A Day in the Life of Almaz Dalsha, Health Extension Worker, AMREF

By AMREF staff in Ethiopia 

Almaz Dalsha bends low to enter the dark, quiet hut in the village of Doiso in South Omo’s Malle District. She makes out the dark form of a woman draped in a blanket, huddled on a stool at the far end of the hut. Malo Woshto watches in silence as her visitor approaches. A toddler peers curiously from behind her. On the floor beside them is a cowhide, on which sleeps a tiny baby, under a mosquito net.

Almaz, a health extension worker, travels miles of rugged terrain daily to the village’s 6,070 inhabitants, providing health education and basic care. She gives mothers ante-natal care, educates them on nutrition and the importance of using a mosquito net. She also advises them to breastfeed exclusively for six weeks and encourages them to take all their children for vaccination at the monthly outreach clinics.

Almaz examines the baby – he has no name yet and will only be given one when he begins to walk. Malo was in labor for three days, with a traditional midwife in attendance. When the baby finally came, she was exhausted from the ordeal. Three days later, she is still bleeding, and getting increasingly weaker.

Almaz visited 27-year-old Malo frequently when she was pregnant, providing ante-natal care. She had instructed Malo to send for her when she went into labor, but that did not happen. A day after the baby was born; Almaz visited and found her bleeding.  In her weakened state and with no appetite, Malo had no breast milk for her new baby.  She has three other children.

“I refer cases that I cannot handle to the health centre. But Malo is reluctant to go because she cannot afford the five birr (39 US cents) the center charges for things like gloves and drugs,” explains Almaz.


“Many women are wary of going to the health centre for services like family planning, ante-natal care and delivery,” Almaz says. “The nurses who have been posted here do not speak the local Malle language, so the local women feel like they are talking to strangers. Instead they come to me. I am often overwhelmed because I cannot serve them all effectively.”

“Sometimes they simply ignore our advice. For example, if you tell a pregnant woman to get a lot of rest, she will not be able to because she has chores to do – fetching water and firewood, cooking, and taking care of the children. Many women have miscarriages because of walking up to eight kilometers to the river and back with a 20 litre-jerrican on their backs,” says Almaz.

Things are gradually changing though.  “What I have learnt from AMREF has been very helpful because it has given me additional skills that help me to work well with the community. AMREF’s training has made me more effective in my work, and I am seeing the results.”

Written by: AMREF staff in Ethiopia.  AMREF is a member  of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

How A $300 Investment Saves Lives

By Susan O’Halloran, MPH

If you’ve ever been to the developing world, you know how especially important it is to keep from getting sick or injured.  The hospital can be miles away and there is really no easy way to get there.  So what happens when a child gets sick, or a woman needs help delivering her baby, or a man is cut with a machete while hunting?  Maybe there is a clinic within walking distance. Maybe not.

Who does the community turn to?  More and more communities have come to depend on local residents who have been trained as frontline health workers.  Frontline health workers are the first point of contact for millions of people who live beyond the reach of hospitals and clinics.  Many are community health workers, midwives, and local pharmacists, though they can also include doctors, nurses and other clinicians who serve near the community.

Training a frontline health worker from the local community makes good sense.  Once the frontline health worker is trained, they typically stay to care for the community and don’t leave to take work elsewhere.  They understand the local attitudes and behaviors and can work closely with their community to educate them about how to achieve optimal health. And, they are a “best buy” for the money.  It can cost as little as $300 to train a frontline health worker in crucial lifesaving skills.  Countries like Ethiopia and Bangladesh, who invested in training frontline health workers, are cutting mortality rates significantly among vulnerable groups like women, newborns and children under five years old.

How much is a life saved worth? If each frontline health worker trained for $300, saved 10 lives, you could say the cost of saving that life was $30!  Yes, this is overly simplified, but you get the point – training frontline health workers is a cost-effective investment and we need MORE frontline health workers trained, retained and supported in developing countries to meet our global health challenges.

How will we make this happen?

  • By calling upon the U.S. government to increase the number of trained and supported frontline health workers from 140,000 to 250,000 by 2015.
  • By sharing what we learn about how frontline health workers save lives, what it costs, how to continually motivate frontline health workers in their jobs and how to attract new frontline health workers, to name a few topics.
  • By forming alliances such as the Frontline Health Workers Coalition to work together with the U.S. government policy makers and administrators, corporations, NGOs and others to set frontline health worker goals in countries where the need is greatest and to measure our progress toward achieving those goals.

The 25+ members of the Frontline Health Workers Coalition will contribute to this weekly blog to tell the story of the frontline health worker – success stories as well as what happens when there is no frontline health worker.  We’ll look at how important U.S. policy efforts are to guide programs and we’ll put a name and a face to the frontline health workers responsible for saving lives where the need is greatest.  Your comments are always appreciated.  You are encouraged and thanked for sharing this blog.

Written by: Susan O’Halloran, MPH. Susan is the Director of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.