Solving Health Issues in Ethiopia with Religion
Dealing with the issue of healthcare is not a small deed for any country, either rich or poor. For Ethipoia, health issues represent a major challenge. Tuberculosis, malaria, mental illnesses, and especially HIV/AIDS are health issues with which Ethiopia must grapple. In the battle to prevent and eradicate such maladies, religion has become an asset. In the case of official religions, such as Christianity and Islam, the prevention of such maladies is aided via resource mobilization, community empowerment, the dissemination of health information through religious institutions, and assistance in the care of AIDS patients by establishing hospices and other community resources. Traditional religious beliefs and practices can be another major health resource, often overlooked by the mainstream medical system. They can not only provide relief in the case of some maladies, such as mental illnesses, but they are also a way to bring together the community in healing and caring for the patient, and even mediating between the traditional community and various Western, biomedical prevention projects.
A Brief Introduction to Ethiopia’s Religions
Ethiopia’s population of 76 million makes it the 3rd most populous African country.1 The most numerous ethnicities are the Omoro (40% of the population), the Amhara and Tigre, who together constitute 32% of the Ethiopian population.2 Out of the 76 million people, 61% are Christian (51% Orthodox), and 33% Muslim.3 Another, more recent estimation, puts the number of Orthodox Christians at 71% of the population.4 In the 4th century, Christianity was introduced, via Egypt, and accordingly, the Ethiopian Orthodox Church is Coptic5 in orientation (claiming that Jesus had only one divine-human combined nature). From the first bishop, Frumentius, until 1959, Ethiopia did not have a native bishop. In 1959, the Ethiopian Orthodox Church also became autocephalous.6 The Bible was translated into Ge’ez in 615 A.D., and after Axum declined due in part to Muslim invasions, a resurgence in Ethiopian Christian culture took place after 1135: churches and monasteries were rebuilt, manuscripts illustrated and cult objects beautifully ornamented and adorned with precious stones. The EOC practices are similar to those of other Orthodox churches: it has 7 sacraments (baptism, confirmation, penance, Holy Communion, unction of the sick, matrimony and holy order), 5 faith pillars (the Trinity, incarnation, baptism, Eucharist, the resurrection of the dead), and fasting (no meat, dairy products, alcohol or sex) is respected.7 However, it retains some Judaic features, such as having an Ark of Covenant, respects the Sabbath and the difference between clean and unclean meats. Also, women enter through the right side of the church, separated from men.8 The present church language is Amharic, the lingua franca of the country. Less than half a million Ethiopians are Catholics9 and less than 10% are Protestants.
The other major religion in Ethiopia is Islam, which entered Ethiopia during the Axumite kingdom. In the 15th and 16th centuries, Muslims wanted to conquer and destroy the Christian power in Ethiopia but were defeated in 1543, and subsequent attacks reappeared in 1875 and 1888, but were always foreign. Most of the Muslims are Oromo,10 an ethic group of people originally from the southwest of Ethiopia, who converted after their association with another ethic group, the Galla.11 The Oromo, the largest Cushitic-speaking group of people,12 used to live as independent neighbors of the Christian kingdom of Abbysinia,13 and interacted with the Muslim traders. But it was only in the nineteenth century, with the rise of the war leaders, Muslim traders finally found a propitious ground to spread their religion, in a slow, strong process of syncretism.14
An Introduction into Ethiopia’s Health Issues
