The Common Good

Ethiopia: How Foreign Aid Has Helped a Generation

View of the Amhara Region from the plane bound from Addis Ababa. Photo by Cathleen Falsani.

LALIBELA, Ethiopia -- You know the images you have in your mind of Ethiopia from 27 years ago? The ones from the nightly news reports on TV about the famine in the Horn of Africa as the death toll and horror stories grew.

Scorched, cracked earth. The carcasses of emaciated, dead cattle lying in the baking sun. Hundreds of thousands of stick-thin refugees wandering in the dust, hoping to have enough strength to make it to a camp that might have water and food. The babies and children with orange hair and distended stomachs -- indications that they were in the advanced stages of malnutrition and starvation.

I am happy to report that the Ethiopia of 2012 is not the Ethiopia of 1985.

Thanks to global efforts (Live Aid, etc., back in the day), foreign aid, and the very real efforts of the Ethiopian government and people themselves, the land I saw earlier this month looks nothing like those old images in my mind. In fact, parts of the country that we traveled through were so verdant and lush -- farmlands rolling out in various shades of green like a St. Patrick's Day quilt  -- that if you'd blindfolded me when I got on the plane and taken the blind of when I stepped of the bus in the rural area outside Bahir Dar near the Sudanese border, I might have thought I was in Ireland's County Kerry rather than Ethiopia's Amhara Region.

Ethiopia is beautiful. In every way. Its people. Its resilience. Its ingenuity and entrepreneurial spirit. In the way it cares for its land and its people, and the way they care for each other and their visitors. There is a spirit in Ethiopia I've experienced elsewhere only rarely.

In a word I'd call it HOPE. But it's a hope not based on daydreams and fairytales. It's a hope based in hard work, smart planning, and forward thinking.

The ONE MOMS/ONE MUMS group I traveled with to Ethiopia this month spent a few days out in the northwest of Ethiopia, visiting hospitals, clinics, agricultural collectives, demonstration farms, and a remarkable group of women bee keepers (but I'll save that for a future post.)

What those few days in the Amhara region put regal faces, calloused hands, quick minds, strong backs, and busy feet to the statistics we hear so often about foreign aid to the developing world -- Africa in particular -- and what financial resources from the U.S., U.K., and the rest of the G8 (and their posses) can and cannot do on the ground half a world away.

Let me tell you what I saw: A lot. Epic change. Hope for the future. Plans to avert disasters -- "natural" or human-made.

In 1992, the proportion of the Ethiopian population that was undernourished was 69 percent. Today, the percentage of undernourished Ethiopians is 41 percent. That's still a lot of hungry people, but it's a dramatic decline in 20 years. Infant mortality in Ethiopia is one of the highest in the world (68 per 1,000 live births) -- but that rate dropped 39 percent between 1990 (when the rate was 111 deaths per 1,000 live births) and 2010, according to UNICEF.

Ethiopia also has reduced the under-five mortality rate by 47 percent between 1990 and 2010.

"These achievements are largely a result of Ethiopia's investment in a community health system and a cadre of 35,000 health workers who provide front-line care,"
 Dr. Rajiv Shah, administrator of the U.S. Agency for International Development (USAID), wrote in the May/June issue of Frontlines magazine. In a nation where only 10 percent of births occur in health facilities, community health workers -- skilled in birth attendance and equipped with affordable tools to save the lives of mothers and newborns -- serve a critical role.

"But despite this significant progress, one in 11 children in Ethiopia do not live beyond their fifth birthday," Shah wrote. "Development is full of problems we have few ways to solve. Helping children reach their fifth birthday is not one of them."

Here are a few statistics (because I know some of you have an easier time getting your heads around numbers than stories) that speak to the challenges Ethiopia (and elsewhere in the developing world) still face:

  • In 2011, Ethiopia's under-five mortality rate was 88 child deaths per 1,000 live births (and childhood mortality is higher in rural areas than it is in urban areas.)
  • 29 percent of children under the age of five are underweight, and 44 percent of all children in Ethiopia are stunted
  • Only one in every four children 12-23 months old has been fully vaccinated (according to 2011 statistics) -- but that is a 19 percent increase since 2005.
  • Ethiopia has a high maternal mortality rate -- 676 maternal deaths per 100,000 live births in 2011.
  • In Ethiopia, 30 percent of all deaths of women ages 15-49 are pregnancy related, and only 34 percent of pregnant women receive post-natal (or antenatal, as they call it in Ethiopia) care from a skilled provider after their most recent birth
  • According to 2011 figures, the most significant barriers in Ethiopia that prevent women from seeking adequate pre- and post-natal care are the distance they must travel to the nearest health facility (66 percent), the availability of transportation to the health care facility (71 percent), and a lack of money (68 percent.)
  • 7.6 million children worldwide under the age of five die every year because they don't have access to basic life-saving interventions such as vaccines and bed nets
  • 370,000 children are born every year with HIV, transmitted to them by their mothers

OK. So that's the bad news.

But there's good news, too, and lots of it, from what I witnessed in person across Ethiopia.

There is a new program, run by the Ethiopian government and funded by USAID, called the Integrated Family Health Program (IFHP). It's a five-year program (begun in 2008) that ultimately is expected to reach half of the Ethiopian population with training and services to improve health practices both in individual households and in communities at large. One of the program's big pushes is to get young children fully immunized. So, for instance, when a mother or parents come into a health center or outpost to discuss family planning -- Ethiopia is encouraging the use of long-term contraception such as Depo Provera injections or sub-cutaneous contraceptive implants -- their child or children can be immunized at the same time.

