Traveling With Bill Clinton in Africa

Debra Zeit, Oromia, Ethiopia -- I just met a group of young women who save lives for a living. They are not nurses. They don't even have a high school education. Yet, they are professional lifesavers. How? These young women are community liaisons between the Godina Health Clinic and the rural community of Debra Zeit. In doing so, they are critical players in a new trend in global health.

In developing countries like Ethiopia, the global health community's focus is starting to turn from initiatives to take on specific diseases like HIV/AIDS, Malaria and Tuberculosis to programs that strengthen public health infrastructures as a whole. The so-called "Health Extension Workers" that I met are at the cutting edge of this trend.

As I travel throughout Africa and Mexico with President Clinton this week I'll document how the donor community (including the Clinton Foundation and the United Nations Foundation, which is sponsoring my trip and sponsors my blogging UN Dispatch, respectively), UN agencies like UNICEF and the World Health Organization, and governments are shifting from disease-specific initiatives to strengthening public health systems.

The story of the young Health Extension Workers helps explain why this shift is so important--and why tackling the scourge of HIV/AIDS, Malaria and other public health emergencies in the developing world depends on recruiting more women like these.

First, some background that helps explain why targeting the disease--and only the disease--is not always effective. In the developing world about 30% of children born to mothers with HIV contract the virus. A drug that helps prevent transmission at birth is relatively inexpensive so around the millennium, the attention of the global health community turned to prevention of mother to child transmission of HIV/AIDS. Donors, NGOs and national governments invested great money and effort to programs that distribute this drug to HIV infected women.

But they hit a snag. The single pill, while helpful, did not have the dramatic affects that donors had expected. Not enough pregnant women were tested for HIV. And those that did know their HIV status did not always have access to health clinics. Even women that did take the pill did not always have the means or wherewithal to maintain the 18 months follow-up regimen. Programs to prevent mother to child transmission were, simply put, not comprehensive enough to put as large a dent into the statistics as donors had hoped.

Enter Health Extension Workers. Young women, who generally lack secondary education, are recruited as community liaisons for local clinics. They are trained not in medicine, but in social work. They are rural health clinics' eyes and ears in their local community. If their neighbor is pregnant, the health worker will let her neighbor know of available HIV testing and prevention programs. The worker is the go-between for the clinic and rural populations.

In Rwanda, use of community health liaisons is more commonplace than in Ethiopia--and have results to show for it. Rural Rwandans generally have quicker access to malaria medicines and higher adherence rates to treatment programs. In some Rwandan villages, women are even elected to the post in open caucuses.

This was one critical missing link in previous efforts to combat mother to child transmissions. This week, President Clinton's visit to Godina Health Center in rural Ethiopia marked the launch of a new partnership between the Clinton Foundation and the government of Ethiopia to, among other things, train 30,000 Health Extension Workers in rural communities throughout the country.

Clearly, this is an ambitious target. Nevertheless, is a goal upon which many thousands of lives will depend.

Mark Leon Goldberg writes for UN Dispatch, a blog about the UN and global affairs. He is traveling with President Clinton this week through Africa and to the Global AIDS Summit in Mexico City.

Comments

[PumaAnn]

It sounds like it's a fascinating trip and endeavor. I look forward to reading about the project and the progress made.

[stell]

Charity begins at home. Why don't you Clinton folks stop showing off, and only talking about it and show results? Enough about targets. Yet another racket where they get to skim money off of the top of billions of dollars pledged by President Bush and other sources, that goes right into the hands of pharmaceuticals that Clinton is contracted with. Rarely does this every really change anything. Just report back when something has actually changed. Enough hearing about the problems already. Another Clinton racket is the whole check cashing thing. These people are obsessed with money. Since this is under the umbrella of a foundation, all of the money gets recycled virtually tax free. They have the money to pay off all of their vendors (who are hard working white Americans I might add) yet they want their supporters to pay it. Then the fly halfway around the world to do "good works".

[Softnsweet]

The Clinton years are over. Impress me and campaign for Obama. Stay out of Africa because you never do anything anyway. Africans have Bush tatooed on their butts because he put the money where his mouth is.

[DBC]

PRESIDENT CLINTON IS A GREAT PERSON . IT'S SAD THAT WE LOST A GOLDEN OPPORTUNITY BY NOT HAVING SENATOR CLINTON IN THE OVAL OFFICE .

[gigi09]

It's sad that you people won't retire their debt! That's what SAD! The Clintons are not to be trusted and we will not forget them either. Obama 08!

[closetodemfection]

Nice to see an article that is actually acknowledging the positive impact Bill Clinton has had on the world. Even if it's buried.

[kevinw]

It is a great effort that President Clinton has been performing in Africa. This system may not be a bad model for urban and rural poor areas, where medical compliance can be an issue in treatment. I wish the MSM would cover items like this rather than speculating whether Obama and Clinton are speaking. Great Job Mr. President.

[gotalife]

Plese tell the President we still support them.

God bless.

[texanna]

This work of Pres. Clinton's doesn't seem to jibe with the angry accusations of the Obama maniacs does it?

[Jjc2006]

Thanks President Clinton. You continue to do good in the world. So glad the hatemongers of your own political party did not get you down.

[gloriar8]

Well you Clintonistas need to know this won't save his ass from being called racist and divisive. He made his own bed, now he has to lie in it. I would vote for another Clinton ever again.

[kevinw]

He was working on this before the campaign, dummy. His foundation has been working on issues like this since he left office. You may want to let go of the Clinton thing. Obama has to face McCain now. That should be the target of your hatred.