Ethiopia has a long history of disease, epidemics and famine, mainly due to poor sanitation, a lack of potable water (only 25% of rural population and 75% of the urban population have clean water), malnutrition, and uneven concentration of health services. It is estimated that there is one doctor for every 40,000 Ethiopians, 87 hospitals with 12,000 beds for over 70 million people. The primary killing diseases are HIV/AIDS (the major killer), perinatal-maternal conditions, malaria, tuberculosis, and diarrhea. HIV/AIDS is a major problem, Ethiopia having the world’s third highest number of HIV-infected persons.15 The national prevalence stands at 5.4% with a prevalence three times higher for women than for men,16 and as of 2003 it was estimated that almost 4 million people were infected. In 2004, an estimated 250,000 children under age 5 were HIV-positive, and an estimated 1.2 million Ethiopian children had been orphaned by AIDS. Ninety percent of the reported AIDS cases in Ethiopia affect people between the ages of 20 and 49.17 Malaria is another problem, with children the most frequent victims, being endemic in 70% of Ethiopia.18 An estimated 49.7 million people were at risk for infection in 2005.19 As regards tuberculosis, the incidence is 370 per 100,000 of the population, and the mortality due to TB is 88 per 100,000 of the population. Compounding this problem is the fact that 30% (rural) and 60% (urban) of the TB patients are also HIV-positive.20 In terms of children’s health, the statistics of 2005 showed that 60.4% of children between 12 and 23 months were vaccinated for BCG, 31.9% for DPT (3), 44.7% for Polio, and 34.9% for measles. Moreover, 10.5% (weight-for-height measure) or 46.5% (height-for-age measure) of children younger than 5 were found to be malnourished.21 Also, many children die as infants: the mortality rate in 2000 was 113 per 1,000. In general, the maternal and infant mortality rates in Ethiopia are amongst the highest in the world.22
"Official" Religioin Helping Solve Ethiopia’s Health Issues
The use of healthcare services and prevention methods for various diseases is influenced by the cultural milieu in which one lives. In this, Ethiopia is no exception, and although such factors as the level of education and socio-economic status are important and play major roles in what prevention and healing routes people decide to take, cultural factors, and among these religion, are equally important. Because Ethiopia is one of the countries with the highest number of HIV-infected people and with the highest maternity and infant mortality rates, it is interesting to see how religion plays into the use of prevention and healthcare services in these cases.
For example, religion seems to play a role in women’s decisions to seek antenatal care. A study done in 2000, showed that, in urban areas, more Orthodox (27.5%), Muslim (28.3%), and Protestant (24.8%) women tended to use antenatal care than women following traditional religions (11.3%). In general, Muslim women were 30% more likely to seek such services, in contrast to women from traditional faiths who were 50% less likely to seek them compared to Orthodox/Catholic women. In rural areas, Muslim women were 1 ½ times more likely while women from traditional religions were 40% less likely to seek antenatal care than Orthodox/Catholic women.23 In the case of delivery care, the situation seems to be much grimmer. Only 6% of women received such care and the women in urban areas far surpassed women in rural areas in seeking such care. Out of this small number of women that actually sought delivery care, more Orthodox/Catholic women (8.1%) used these services than Protestant women (4.5%), Muslim women (4.3%), and women following traditional religions (1.4%).24
Another case is the use of contraceptives. A study concerning this issue was done in 2004, in the Southern Nations, Nationalities and People’s region, a federal region that accounts for one-tenth of Ethiopia’s land, has the highest population density and is one of least urbanized regions. This region is plagued by high infant mortality and low levels of contraceptive use. In addition, it is a highly diverse region in terms of its population (80 ethnic groups), and culture, especially religion. The most numerous are the Protestant (35% of the population), followed by Orthodox (28%), Muslims (17%), and followers of traditional religions (15%).25 Results showed that Muslims are 15% as likely to use birth control as Protestants, and it increases to 30% if ethnicity is controlled for, and to 48% when compositional factors are controlled for. This suggests that values of women’s role express religious differences, but it also shows that exposure to ethnic and religious diversity in a community increases the likelihood of birth limitation,26 something worth noting for future birth control intervention programs.