The USAID's IFHP works side-by-side with an innovative program of the Ethiopian government itself called the Health Extension Program. The Ethiopian government had trained and salaried more than 35,000 health care providers -- the vast majority of them women -- and dispatched them to 286 districts in the country serving approximately 32 million people. Most of the people served by Health Extension workers live in rural areas where hospitals and clinics are few and far between. They go out to the villages and make old-fashioned housecalls, providing services from prenatal exams and post-natal follow-ups to immunizations and basic health care needs.

I had the privilege of meeting some of the Health Extension workers and they are an extraordinary bunch. Young, ambitious, and seemingly tireless. Their work has been credited with the 28 percent decrease in under-5 child deaths, literally saving the lives of 560,000 children since 2005. Amazing.

MADERA WOREDA HEALTH OFFICE AND NBESAME HEALTH CENTER

Listen to one of my traveling companions, the marvelous British ONE Mums blogger Michelle Pannell (aka @michelletwinmum) talk about our visit to the health centers below as you view the slide show of my photos from that amazing day in rural, northwest Ethiopia.


At the end of 2011, a severe drought began in the Horn of Africa, leading Ethiopia's neighbor to the east, Somalia, officially to declare a famine in June. The drought is believed to be the worst in more than 60 years, affecting more than 13.3 million people -- echoing the emergency and images of the famine that struck Ethiopia in the mid 1980s. But this time, in Ethiopia, the story unfolded differently because of a safety net. After a severe drought hit the country in 2003, with the help of USAID and other foreign donors, the Ethiopian government launched a food security program -- the Productive Safety Net Program.

This safety net "ensures families living on the edge are not forced to sell off their assets, mainly livestock, in order to feed their families," Dina Esposito, director of USAID's Office of Food for Peace, told Frontlines magazine earlier this year. "The labor, the quid pro quo for those fit enough to partake, is channeled into public works projects designed to improve communities as a whole."

Watersheds and irrigation systems were built. Canals were dug, and schools and health clinics were constructed or rehabbed by workers who were at the risk of becoming food insecure. According to USAID, today, because of Ethiopia's safety net program, 8 million people receive assistance in a timely and predictable way, and crises -- like the famine of the 1980s -- have been averted.

Our group visited a USAID-funded project -- Empowering New Generations to Improve Nutrition and Economic Opportunities (ENGINE) -- that compliments the Ethiopian government's food safety net program in Lalibela, a rural district about 150 km from the urban center of Bahir Dar. The program, focused on women and their children, strives to improve nutrition and financial stability by teaching new agricultural and nutritional skills.

We visited what is called a "demonstration farm," nestled in the verdant rolling hills and farmlands, where goat, sheep, and cow herders passed by on their way to and from pasture land. At the farm, ENGINE workers have planted new crops -- such as beet root, cabbage, carrots, chard, and other greens -- that are rich in nutrients and vitamins in the hopes of getting local mothers to introduce them into their everyday menus.

Women from the surrounding villages come to the farm for classes, learning about cultivation, nutritional values of the new foods, and, perhaps most importantly, how to prepare the vegetables ways that preserve their nutritional content best. This led to one of the more enjoyable outings of our sojourn in Ethiopia: a food demonstration where mothers (many of them with a toddler at their elbow and an infant nursing at their breast) watched as ENGINE workers showed them how to prepare the traditional porridge -- a starchy staple in Ethiopian diets, particularly among children -- with a nutritional and protein boost by adding legumes to the grains, and then stewed or chopped carrots, greens, beets, etc., to the mix to give it flavor and more vitamin power.

Baby food! It was so simple and yet so brilliant. By adding a handful of ground beans and a soupcon of Swiss chard and mashed carrots to the porridge, children would receive a complete protein in one dish.

At the end of our visit to the farm and baby food cooking demonstration, I was asked to say a few words to the villagers -- mostly mothers and girls, but a few men looking on from a safe distance, too. I told them (in English, as a USAID guide interpreted for me) that while we may look different and sound different than they do, we are essentially the same. They are our sisters. Their children are our children. And we care for them, want them to be healthy, and succeed, just as we do our own children.

I said it was an honor  -- a blessing, realy -- to meet them, that we would share their stories with the rest of the world so that other mothers in other countries who are struggling to make ends meet, feed, and care for their children, would be encouraged.

And I told them that we would remember them and pray for them.

I hope you might join me in that effort, praying for their continued strength and tenacity, and giving thanks for the same. I also hope you will join me in reminding our politicians in this election season that U.S. foreign aid does make a difference. It saves lives. It changes whole communities and can help transform a whole generation.

Let's do what we can to make sure foreign aid stays safe and that our budgets aren't balanced on the backs of -- or by mortgaging the lives of -- the poorest of the poor.

Below you can see a few images from the farm and cooking demonstration.

They are such beautiful people -- in every way.

USAID/ENGINE DEMONSTRATION FARM

Cathleen Falsani is Web Editor and Director of New Media for Sojourners. Follow Cathleen on Twitter @GodGrrl. Cathleen is traveling in Ethiopia this week as an expense-paid guest of the ONE Campaign on a listening-and-learning visit to programs and organizations that work primarily with women and girls. Learn more about ONE Moms and the Ethiopia trip HERE. Watch for Cathleen's tweets (and those of her ONE Moms traveling companions) on Twitter with the tag #ONEMOMS.

Photo credit: All photos by Cathleen Falsani for Sojourners.

Read more of Cathleen’s posts from her Ethiopian journey by clicking on the links below.

What Americans Think About Foreign Aid Might Surprise You

Ethiopian Orthodoxy, Tawahedo, and 'Being Made One'

GGNFT (Ethiopia Edition): Teddy Afro

Ethiopia: The Face of God

Ethiopia: Motherhood is Powerful, Precious

Ethiopia: God Is Even Bigger Than We Think

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