A rural health reform has been introduced in Tigray since 2006-07 by establishing health posts in every tabia (municipality). At each health post there is a female health extension agent who have received one year of training in advance. The reform furthermore includes a considerable number of health packages that are provided at tabia level where relevant. These include malaria prevention (where malaria exists), first aid, sanitation, environmental hygiene, personal hygiene, waste management, nutrition training, HIV/Aids testing and treatment. Treatment for most of the health problems is given free to households.

As an example of an impact, we found only in one of the 17 communities surveyed in 2006 that a small share of the households had dug toilets and this was under a pilot health project. Now, four years later this has been implemented in all communities. The same community where we found the pilot project now has 85% of the households covered with toilets. Now 15 tabias in Tigray have been declared as feces -free which requires that all households have dug toilets and environmental and personal hygiene have created a clean environment.

We found malaria to be a problem in 6 out of 17 sites in 2006 and we will resurvey these this year. At that time we found that insecticide-treated bednets had been distributed only in one of the locations where a severe malaria-outbreak came in 2005-06. All households then received free bednets. Under the new reform, all who are living in malaria-risk areas should have been given bednets. They say that there has been a reduction in malaria since then due to the bednets as well as treatment. They fear, however, that the reduced prevalence will cause households to stop using the bednets. This will be investigated by one of our students through our survey.