Eritrea revitalizes the Barefoot Doctor programme

Strengthening community-based health services for rural populations

The Ministry of Health, with UNICEF support, concluded a six-month training for the first batch of 25 front line health workers, who will provide basic services to the most disadvantaged populations in the remotest communities of Eritrea.

Barentu, Gash Barka region, Eritrea – Proud parents and elated family members of 25 Barefoot Doctors looked on with joy as the Minister for Health, Ms. Amina Nurhussein congratulated the graduates, and handed them certificates of completion for the six-month training.

"You are now a part of the health system and the Government is proud of you. We have high expectations from you and know that you will work hard in your respective communities to provide services to the most-needy.” – Ms. Nurhussein

Accompanying the minister in the conference hall of the Nursing Assistants Training School in Barentu, were the Governor of Gash Barka region, the Director of Social Services, the Acting Director General of Policy and Human Resources of the Ministry of Health, the Zonal Medical Officers from Gash Barka, Northern Red Sea and Anseba regions; and team from UNICEF led by the UNICEF Representative, Ms. Shaheen Nilofer.

The Government of the State of Eritrea (GoSE) has prioritized Community Based Health Care as a key service delivery strategy for Primary Health Care. With UNICEF support, this training for the first batch of Barefoot Doctors will contribute towards provision of health services to the most remote communities. They will focus on outreach points even beyond the identified 450 communities in 17 districts of Eritrea, that are currently serviced by mobile outreach health clinics.

This first batch of 25 graduates were selected with the full participation of their own communities and community leaders from the most underserved communities in Anseba, Northern Red Sea and Gash Barka regions. These regions share a border with Sudan to the north and west and include some of the harshest terrain in this corner of the arid Horn of Africa.

The residential training consisted of four months of theoretical work at the Nursing Assistants Training School and was followed by two months of intensive practical training at the Barentu Hospital and other primary health care clinics under the supervision of the trainers. The training comprised a package of preventive, promotive and curative health and nutrition services.

This includes first aid; identification of certain diseases and treatment or referral to health facilities; mobilizing communities on health, nutrition and environmental campaigns including immunization; and providing necessary ANC services to pregnant women and encouraging them to visit and to deliver in health facilities. The training also included postnatal maternal and neonatal health services.

UNICEF Eritrea supported the six-month residential training and will provide further support in the areas of logistics and basic medical equipment and supplies.

“We will be provided with equipment to detect and treat simple diseases – including a thermometer, timers for counting respiratory rate, and medicines for three months that we can distribute to those who need it.” – says Amina Oumer Suleman with pride

The graduates will receive a supply of stationary for data collection and training manuals to use as a reference to detect and treat some common childhood illnesses.

The Barefoot Doctors will be deployed to the remotest communities, even beyond the services provided by the mobile outreach health clinics, and will serve rural populations, including nomadic and semi-nomadic communities. They will help to reduce health costs and provide primary care and are a temporary and transitory measure as the GoSE plans to establish health facilities in those regions within the next 3-4 years.

“The hands-on training helped boost confidence of the Barefoot Doctors and they see this as an immense opportunity to give back to the community by ensuring quality delivery of health services right at the door-steps. As an interim measure this programme will ensure leaving no one behind and lead to improved health and nutrition for all children and women in Eritrea,” said Shaheen Nilofer, UNICEF Representative, in her concluding remarks at the graduation ceremony.

The graduates were handed over to their respective Zonal Medical Officers and after a formalization process will be deployed to the respective field. The Ministry of Health is in the process of identifying candidates for the next round of trainings for a total 100 in 2019. The Barefoot Doctors will also be provided with uniforms and a camel so that they can provide health services even in the most challenging terrain.

The term Barefoot Doctors originated in China in the 1930’s, when farmers who often worked barefoot received medical and paramedical training, and provided health care to rural areas where urban-trained doctors would not settle. They promoted basic hygiene, preventive healthcare, and family planning and treated common illnesses. The Barefoot Doctors programme was hailed by the WHO in 1978 as a “successful example of solving shortages or medical services in remote areas”.