Lieleti Gebremariam casts a last look over her desk in her office in Axum. Folders and loose papers form several piles in between which an Ethiopian table flag is visible. The other desks of her colleagues portray a similar ordered chaos. The Mother and Child Health Care specialist puts on a brown jacket over her sports t-shirt and leaves for the health post in the sub-district (kebele) of Dura. “Normally my main duty is to give training to health extension workers and nurses in the health centres. We train them on how to carry out nutritional screenings and immunisations and we educate them on feeding practices, especially for children under-2,” she explains.

Today, Lieleti will join a Community-Based Nutrition day, which happens once a month. When she arrives in Dura, one of the 16 kebeles under her supervision, groups of mothers with their children have come together. She heads over to the two extension workers of the health post who have already started with the monitoring of children under-2 years of age. “Due to the training, the capacity of the health extension workers increased, and because of that the changes are visible. For example: nowadays we hardly have any cases of severe malnourishment anymore! In Dura, most of the people that come to see a doctor have other health problems not related to malnutrition,” she says.

Demanding health care

The mothers wait patiently. One child after the other gets lifted on the scales and measured around the arms by a health worker with a so-called mid upper arm circumference tape. The other health worker records the respective figures of weight, growth and behavioural changes in a notebook. “Nowadays, mothers are properly feeding their children. This change is because of the effort of the health workers, development agents and community networks,” she says. In Lieleti’s district (woreda), there are 28 health extension workers, 500 voluntary women groups to promote health, hygiene and nutrition – and 2,500 female one-to-five networks. This strong force to combat malnutrition is needed, as transport is limited and distances are long for mothers and their children to travel.

In the course of Lieleti’s 20 years in the health sector, she has seen the change with her own eyes. Having started as a junior nurse, she now works mainly with pregnant and lactating women. “In the earlier times, people were not bringing their children for immunisation but nowadays not much convincing is needed as people have a higher awareness on the health benefits of doing so,” she explains. This has led to fewer births at home, which has decreased mortality rates of children and mothers alike. Also, a more modern lifestyle has changed perceptions towards family planning, unlike “before they had 10 children, now families have 5-6 children”. Ethiopia’s battle against malnutrition is however far from over. Lieleti hopes to see one more change: “I want the community to demand these services,” she says and continues to monitor the work of the health specialists.