Source: International Federation of Red Cross and Red Crescent Societies
According to Ethiopia's 2011 Demographic and Health Survey, nearly half a million children under-five die every year.

Neonatal mortality accounts for 30 per cent of under-five mortality. Due to a weak and difficult to access health system, women continue to die as a result of preventable complications that arise before, during and after childbirth. While 45 per cent of births in urban areas are attended by skilled health personnel such as the health extension workers, there is huge disparity among rural areas and woredas (districts) owing to number of reasons. Some of these factors are: access to and availability and quality of health services, social factors such as low literacy rates, lack of access to information, poor knowledge about obstetric complications and delay in starting first antenatal care visit. Overall, only about 10 per cent of women deliver with the help of skilled personnel.

Since 2013, Ethiopian Red Cross Society with support from The Netherlands Red Cross has been implementing an infant and neonatal health project across West Hararghe, Silit, South Gondar and Jijiga zones. The National Society is complementing the government's efforts in building the capacity of health professionals and strengthening services at health centres. Tine Bebe, a midwife at the health centre in Merwa Rebsu kebele (neighbourhood), Chiro woreda in West Hararghe zone has been working at the health centre for over a year. She benefited from a training on reproductive, maternal, newborn and child health following which, with support from Red Cross, Tine Bebe has organized and facilitated trainings for volunteers on neonatal tetanus. To ensure that the facility is functional, the health centre in Merwa Rebsu has received basic equipment such as floor linen, mattresses, bed sheets, delivery sets and furniture.

To encourage self-care and promote institutional deliveries, pregnant mothers are given mama kit at the centre, i.e. a kit with essential commodities such as clean cloth for wiping the baby, baby wrap, sanitary products, soap etc. "I have seen ANC [antenatal care] and deliveries going up particularly because of the mama kit and mosquito nets. In October 2013, prior to the project, we had 34 ANC [visits] and 16 deliveries at this centre," says Tine Bebe. A year on, "We have 72 ANC [visits] and 43 deliveries." According to Tine, the increased visits can be attributed not only to the volunteers accompanying mothers to the centre but also to their efforts in raising awareness among mothers on the importance of registering for ANC and immunizing newborns.

In collaboration with the Ministry of Health, the Ethiopian Red Cross Society has also trained 720 traditional birth attendants who were selected by the communities in their respective kebeles. The training includes identifying danger signs and symptoms in newborn, care of sick babies and encouraging breastfeeding.

Aisha Isma lives in the kebele of Agedeley in Silit zone. She is an expecting mother. Aisha was pregnant before but that pregnancy did not go well. After a prolonged labour, she gave birth to a still born. Aisha says, "Red Cross has not only provided knowledge and awareness. It has also given support to access health centres with free ambulance service. As a pregnant mother, I received a mosquito net during my ANC visit and seedlings for backyard gardening. I am confident to get Red Cross ambulance [to take me to the hospital for the delivery]." Motivated by the work being carried out by Red Cross since the past year, in September 2014, Aisha became a volunteer herself. She recounts that she has seen a change in the community with regard to uptake in ANC, deliveries at health centre, immunization and people going for HIV testing.

More than 18,000 reproductive age women have been reached with community trainings, including pregnant women, mothers, parents and community leaders. The focus of the community training is to promote household and community practices such as exclusive breastfeeding, overall neonatal health issues, and timely referral for better investigation and management.

Twenty-five-year-old Meseret of Rabsu kebele is a mother of two-year-old, a four-year-old and a newborn. Her first born was delivered at home with the help of a traditional birth attendant. For her second pregnancy, she did things differently. Meseret went for all four ANC visits. She received a mosquito net at ANC and mama kit at delivery. At the time of delivery, a Red Cross volunteer accompanied Meseret to a health centre in an ambulance. A volunteer continues to visit her to provide postnatal support.

A total of 600 couples across 24 kebeles have benefited from the couple workshop on birth preparedness. The training focuses on the importance of antenatal and postnatal care, identification of danger signs during pregnancy and recommended actions, understanding the benefits and components of birth preparedness and complication readiness. Meseret and her husband have benefited from couple counselling at the health centre.

The community health workforce, including Red Cross and Red Crescent volunteers, are delivering crucial and culturally sensitive health messages, empowering individuals, households and communities to make informed decisions and increasing local access to life-saving preventive and curative measures. Volunteers' connections to the community and understanding of the context ideally places them as key resources in developing locally appropriate responses to health issues, encouraging community engagement and promoting sustainability towards reaching universal health coverage.

• Ethiopia