Since 2000, at an International Conference on AIDS, the involvement of the Ethiopian Orthodox Church in the prevention of HIV/AIDS substantially increased. Through its vast network of church members (the 2000 estimation was of 500,000 priests, deacons and monks and 35,000 churches and monasteries), the EOC could be a major player in developing and implementing programs of prevention against this epidemic. Thus, the EOC Development and Inter-Church Aid Commission (DICAC) started a program in 1998 that provided training for priests on HIV/AIDS in order for them to act as counselors in the EOC structure. Two special focuses were put on the Amhara region, where the program included training for all religious denominations and targeted priests, preachers and Sunday school students as future communicators and counselors, and on the Tigray region, where the program was initiated and institutionalized in the EOC structure. Through this, the EOC mobilized its resources to implement this HIV/AIDS prevention program at national, regional and community levels.27 In addition to this, Patriarch Paulos hold large yearly rallies called “Save the People,” and encouraged the promotion of anti-AIDS messages in worship services, Sunday schools and Bible studies.28
The EOC was also backed by humanitarian aid from the International Orthodox Christian Charities (IOCC) in 2004, when a $6 million project was inaugurated. Its target was the enhancing the capacity of the EOC to care for orphans with AIDS and to offer palliative and hospice care for people with AIDS. Thus, the project targeted the increase of “Hope Centers” for AIDS orphans from 13 to 200, and increasing the number of community-based hospice programs to 250. It was estimated that by 2006, 9,000 orphans and children will be provided with adult supervision, education, food, health care, and shelter. Like the program developed by the EOC in 2000, this project included a prevention program that stressed the importance of abstinence/faithfulness to one partner among youth between 15 and 24 years of age. This educational program included public rallies, peer counseling, posters, literature, musical productions, the distribution of t-shirts, but most importantly, the training of counselors who will teach people and other future trainers about the AIDS prevention. The project was implemented in 11 largest urban centers in the Southern Nationalities and Nation-People Region, as well as Oromiya and Tigray regions.29
A year later, in 2005, the EOC-DICAC developed its Strategic 4-year Plan. It is important to mention that the DICAC, although Orthodox at origin, does not discriminate on the base of religion, ethnicity, or gender.30 The Strategic Plan’s main goals are to contribute to a food secure society, to a society free of HIV/AIDS and other diseases, to a literate society, to gender equity, and to promote peace building and advocacy. In the case of HIV/AIDS, EOC established as its goals to create 80% in depth knowledge and 60% behavioral change in the community at large, to increase the quality of voluntary and testing services, to support the research on HIV/AIDS, and to train 200 sex workers into income generation groups.31 Aside from the Church community, the EOC-DICAC mobilized communities and community-based organizations, government partners, funding partners, NGOs, and public figures. In addition, the EOC-DICAC mobilized human, physical (vehicles, furniture, equipment, and buildings), and financial (internal and external funding, estimated at approximately $5,000,011. 32 This strategic plan should be seen in the context of other partnerships. One of these was sealed between the Church and the European Union Civil Society of Ethiopia in 2007, and targeted the implementation of a constituency building program, that would encourage the members of the community to come together and solve the problems in that community. Thus, the ultimate goal is to empower the community to be self-reliable. By training clergies and church and religious leaders in developmental programs, self-initiative resource mobilization, as well as in strategies to tackle issues such as HIV/AIDS, the program hopes to be able to transmit these helpful messages and self-reliability in terms of program implementation at the community level.33
Finally, a partnership between the EOC-DICAC and the Population Council let to a two-year project (2008-2010) that seeks to integrate HIV information in the teachings of the Church. The fact that there are 500,000 clergy that receive education and the Church’s schools, 6.5 million people that attend Sunday school each week, and that a majority of people attend first a religious school before any formal school makes EOC a perfect terrain for spreading information about HIV/AIDS and their prevention. Encouraging priests to talk to their parishioners about HIV prevention, reproductive health issues, and traditional practices such as early marriage and female genital mutilation could help not only in changing mentalities and behaviors in the community. Also, encouraging priests to reject requests of blessing early marriage could reduce the birth complications that arise in these young mothers. Moreover, information can be disseminated through the “Glossary of the Day-to-Day Teachings of the Church,” or “Lexicon,” which comprises of not only in spiritual guidance but also in secular messages. It is supposed to guide Christians in their daily life, earthly and spiritual, and reaches many, so that it is a great resource in spreading HIV and other health-related information.34
A presentation about the involvement of the EOC in the prevention of HIV/AIDS shows that multiple sexual partners, the abuse of alcohol, and untreated STIs determine the high incidence of HIV, and that the involvement of the EOC is crucial not only because it can mobilize its large network and resources that can reach even the most remote areas of Ethiopia to help, but also because it reinforces behaviors such as regular uptaking of VCT and societal acceptance of people infected with HIV. A huge number of volunteers aid the HIV prevention programs: 45,700 clergy, 2,060 Sunday school peer educators, 1,320 project advisors, and 420 C&S volunteers. These volunteers wok up to 40 hours/week, and a total of 33 million hours, and the value of their time is estimated at $8.2 million. In addition, the EOC HIV/AIDS programs help address negative social norms, silence and the stigma associated with having HIV/AIDS. Indeed its impact can be seen in the increased community support for people with HIV/AIDS and in the better implementation of income generation activities.35 Thus, it is clear that the role of the official religion, namely the Ethiopian Orthodox Church, in mediating the health issues that plague Ethiopia and the inappropriateness of the health system is crucial.Continued on Next Page »