Genzebe Tumoro narrates her life story as an urban health extension professional in this photo diary. Ethiopia’s Federal Ministry of Health (MoH) has recognized that the delivery of public health information and services in urban settings is less than optimal and has developed an urban program that builds on the success of Ethiopia’s rural Health Extension Program (HEP).

My name is Sister Genzebe Tumoro. I have been an Urban Health Extension professional in Harar Kebele of Bahil Adarash Subcity in Hawassa City for two years. Before I became a UHE professional, I attended a three-month training program at the Health Science College.

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As part of my work as a UHE professional, I go out into the community each day. I have more than 500 houses in my catchment area, so in order to stay organized I develop weekly, monthly, quarterly and yearly schedules. I visit around 12 to 13 households on a typical day. Sometimes I might work over the weekend because it is on weekends that I can find certain household members at home. Balancing my personal life with work has not really been a problem as my husband is well aware of the program and supportive of my work.

This map represents my catchment area. When you make a left at the big tree in front of the police station, you get to a neighborhood which has made a lot of progress. Many families in this neighborhood have implemented the health extension packages I trained them on and are now ‘model families.’ Most of them have been tested for HIV, and use family planning methods. This neighborhood is also very clean now, as residents no longer dump garbage outside.

In this other area, the red cross-marks represent HIV “hot spots.” You can see the various nightclubs, hotels, restaurants, liquor stores, and bars labeled on the map. One sees many commercial sex workers on the street in this neighborhood, especially around the house of the delala (pimp). It is a challenge but I like to believe that I have done a good job working with the community near the delala’s place, sensitizing people on HIV issues, and prevention in particular.

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 A lot of girls show up in this area from rural areas, although they do not stay very long before the pimp sends them to work, usually in a nearby city. I try to educate them while they are here. Along with my fellow UHE professionals, we have distributed around 6,000 condoms to individuals in this area. I have a penile model I use to demonstrate to the young women how to use condoms. These women are young—about 15 years old—and I do not know much about HIV. So we educate them. When they leave for other cities, new young women replace them. It is an on-going cycle. Still, I think I have created a lot of change so far and will not give up until even greater change comes.

The success of my work depends on the engagement of the community. If I want to meet with a particular household and discuss a latrine problem, I fix a time when the household will be available to work with me before I visit them. For example, Mondays and Thursdays are market days and finding people at home can be difficult, so I don’t schedule visits on these days. During my meetings with the community, I educate them on many health topics according to the guidance provided in the national UHEP Implementation Manual. This might include showing an individual how to protect themselves from HIV, or demonstrating to a family how to improve their nutrition or sanitation situation. Later, I return to the household to check if they have implemented my advice.

The community I work in had major health challenges. There were many sanitation and hygiene problems, and many people did not know how to dispose of either solid or liquid waste. Many did not know how to protect themselves from HIV, or of the referral and support systems that exist for people living with HIV. Personally I had to overcome many challenges while trying to do my job, especially in the beginning. Some people closed their doors on us, others turned us down by saying they were too busy or they refused to participate unless we compensated them for their time. Eventually, with the help of the kebele and sub-city officials, we were able to raise awareness about the UHEP and convince the public that the support and trainings were positive. The support of the kebele and sub-city officials has been invaluable in helping us achieve this result.

These days there are households that have implemented all of what I have taught them. I am proud of those households. They thank me, saying they would not have been able to exhibit these changes if I had not trained them. For instance, I know of one woman who attended my training on the 16 health extension packages and is now training four other heads of households under her. She comes to me for advice when she needs it. I am very proud of her. However, there are also households that have taken the trainings but have not yet implemented what they learned. They say they will do it soon but I have yet to see the changes. Some households are more difficult to change than others, but I am not giving up on them.

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Because this job involves working with women in communities, it is good that the UHE professionals are women. You see, women are more likely to confide in other women or girls about their problems. Also, if the UHE professionals were male, the program might fail because a husband would be uncomfortable to find his wife talking to another man.

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In the future, I want people to witness further changes I will achieve in the community. I have big plans.

My advice to graduating UHE professionals is that even though there are many challenges, they should not be afraid of them. All obstacles, no matter how big, can be overcome if you have patience and perseverance.

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JSI implemented the USAID-funded Urban Health Extension Program (USAID | UHEP) between 2009-2013. The program aimed to strengthen the capacity of UHE professionals to identify and reach vulnerable individuals or groups in their catchment areas and to provide these individuals with public health services that improve their overall health outcomes, including HIV prevention, care and support services.

Extending USAID|UHEP commitment, JSI is currently implementing the USAID-funded Strengthening Ethiopia’s Urban Health Program (SEUHP) 2013-2018. The program works to promote urban health leadership and provide capacity building support for UHE professionals in 49 cities and towns across seven regions in Ethiopia to reach 1.6 million people over five years. The program aims to improve the health status of the vulnerable urban population in Ethiopia by reducing HIV/TB-related maternal, neonatal and child morbidity and mortality, and by reducing the incidence of communicable and non-communicable diseases.

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