Wubitu Hailu Gebrekristos – Kulich Youth Reproductive Health and Development Organization (KYRHDO), Ethiopia
December, 2007
Wubitu Hailu Gebrekristos, a nurse from Addis Ababa, currently serves as a UNICEF consultant. Prior to serving in the position, Wubitu was a clinical nurse in government health centers, NGOs and factory clinics. She joined the Red Cross Society, and managed the Sudanese refugees program established by UNHCR. She also worked with Pathfinder, Action Aid, UNICEF, and UNFPA and served as consultant for WHO. She founded the Kulich Youth Reproductive Health and Development Organization in 2003, and served as managing director from 2004-2006.
The HIV/SRH Integration site interviewed Wubitu Hailu about her experience with providing integrated services in Ethiopia.
Can you provide background information on the HIV/AIDS and sexual and reproductive health situation in your country?
HIV/AIDS
HIV was first detected in Ethiopia in 1984 and the first two AIDS cases were reported in 1986. A National HIV/AIDS taskforce was established in 1985 and the National AIDS Control Program (NACP) was established at a Department level at the MOH in 1987. HIV/AIDS surveillance activities began in 1989. There are many factors that promote the spread of the disease including the presence of sexually transmitted infections, gender inequality, multiple sexual partners, prostitution, men with disposable income, alcohol, unsafe blood transfusion, and transmission from infected mothers to their fetus/child during pregnancy and breastfeeding.
Two medium-term prevention and control plans were designed and implemented in 1989 and 1996, respectively. The HIV/AIDS Policy was formulated by the Ministry of Health (MOH) and adopted by the Council of Ministers in 1998. This created an enabling environment for HIV/AIDS prevention and control. The policy supplemented several policies such as the Health Policy, Women's Policy, and the Education and Training Policy calling for a multisectoral response; guaranteeing rights for People Living With HIV/AIDS (PLWHA); and facilitating the development of policies; e.g., on the supply and use of antiretroviral (ARV) drugs, among other things.
The HIV/AIDS Prevention and Control Office (HAPCO) was established in 2002 after 2 years of functioning as the National HIV/AIDS Council Secretariat (NACS). It had developed and implemented a five year (2000-2004) national strategic framework as part of the national response to HIV/AIDS. Several priority interventions were implemented and several targets were successfully achieved in this period. The strategic plan for the succeeding four years (2005-2008) focuses on the provision of preventive, care, support and treatment services and stipulated ambitious targets.
Encouraging achievements have been seen within the last one and half years of the start of the implementation of the five years strategic plan. These include training and deployment of health extension workers who are implementing the health extension package, the construction and furnishing of various health institutions especially in rural areas, the massive scale-up of ART, HCT and PMTCT services and the massive involvements of communities in the provision of IEC/BCC, social care and support and other activities.
According to the MOH report, AIDS in Ethiopia 6th edition, national HIV/AIDS prevalence in Ethiopia in the year 2005 was 3.5 % and the number of people living with the virus decreased from 1.5 million in the year 2003 to 1.3 million people in 2005. According to the MOH, currently one out of 13 adults in the country is positive. Unless various measures are taken to mitigate the prevalence of HIV/AIDS by all concerned bodies, projections reveal that adult prevalence rate will reach 9% by 2007 and the total number of infected people would increase to 4.7 million by 2014 (MOH, 1998).
Despite early preparation to mitigate the situation, the country ranks among the top 15 countries in the world with regard to the prevalence of HIV/AIDS.
Sexual and Reproductive Health
According to Ethiopia-Netherland AIDS research project, youth under the age of 20 make up more than 50% of the total population of Ethiopia. Early marriage of adolescent women is prevalent among this group with average age of 16.8 years. In urban areas early sexual activity occurs within this group with a mean age of marriage of 16.5 years.
During childhood, girls especially in developing countries including Ethiopia are victims of child marriage, sexual abuse, and female genital mutilation. Throughout their life they may be denied of education, health care, nutrition by their parents. They may be subject to emotional, physical, or sexual abuse by their partners, their relatives or non kin; and forced pregnancy, harassment, trafficking, and rape.
