In response to the COVID emergency, we donated €2,000 to support the families of children receiving treatment at the center and €2,000 to support families involved in the CHANGE project.

Context and intervention strategy

The project will take place in Ethiopia’s Wolisso district, a rural area in the South West Shewa zone of the Oromia region, approximately 110 kilometers southwest of the capital, Addis Ababa. Although the current period of political reform offers hope for equitable development for the Ethiopian population, the country faces many challenges.

With more than 100 million inhabitants, Ethiopia is Africa’s second most populous country. Eighty-four percent live in rural areas, where access to healthcare is very limited. Forty-three percent of the population is under 15. The malnutrition rate among children under five exceeds 23%. Access to schooling is also limited, with an illiteracy rate of 54% in rural areas (Ethiopia Demographic and Health Survey 2016, Central Statistical Agency).

The needs of people with chronic illnesses, mental health conditions, and disabilities are severely neglected. The 2007 census reports an unrealistic figure of 1% of the Ethiopian population having disabilities, far below the WHO estimate of 17.6% (World Report on Disability, WHO 2011). People with disabilities are the most disadvantaged social group and face strong sociocultural stigma that leads to isolation (Disability Rights in Ethiopia, SIDA 2014). Access to healthcare is poor, while families of children with disabilities report greater satisfaction with services provided by nongovernmental organizations—CBR, physiotherapy, occupational therapy, and speech therapy—than with government services (Children with disabilities in Ethiopia: The hidden reality, The African Child Policy Forum 2011).

In Wolisso district, approximately 8,000 people with disabilities, including 1,280 children and adolescents, are registered with the Ministry of Social Affairs. These figures are far below the global average because there is no systematic identification process: only people who come forward voluntarily are registered.

The main problems are limited access to care, particularly because of cost, a lack of coordination and follow-up for children, and a shortage of qualified healthcare staff.

The intervention strategy builds on the complementary expertise of two key organizations in Wolisso, St. Luke Hospital and VCBRA, by:

• Drawing on St. Luke’s central role
• Strengthening its services, starting with the physiotherapy clinic, by hiring a second physiotherapist to work with pediatric patients and purchasing suitable equipment
• Developing staff skills through training and technical supervision
• Establishing coordination with VCBRA and other hospital departments, including pediatrics, neonatology, and the malnutrition unit
• Mapping children with disabilities in the urban area as a foundation for future mapping in rural areas
• Training staff at local healthcare facilities—health centers and health posts—to identify and refer children with disabilities

The current situation presents a valuable opportunity: responsibility for rehabilitation has moved from the Ministry of Social Affairs to the Ministry of Health. This change is expected to reshape how healthcare services are organized. They will no longer be able to focus solely on acute care but will also need to address the course of conditions, follow-up, and rehabilitation.

Beneficiaries

The main group of direct beneficiaries consists of children and young people aged 0–18 with disabilities and developmental delays. The most common conditions are cerebral palsy, Down syndrome, clubfoot, spina bifida, hydrocephalus, autism, and brain injuries resulting from malnutrition, infection, or complications during childbirth. Each year, around 100 children receive treatment at St. Luke Hospital’s Physiotherapy Unit, out of a total of 874 patients treated by the department in 2018. Another 115 children participate in VCBRA’s Community-Based Rehabilitation program. However, the total number of children with disabilities in the target area is estimated to be much greater. Beneficiaries will be identified through a survey during the project’s first months, based on their physical and psychological condition and their family’s socioeconomic circumstances, prioritizing those in the most vulnerable situations.

The second group consists of the children’s family members, particularly mothers. They often experience social isolation because of prejudice toward their children’s disabilities and the responsibility implicitly attributed to them in most cases. They rarely have financial independence, as caregiving takes up almost all their time.

The third target group is a representative group of healthcare staff working at St. Luke Hospital and local health centers and health posts, approximately 80 people. Among them, one existing physiotherapist and a second to be recruited will help implement activities as well as receive training and supervision. The hospital’s other staff will receive general disability training.

Quantitative outcomes: 40 children with disabilities will be identified and referred to care and rehabilitation services; a total of 150 children with disabilities will receive physiotherapy rehabilitation, through more than 300 sessions combining hospital treatment and home visits by the Community-Based Rehabilitation team; 50 mothers will receive psychosocial support, and 20 will start income-generating activities; more than 500 people will receive information about disability, beginning with the children’s families, their neighbors, and hospital staff.

