More than 40,000 women have been recruited to be sentinels for the early detection of TB.

At first, Beyera Guta assumed he had a cold. Months passed and the sickness dragged on until he became so weak that he could no longer provide for his family. Tuberculosis was consuming his lungs and slowly killing him.

The person who saved his life wasn’t a doctor, or a nurse. It was a 24-year-old woman from his village called Anuma Moreda, who hadn’t completed high school. Alerted to Guta’s symptoms by his cousin, she examined him and sent a sputum sample to the local hospital. When the result came back positive, Moreda supervised his treatment and nursed him back to health.

This is the future of healthcare, Ethiopian-style. In a country where 22 per cent of the population lives below the poverty line, and there are just three doctors for every 100,000 people – compared with 30 or 40 in Europe – the government has pioneered a strategy that would be unthinkable in most developed countries. More than 40,000 women – some as young as 16 – have been recruited to carry out tasks normally only done by doctors and nurses: give childhood vaccinations, provide antenatal care, screen for deadly diseases and supervise their treatment.

In a post-Ebola world, these health-extension workers create a link between the community and the health service that allows for the quick dissemination of information. “The problem with Ebola was recognizing it. It took three months from the first people showing symptoms to a diagnosis being made, says Seth Berkley, CEO of Gavi, a global vaccine initiative. “Ethiopia has established an infrastructure whereby the extension workers could be sentinels for the early detection of disease.”

Women make more reliable recruits than men as they are less likely to leave the village to find work. The first graduates of the program were deployed 10 years ago. Since then they have been credited with improving the health of the population to such an extent that other African countries are taking notice. The increase in life expectancy, for example – from 47 years in 1990 to 64 years in 2013 – can partly be attributed to the scheme, as can the reduction in child mortality, deaths related to malaria and new HIV infections.

“There are now 11 to 13 African countries that are either working on or thinking about introducing similar programs,” says Haileyesus Getahun of the WHO community engagement unit in Geneva, Switzerland.

A current focus of the program is TB, a disease that kills an estimated 4400 people around the world every day –more than HIV and AIDS. Ethiopia has the third highest rate of TB in Africa. It is tough to treat: diagnosis takes several weeks, and drugs must be taken for six to eight months, otherwise you risk the disease coming back, or drug-resistant strains emerging.

Moreda and her colleague Gobinei Kebede work out of a mud and timber hut plastered with immunization charts and disease prevention posters, in the rural region of Oromia, about 2 hours’ drive from the capital, Addis Ababa. The women serve a community of around 5000, some a 2-hour walk away. Things get particularly tough during the rainy season, when the roads turn to mud.

The women screen and test the community for TB, and ensure people take the drugs they receive from the local TB clinic correctly. In serious cases, such as drug-resistant TB, patients are moved to the larger hospital in Addis Ababa.

When Moreda completed her year-long training at the age of 17, she received a starting salary of around $30 per month. Today she earns $80 and expects this to rise to $100 – just short of a nurse’s salary – in the near future. The pay and level of training is a key difference from community schemes in other countries, which tend to use volunteers.

“Ethiopia has done a number of smart things,” says Mario Raviglione, director of the WHO’s Global TB Program. “They pay their workers, which means they get status in their community. With this you can actually reach all the people in the community who need treatment.”

At the Ministry of Health, there’s talk of training some workers to the equivalent of a family doctor. When I ask Moreda and Kebede about this, they smile and shake their heads. “That would be good, but I don’t think it will happen soon,” Kebede says.

Both have young kids, but they continue to work. “We are the only ones who are providing health services for the community,” Moreda says. “Juggling childcare is difficult, but I hope I am being a good role model for my son.”

Source: New Scientist
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