During adolescence, women are exposed to a new set of health risks. Lack of knowledge about their bodily health and appropriate health care services put adolescent women at risk of unwanted pregnancy, early childbearing and unsafe abortion as well as sexually transmitted infections including HIV/AIDS. Denial of formal education and employment to girls makes them vulnerable and unable to make decisions regarding their own sexuality and reproduction to delay marriage and pregnancy, and refuse unwanted sex.
STIs and HIV/AIDS are other major risks adolescents are exposed to, with lack of knowledge about their bodily health system and appropriate health care services. In Ethiopia, because STIs are mostly self treated at home by individuals and masked, it is difficult to estimate its magnitude accurately. However, available data from health institutions demonstrate a high incidence of STIs among youth in the country.
Please tell me about your project or program experience integrating HIV/AIDS and sexual and reproductive health services.
I can tell you about the project experience of my organization, Kulich Youth Reproductive Health and Development Organization (KYRHDO) in integrating HIV/AIDS with sexual and reproductive health: Program in Flowering Plantation Companies.
The situation of HIV/AIDS is serious among workers who are working in different agencies and factories in the country. Currently, there are around 500,000 formally employed workers in government or private organizations. Most of the workers are youth. A pilot study conducted by KYRHDO shows that there are 50,000 formally employed workers of which 37,500 are female youth workers at flower plantations in Oromia region of Ethiopia. Almost three-fourths (75%) of workers are youth in the age group of 15 to 24. These workers are gathered from different parts of the region.
Lack of proper information about HIV/AIDS and RH-related services and the lack of availability of care and support programs are associated with the likely presence of risky sexual behavior .
Some of the reasons that aggravate the risk of HIV/AIDS among flower plantation workers identified by Kulich are:
(1) Absence of workplace orientation at these flower plantation sites about HIV/AIDS and RH- related issues.
(2) Lack of open discussion among youth about HIV/AIDS and RH-related problems
(3) Lack of networking and coordination between the Woreda HIV/AIDS secretariat and flower plantation association
(4) Absence of necessary HIV/AIDS and RH-related services in each project site
(5) Large flow of youths to be employed in the flowering plantation and production sites due to excessive unemployment rate both in Addis Ababa and Oromia region.
(6) Nature and type of work interlink youth women with foreigners, owners and traders in the flower plantation and production sites.
(7) Discrimination and stigma of people living with HIV/AIDS among workers is a common practice.
(8) Some available media are not in a position to disseminate HIV/AIDS and RH education to all the employees working in the area.
Thus, from all the aforementioned identified problems we can conclude that these flower plantation workers are among the highest vulnerable section of the society to HIV/AIDS and RH-related problems.
In this connection KYRHDO has planned to intervene at flower plantation and production companies' workplaces through providing HIV/AIDS prevention for youth workers around Holeta area of Oromia region. The project includes HIV/AIDS and RH-related information dissemination and service, advocacy, psychosocial support and care and support activities. Reducing youth risky sexual behaviour and providing care and support program are vital to avert the spread and impact of HIV/AIDS.
What were the dates of the project/program?
The program began in January 2006. The project is to reach 50,000 workers and right now we have secured funds to work on about 30 companies (15,000 - Workers) up to Year 2009. We are searching for funding to support additional groups in the future.
What was the problem you were responding to when you developed the program?
Most of the workers are young between the ages of 16 and 25 and come from different parts of the country without their parents. They live by renting single rooms in groups. As most of the groups come from rural areas, they lack information on HIV/SRH and are also are vulnerable to contracting HIV/AIDS and other STIs. They also have chances of unwanted pregnancies and for this, they need this integrated program.
What kind of family planning methods do you speak about when you provide information to the factory workers?
Regarding family planning methods all traditional and modern methods are being addressed. Similarly harmful traditional practices are common and is being taught. HIV/ADS, STIs and Maternal and Child Health is also included in the topics.
