When malaria swept through the green hills of his village in southwest Ethiopia three years ago, Biya Abbafogi was lucky. The 35-year-old coffee farmer and three of his children were stricken with the deadly, mosquito-borne disease, but they all survived. Thirteen neighbors and friends in Merewa didn't.
“We would take one child to the hospital and come back and another one would be sick,” he says.
The treatment Abbafogi and his family received was cheap by Western standards — just $40. But that was about a third of his annual coffee earnings, and the bills from the medical clinic — located two hours away by foot — forced Abbafogi to sell one of the oxen he used to plow his small corn field.
But today things are much better for Merewa's 4,335 residents, thanks to two young women trained to treat and prevent malaria and other common ailments. They're not doctors or nurses, and they haven't been to college. But with just one year of training they've cut malaria rates during the infectious season from 15 to 20 new cases per day to one to three.
Merewa's success has been replicated all across Ethiopia, where the government has dispatched an army of up to 30,000 “health extension workers” in the past four years. With money from donors like the Geneva-based Global Fund and the Carter Center in Atlanta, the women have distributed 20 million mosquito-repelling nets and offered basic malaria testing and treatment in isolated villages dozens of miles from the nearest paved road.
Every year 4 million Ethiopians contract malaria, which is particularly deadly for children. As many as one in five youngsters under age 5 who get the disease die from it. In response, Ethiopia is at the forefront of two major public-health initiatives in poor countries. The first, known as task-shifting, trains lower-skilled health professionals — who are cheaper to pay and easier to retain — to provide basic treatments and teach prevention. The second aims to distribute anti-malarial bed nets to 600 million Africans living in mosquito-infested regions by 2011.
Ethiopia's poverty helped drive the new approach. As one of the world's poorest countries, Ethiopia has trouble keeping doctors from moving to better-paying jobs overseas, says Tedros Adhanom, Ethiopia's health minister. “Right now, 50 percent of the doctors Ethiopia trains will emigrate,” he says. To compensate, he says, Ethiopia is training more doctors — medical schools admitted 1,000 students in 2008, four times more than in 2007 — and shifting as much work as possible to nurses and health extension workers.
Lower-skilled extension workers don't emigrate, and they're also willing to work for less and to serve in rural areas, Adhanom says. “To tackle our health problems, the solutions are simple,” he says. “You don't need highly skilled people to tell you how to prevent malaria.”
Health workers learn 16 different health-education and treatment interventions, including midwifery, malaria treatment and hygiene education. They also make sure villagers are vaccinated and organize insecticide spraying to kill malaria-transmitting mosquitoes.
The mosquito net distribution program faces many obstacles in a country where many of the 85 million citizens live miles from paved roads. But improved technology offers hope the new anti-malaria effort will succeed where earlier attempts failed.
Bed nets not only provide a physical barrier against malaria-bearing mosquitoes but also kill the pests with insecticide sprayed on the nets. In the past, bed nets had to be dipped in chemicals annually to retain their potency. But newer nets are treated with long-lasting chemicals that require re-dipping only once every three to four years.
Dipping the older nets every year posed “a huge logistical problem” in rural places, Adhanom says. “Fewer than 40 percent of villagers would show up to have their old nets dipped. That really compromised the whole program.”
So far, the combined initiatives seem to be working. Malaria prevalence dropped by 67 percent in Ethiopia between 2001 and 2007, according to a World Health Organization study, while the number of deaths of children under 5 has dropped 56 percent.