In response to severe healthcare challenges in Ethiopia’s Moyale woreda of the Somali Regional State, a Community Based One Health Insurance scheme was launched in January last year. This initiative has since improved access to both human and veterinary healthcare services, benefiting over 800 residents in its first six months of operation alone.

The Moyale woreda of the Somali Regional State in Ethiopia, particularly in the kebeles (neighborhood districts) of El-Gof, Dik, Baligoriyo, and Gulale, faces significant challenges due to persistent drought conditions. In this region, income generating activities heavily rely on livestock rearing and small rain-fed agricultural practices. However, infrastructure related to human and livestock health, road transportation, education facilities, and agriculture are underdeveloped.

In this context, the local health facilities are facing insufficient availability and accessibility of essential human and veterinary medications. Mr. Hussein Nurow, a veteran employee at El-Gof health post, a government-operated health facility for the past 16 years, noted that “the Moyale woreda health office, provides drug supplies only once a year, lasting for a maximum of 5 months.” During the remaining 7 months, with an average of 3-5 patients visiting the facility daily, Mr. Nurow is forced to refer them to remote health facilities in Lehey or Moyale, located 22 to 37 kilometers away. He expressed his frustration: “this not only affects my confidence and morale but also hinders my ability to help patients effectively.” The residents of the Dawa zone also lack insurance coverage, as the community health insurance scheme operational in other regions of Ethiopia has not been introduced. Consequently, the wellbeing of pastoralist and agro-pastoralist communities is severely impacted.

 

 

The Story of Mrs. Makay Mohamed Edin

Take the case of Mrs. Makay Mohamed Edin, a 36-year-old mother of five. When she suffered from acute watery diarrhea, the local health post’s medication shortage forced her family to seek treatment at Lehey primary hospital. This led to reallocation of their household food budget for medical costs, loss of three goats to predators during their absence, and additional transportation expenses. “Our means of living has been adversely impacted,” she shared,” these occurrences were a result of the lack of access to essential health services in our kebele.”

As a result, these challenges have let to broader consequences including the loss of human and livestock lives, increased medical expenses, diminished livelihood assets, heightened job burden on women, deteriorating wellbeing of community members, and the perpetuation of poverty, among others.

Addressing healthcare issues with the One Health insurance initiative

To improve access to health services, a community based One Health insurance scheme was launched in two Moyale woreda centers in January 2024 as part of the HEAL project, an initiative that aims to improve the well-being and resilience of vulnerable communities in pastoralist and agro-pastoralist regions of Ethiopia, Somalia, and Kenya. The project focuses on piloting and expanding new and proven methods such as transforming service delivery to an integrated and comprehensive approach that addresses human, animal, and environmental health issues. Funded by the Swiss Agency for Development and Cooperation (SDC) and implemented by VSF-Suisse in collaboration with amref Health Africa and ILRI, it underwent consultations with community leaders, healthcare providers, and local authorities.

VSF-Suisse has provided essential human and veterinary drugs, renovated health facilities, printed and distributed member ID cards, and various vouchers. We also offered technical support to the established health insurance scheme and conducted capacity-building training.

To guarantee access to human and veterinary services for all, non-members of the insurance scheme should be granted access to both human and livestock health services through the One Health Insurance after paying an appropriate service charge for the services they receive. Households identified as extremely poor are exempt from the membership fee.

The impacts of One Health Insurance

The program is improving the availability and affordability of essential drugs in local human and veterinary health facilities. Hussein Nurow stated that “the drug shelf is currently stocked with a wide range of essential medications in sufficient quantities. I confidently claim that a health post similar to El-Gof’s, which is fully restocked with all essential medicines, cannot be found elsewhere in the Somali region of Ethiopia.”

Individuals and particularly the ones from disadvantaged backgrounds can now easily access healthcare services near their homes, reducing the need for referrals to other facilities except for cases requiring specialized medical care. As of June 30, 2024, a total of 841 individuals have utilized various medical services in the target kebeles. The number of clients visiting these health facilities increased by five times.

The implementation of the one health insurance scheme has enhanced the health outcomes of both humans and livestock by decreasing morbidity and mortality rates, cutting down medical costs, alleviating the burden on women’s job overload, and boosting household income within the designated HEAL sites. The One Health Insurance has also had a positive impact on the well-being of healthcare professionals employed in local one health facilities. Furthermore, the scheme has further facilitated closer cooperation between human and veterinary service providers. This collaboration has resulted in improved planning, documentation, resource and experience sharing, as well as weekly joint discussions to review achievements, identify gaps, and address challenges.

Finally, Shaga Mohamed, a participant of the One Health Insurance program, asserts that “this innovative concept has enhanced the provision and accessibility of essential healthcare services, thereby addressing the root causes of poverty within our communities. There is a clear consensus that this initiative should be expanded to other kebeles in Moyale Somali woreda to maximize its impact.”

Contributed by

Mohamed Haji

Moyale Field coordinator

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