Indirect beneficiaries: all healthcare staff across the hospital’s departments, 360 people, will benefit indirectly from awareness-raising. This is expected to create a more welcoming hospital environment for all St. Luke patients. Likewise, the entire population of Wolisso, around 50,000 people, will benefit from awareness activities through coffee ceremonies, reflection on the circumstances of people with disabilities during religious ceremonies, and specially produced information materials. Children with disabilities attending Wolisso’s special classes will benefit from a better educational experience through the purchase of games and teaching materials. Public social and healthcare services will benefit from the knowledge generated by the project, beginning with the survey findings.

Partnership

Local partners were selected for their expertise, experience, mission, and existing role in serving the community. St. Luke Hospital in Wolisso plays a particularly strategic role as the zonal referral hospital for a target population of 1,200,000 people. Although privately owned, it operates under a multi-year agreement involving the Ethiopian Catholic Church, CUAMM in Padua, and the Oromia Regional Health Bureau, which is represented on its governing board. The hospital’s participation therefore also ensures active collaboration with health centers. Basing the project on hospital services enables comprehensive patient care, which is valuable given the frequent presence of multiple conditions in children with disabilities. It also lays the groundwork for progressively involving health centers, local clinics serving 25,000–50,000 people each, and subsequently health posts, peripheral clinics serving 5,000 people each. In disability care, the hospital has basic services in place that need further development. These provide a sound foundation for inclusive access to quality services, which are almost entirely absent outside the capital. Physiotherapy is currently provided by one physiotherapist supported by an unqualified assistant, and the addition of another qualified professional is essential. The workload is substantial, particularly given referrals from the orthopedic department. With more than 4,000 births each year, the hospital is also at the heart of a regional healthcare system beginning to seriously consider the need, already highlighted by the WHO, to look beyond preventing and treating endemic and communicable diseases and address chronic conditions and disability. In mental health, St. Luke is effectively the region’s only medical facility. Without it, the only option for people with mental health conditions is “holy water” treatment by traditional healers, a cultural practice with anthropological significance but little scientific basis or supporting evidence.

The hospital also faces objective limits in its mandate and capacity. Follow-up, for example, is a weak point in patient care. Too many patients fail to return for monitoring, mainly because of distance and cost. The hospital cannot provide home-based community work itself, but it can coordinate with organizations working at community level. One such organization is VCBRA, established with training and supervision from the Austrian organization Light for the World. It therefore follows the principles of Community-Based Rehabilitation and the participatory approach of the United Nations Convention on the Rights of Persons with Disabilities. Over the years, VCBRA has developed a model combining rehabilitation, social inclusion, psychosocial support, economic empowerment, and community involvement. It can therefore provide what the hospital lacks. Until now, the two organizations have worked in parallel with little interaction; the project aims to bring together the best that each can offer.

Expected results

The project aims to achieve the following results:

R1: In the first year, 40 children with disabilities are identified and referred to rehabilitation services for the first time.

R2: In the first year, a total of 150 children receive rehabilitation and follow-up services.

R3: In the first year, 50 mothers receive psychosocial support and 20 start income-generating activities.

R4: Awareness of disability increases among healthcare staff and the population of Wolisso.

Activities

A1 – Map children with disabilities in the urban area of Wolisso.

A2 – Train staff at local healthcare facilities, including health centers and health posts, to identify children with disabilities and refer them to rehabilitation services.

A3 – Recruit a second physiotherapist for St. Luke Hospital’s Physiotherapy Unit.

A4 – Establish coordination between St. Luke’s physiotherapy service, other hospital departments, local healthcare services, and VCBRA to identify and monitor patients.

A5 – Support a group of mothers in understanding and accepting their children’s conditions and starting income-generating activities.

A6 – Establish community-based rehabilitation services through home visits by VCBRA’s team, in coordination with St. Luke.

A7 – Raise awareness and provide training for the community and healthcare staff to reduce stigma toward children with disabilities and their families and facilitate access to services.

First-year costs

In subsequent years, the plan is to expand the mapping exercise and strengthen community-based rehabilitation, potentially establishing rehabilitation services at local health centers.

Poggio Torriana, July 1, 2019