center.
Abraham took no time when he called his neighbors
and carried her to the health center on a traditional
ambulance, a wooden bed with leather strap having
four handles at each corner to help carry on the shoulder.
Weary of the long journey through a difficult terrain,
they eventually arrived after three hours.

Shewarega, a midwife working at the health center,

welcomed Amaru and the people accompanying her,
took her in to a curtained examination coach, did an
assessment and confirmed that she was having a labor.
However, as the labor was early, Amaru had to wait
at the health center for extra hours so did some of the
people accompanying her.
As part of the effort to make delivery services women
friendly, the health center has a special maternity waiting
room. In this room, families are allowed to do rituals
for laboring woman in accordance with their customs.
The health center provides the woman and her family
with flour to make porridge as is the practice in the area.
Family members and neighbors are allowed to cater
for their own food. They are provided with firewood,
kitchen space and some necessary utensils. They also
conduct coffee ceremonies. All of these support to make
them feel at home.
When the labor was progressing, Amaru was transferred
to the delivery room for close monitoring. Because
the labor was a bit delayed, Amaru had to give birth
with the help of a vacuum extractor, a cup like device
attached to a vacuum extractor to help expel the baby
in such cases. Shewarega assisted the delivery. He has
been behind most of the deliveries at the Health Center
after he received training on Basic Emergency Obstetric
and Newborn Care (BEmONC) organized by USAIDs
IFHP. He explains that the training has helped him build
his knowledge and skills to respond appropriately to
situations like Amarus. The BEmONC training is a
practical hands-on training to manage normal births as
well as complications of pregnancy, childbirth and the
newborn.
Due to the commitment of the government, the staff and
the continued support from partners such as USAIDs
IFHP, skilled birth attendance in Yaya Gulele woreda has
significantly improved from less than 20% in 2012 to
87% in 2015 said Yirga Tessema deputy head of Yaya
Gulele woreda health office.
Mesfin Nigussie, IFHPs Regional Program Manager
for Oromia also says; Previously, health centers were
staffed with health workers with minimal midwifery
training, totally on their own without adequate medical
equipment, supplies and supervision.
So far, IFHP has trained health workers on BEmONC
from Amhara, Oromia, SNNP and Tigray regions.
B
irke Assefa dreams for her daughters to
be doctors, and with the freedom she
now has to decide when and how many
children to have, she has more hope than ever
for their future.

At 26, Birke has not had an easy life; abandoned

by her first husband after the birth of her first
daughter, she returned to her parents home to
be supported by her father while working as a
daily laborer. There she met her second husband
and became pregnant with her second daughter
after discontinuing her use of depo-provera
(a contraceptive method that is injected into
the arm and is effective for three months) due
to side effects and the challenges of having to
remember a quarterly appointment.

Like many women in rural Ethiopia, Birke had

limited knowledge of the available choices of
contraception, and limited access to long-acting
reversible contraception methods that were
available only at the health facility that was a far
distance from her home. Birke didnt know that
she had other options I am poor. I do not have
enough income to give a decent meal to my two
children, let alone having another child.
Her knowledge and access increased when she
met Tsehay and Banchi. Tsehay and Banchi are
just two of more than 38,000 health extension
workers (HEWs) working throughout Ethiopia
to improve the quality and availability of primary
health care by teaching communities about
family planning, maternal newborn and child
health, malaria prevention, nutrition, hygiene,
sanitation, and more. For Birke, and the 3,000
members of Sojole Village, Tshey and Banchi
are the primary source of health information
and basic health services. And now, thanks to
the training the HEWs received from USAIDs
IFHP, they are able to provide family planning
counseling and service provision at their health
post. When Birke came to the health post for
one of her antenatal care visits, I explained
to her that there are other choices including
Postpartum Intrauterine Contraceptive Device
Tsehay said.
On the day Birkes labor started, she was accompanied
the 10km distance from her village by Tsehay and
Banchi to the Sheno Health Center of North Shoa
Zone, Oromia Region where they linked her with Sister
Amelework. Like other midwives at the health center,
Sister Amelework had received training from IFHP
on Basic Emergency Obstetric and Newborn Care and
Postpartum Intrauterine Contraceptive Device, so she
was able to provide Birke all of the services she wanted,
including contraception. Now, I do not have to worry
about my appointment days and the discomforts have
gone for good Birke said with gratitude.
Birke hasnt been the only beneficiary of IFHPs work in
her community. The total number of intrauterine
contraceptive device clients in the Woreda was only 60
in the year 2013, but now it has grown to 363 thanks to
the technical, material, and capacity building support of
the USAID funded IFHP Sister Amelework concluded.
 Reaching
Young People
with Youth
Friendly
Services
S
olomon and Hirut are loved by most young people
residing in the rural town of Kombolcha, located
in the Hararghe Zone of Oromia Region - about
548 km East of Addis Ababa and just 16 km away from
the ancient city of Harar. Both of them are nurses at
Melka Fura Health Center. With a population close to
62,446, like many towns in Ethiopia, Kombolcha is
predominantly inhabited by young people.
Talking about sex is considered a taboo in this community.
Specially, old people and parents deliberately shun
discussing the topic in front of young people. Thus,
young people have to explore and learn about it on their
own. Unfortunately, they may have exposed themselves
to substantial risks of unwanted pregnancies and
sexually transmitted infections including HIV before
they acquire the right information.
With the newly established youth friendly service
(YFS) unit at Melka Fura Health Center, Solomon
and Hirut provide sexual and reproductive health
(SRH) information and services to young people in the
community. They also recruit, train and deploy young
people as peer-educators and counselors. This has helped
in improving the SRH awareness of young people in the
area. One day, before the YFS was established, a 16
year old girl burst into my office to avoid public eyes
and whispered into my ears that she wanted to talk to
me in private. I took her to the backyard of the building.
She kept quiet for a while. Afraid of how to start her
story, she finally said I am pregnant. She pleaded for
termination. If I wouldnt help her, she said, I will
commit suicide. Because I had to confirm her pregnancy
first, I ordered a pregnancy test. Luckily, the laboratory
test was negative-she was not pregnant!! I counselled
her, gave her contraceptive and saw her off. These days,
after the YFS is established, young people come straight
to the YFS and get the services they want without fear.
They also get adequate information concerning the
services available at the YFS from peer educators says
Hirut, one of the health service providers trained by the
project.
Most health facilities did not have YFS units to provide
youth friendly services to young people. They did not
have trained staff either. Young people were treated like
adults and services were not sensitive to their needs. As
a result, young people faced various health problems.
Unless you handle young clients in a friendly manner
and with assurance of confidentiality, you cannot give
them the service and tackle their problems says Nurse
Solomon, YFS provider at Melka Fura Health Center,
IFHPs training has helped me a lot in this regard he
added.
In collaboration with the public health system and with
technical and financial support from USAID and
KOICA, IFHP has established 248 YFS facilities and
trained several youth friendly service providers in
Amhara, Tigray, Oromia, SNNP, Benshangul and
Somali Regions of Ethiopia. This has increased access
to SRH services for millions of young Ethiopians.