Who was involved in the discussion and decision-making on the approach to take to address the problem?
As the companies form an association, we approached the association management and the association agreed on our program intervention and assisted us by formulating a Memorandum of Understanding in order to mobilize the companies. Later on a sensitization workshop was organized for owners, managers and supervisors of the companies and then after they became part of our collaborators in facilitating the program
Did you involve the community in developing the program?
We involved some sector organizations, such as women affairs, district managers and others.
How did you work with the District Health Office in setting up the program; for example, in strengthening the systems and services?
Whenever we have trainings and need some supplies, we contact them. Also we have referral and reporting linkages with them. In any workshops and seminars as well as common agendas we have good working relations.
Are there links to community support groups as part of your program?
Our young peer educators, after the working hours and holidays, pass information to the community members using dramas and musical entertainments. Similarly, the community members will be invited and participate in any sensitization and educative activities of RH/HIV/Gender issues.
How do the providers and clients feel about the integrated activity?
Currently this integration is practiced in most of our health institutions, be it NGO or GO. The integration in our project sites is very important and has no such significant problem and all providers consider both issues of HIV and SRH to be inseparable.
What obstacles did you encounter from a program standpoint and how did you address them?
Creating different approaches to entertain youngsters to get a large number of youth clients and getting ample time to address the workers in the workplace were some of the obstacles we faced during program implementation. To overcome this problem, we used different approaches and also discussed with plantation owners, managers and supervisors how to improve the young SRH problems of the workers in the workplace. We formed a steering committee drawn from workers, supervisors, managers and district women and health offices.
Another problem arose when we tried to communicate with the company owners regarding the program. The owners feared using worker time for HIV/SRH training and this was a bottleneck for the start of the program.
Did you make adjustments to your approach as you went along? Please describe.
In the case of workplace RH/HIV/Gender programs, time is a big issue for the company owners and in this case we use multimedia on top of the peer approach. In this approach we organize youth groups to manipulate tape recorded audio cassettes which consist of different RH/HIV/Gender topics. Using amplifiers and speakers the message reaches each worker in different green houses for workers in flowering companies. Currently we are working on 10 flowering companies and after some weeks we will add another 30s. This approach is unique and donors appreciated the innovative activities being carried out by the organization.
Did you have need for special resources to implement your approach (e.g., funding, staffing, supplies, and consultants)?
Of course resources (funding, human and materials) are very important, particularly to establish clubs and use multimedia channels.
Who funds your program?
World Learning, DSW- A German Foundation Organization, UNAIDS, Stephen Lewis Foundation and Pact.
How did the project team decide on a system to balance work activities (e.g., addition of new activities with existing activities for the purpose of integration)?
If there is a potential beneficiary in immediate need of integration activities, the project team will immediately discuss and act to bring the activity in place. There are many times that this type of action took place in the process of activity incorporation.
Were there systems you developed to manage integrated services, such as client follow-up or special complicated cases?
We have referral services for workers for surgical contraceptive methods. For workers that are positive, we have home based care services as well as counseling services for FP.
Was there training needed in order to be able to offer integrated services?
Yes we organized different trainings for both providers and youth on peer education and on how to manage clubs. Trainings also focused on issues related to gender, HIV/AIDS and family planning, and how to communicate with and handle clients. The trainings took one to two weeks.
How did you evaluate the success of your activity?
To meet our objectives we have daily evaluation formats as well as checklists. Using this tool we evaluate the activities and also provide feedback on the spot for corrective measures.
Do you have reports or tools related to the project?
Yes, we have a strong Management Information System in our project area. There are different periodical report formats developed for field workers, program officers, finance officers and finally report format for compilation. Some forms are developed by donors based up on their interest and some are by the implementing organization. On top of this we have periodical meetings and monitoring visits.
Contact Information
Wubitu Hailu Gebrekristos
P.O. Box 28511/1000
Tel. 09-405661 0r 011- 5 156220
Addis Ababa, Ethiopia
fitsum2002@yahoo.com