Hamid’s Story: Healthcare Facility Renovations Bring Vital Change
The Afar region in Ethiopia has performed worse than the rest of the country regarding improvements in most reproductive, maternal, and child health services—mainly on family planning services, antenatal care visits, births attended by skilled providers, and facility-based deliveries. According to the Ethiopian Demographic Health Survey 2019, Afar has a high adolescent birth rate (28.7%), low CPR (12.7%) and low skilled birth attendance (35.3%). An analysis of hospital-based maternal deaths also reported dramatic inequalities in maternal mortality ratios among regions, ranging from 74 deaths per 100,000 live births in Tigray to 548 deaths per 100,000 live births in Afar.
Health workers in the rural town of Kelwan, in the Afar region of Ethiopia, struggle to provide essential reproductive, maternal, newborn, child, and adolescent health services due to poor hospital infrastructure. This often means rationing supplies, making impossible decisions, and being unable to meet the needs of patients.
Hamid is a young public health expert born and raised in Kelwan. He was assigned to lead Kelwan Hospital in the Afar region, an underperforming hospital. The hospital infrastructure was not helpful to health workers, especially in the maternal and child health area, which was overcrowded, lacked privacy for clients, didn’t have basic amenities like water and electricity, and was not equipped with essential medical equipment to provide the service. On top of that, the segregation of duties between departments made work difficult.
Conflict in northern Ethiopia has affected several areas in Afar and neighboring regions for the past few years, compounding Hamid’s challenges. Due to the fighting, millions have been displaced, thousands have lost their lives, and several public-sector health facilities have been damaged and looted. These conflicts have hampered the delivery of essential services, disrupted livelihoods, and heightened risks—including maternal and infant mortality and dangers associated with gender-based violence (GBV), disproportionately affecting women, girls, and adolescents. Health facilities throughout the region have been destroyed during the fighting. Kelwan Hospital was not spared, as the hospital was looted and left even more damaged.
Functional health posts are crucial for increasing community-level access to reproductive, maternal, newborn, child, and adolescent health services. Through the A’ago project, EngenderHealth built on decades of successful experience supporting health facility renovations to provide support and technical assistance to Kelwan Hospital.
We developed and implemented a rehabilitation preventative maintenance plan with our partners and advocated for annual budget allocation. We support restoring essential reproductive, maternal, newborn, child, and adolescent health services by strengthening facilities’ ability to provide the minimum essential service packages, providing intensive technical assistance, and mobilizing crucial medical equipment and furniture. When we work to rehabilitate health facilities, a key focus is on optimizing financing and in-kind donations—this builds off our recent experience supporting the renovation and restoration of essential services in more than 60 health facilities in conflict-impact areas of the Afar and Amhara regions.
Hamid received support to mobilize resources from his facility and the local government. Because of these additional resources, the standard of care at Kelwan Hospital has been greatly improved. The maternal health department now has dedicated rooms for antenatal care, skilled birth attendants, and family planning services. Additionally, WASH facilities, the electric supply, and waiting rooms have been restored. The looted and damaged diagnostic equipment has been replaced. Crucially, Hamid helped to establish a one-stop gender-based violence center that supports survivors affected by the Northern conflict.
Through community mobilization and renovations to the facility, Hamid’s healthcare facility can now hire more skilled birth attendants, improve access to quality RMNCH services, ensure a continuous supply of essential medicines, and expand family planning and child health services. And, should the facility need renovations in the future, Hamid now has the confidence and skills to mobilize additional resources.