The context
According to UNICEF (2018), around 9.3% of the Ethiopian population lives with some kind of disability, corresponding to roughly 7.8 million people, and almost 30% of these people are children and youngsters under 25. Most of them reside in rural contexts where access to diagnostic, rehabilitation, scholastic, and social services is very limited.
In Ethiopia, mental disorders represent a significant health challenge with an estimated prevalence of 18% in adults and of 15% in children. Epilepsy is the most widespread neurological disorder, with a prevalence of 5.2 cases every 1,000 inhabitants. However, in rural areas only 1.6% of patients receive adequate pharmacological treatment (Worku, 2013) due to the shortage of specialized services, the limited availability of medications, and inadequate inclusion of mental health services in basic healthcare.
In rural areas, access to healthcare services often occurs only in cases of emergencies or acute events, while the management of chronic conditions, such as mental disorders or epilepsy, is hindered by economic, logistical, and geographical barriers. The distance from health centres, transportation costs and the limited availability of local services make it difficult to guarantee continuity for treatments and ongoing therapeutic monitoring.
Both in the Wolisso area and in the Gurage zone, where Cittadinanza operates, scarce knowledge on disability, mental disorders, epilepsy, together with the social stigma that still surrounds these conditions, contributes to limited access to diagnoses and adequate treatments for both adult and child patients.
To conclude, the local context is characterized by a growing number of cases of gender-based violence, which also affects girls and adolescents. The system of care for survivors is still lacking in terms of support services, and it does not always ensure an adequate integration of healthcare, social, and institutional services. Cultural barriers continue to exist and they continue to hinder the acknowledgment of the issue.
Cittadinanza‘s approach
In Ethiopia, Cittadinanza is working to improve access to mental health services for people with mental health issues and neurological disorders like epilepsy, as well as access to rehabilitation services and support for children with disabilities, while also strengthening the skills of health and social workers and promoting interventions to support families and communities.
The activities are implemented mainly in the Wolisso district, in the South West Shewa zone of the Oromia region, through collaboration between two key local partners: St. Luke’s Catholic Hospital, one of the leading healthcare facilities in the area, and Vision Community Based Rehabilitation Association (VCBRA), an organization dedicated to community-based rehabilitation programmes in rural areas.
Since 2023, Cittadinanza has also started a collaboration with the Ethiopian Catholic Eparchy of Emdibir and with the Angelo in Africa Association, capitalising on the skills and resources developed in the Wolisso area with the aim of strengthening the support network for children with disabilities in the Gurage zone as well.
The activities are divided into different areas of intervention:
1. Mental health and epilepsy
Cittadinanza supports the activities of the Mental Health clinic at St. Luke’s Catholic Hospital, one of the few services available in the area for the diagnosis and treatment of mental and neurological disorders.
The clinic carries out about 5,000 visits a year, with over 2,000 patients, including many children and adolescents. A considerable portion of patients have been diagnosed with epilepsy, a condition often associated with social stigma and difficulty accessing care.
Activities include clinical management of patients, the free availability of psychiatric and anti-epileptic drugs, counselling for patients and families, and outreach initiatives to improve knowledge of mental disorders and reduce stigma in communities.
At the same time, training and clinical supervision activities are carried out for the health personnel of the hospital and local services, involving Ethiopian and Italian professionals, with the aim of improving the quality of healthcare services and strengthening collaboration between the hospital and local health centres.
2. Decentralization of local services and training of operators
Cittadinanza promotes the skill building for community health workers and health personnel working in local services in the context of mental health, epilepsy, and disability.
The training activities are inspired by the guidelines of the World Health Organization’s mhGAP (Mental Health Gap Action Programme), which promotes the integration of mental health into basic healthcare services. Through this approach, non-specialist health workers are trained for an early recognition of the most common disorders, as well as to ensure basic clinical management and refer the more complex cases to hospital services.
This work contributes to strengthening the connection between hospitals and local services, improving referral and ongoing monitoring mechanisms of patients, especially for chronic diseases like epilepsy, thus reducing the risk of discontinuation of treatments by patients who live far from health centres.
3. Rehabilitation of children with disabilities
Cittadinanza supports the Physiotherapy department at St. Luke’s Catholic Hospital, one of the few rehabilitation services available in the Southwest Shewa zone.
Each year the department welcomes hundreds of patients, including many children with different types of disabilities who are referred by the paediatric ward and neonatal intensive care unit.
Activities include assessment and motor rehabilitation, paediatric physiotherapy and family support. Through the hospital’s carpentry, custom-made assistive devices are also created, helping to improve children’s autonomy, and the quality of their daily life.
Particular attention is paid to supporting families, especially mothers of children with disabilities. Caregivers are supported in the care pathway, also through training activities and psychological counselling.
4. Community-Based Rehabilitation
Alongside hospital services, Cittadinanza supports the Community-Based Rehabilitation (CBR) programme carried out by the VCBRA association, which represents one of the few services available for children with disabilities in the rural zones of the Wolisso area.
The programme operates in several districts of Wolisso and reaches over one hundred children with disabilities, offering rehabilitation interventions directly in communities and family homes.
Activities include home rehabilitation, early stimulation, medical support, distribution of aids, speech therapy and psychosocial support for mothers, as well as training families on care practices and the education of children with disabilities.
At the same time, initiatives are promoted to encourage school inclusion, through the distribution of educational material, training activities aimed at teachers, and the creation of outreach groups in schools. Through art, poetry, and theatre, these groups help promote greater awareness on the rights of people with disabilities and the importance of school inclusion.
The programme also includes nutritional support interventions, which combine food distribution with training activities aimed at families. It also involves economic empowerment initiatives for the most vulnerable groups, through start-up support of income-generating activities and training courses on business management.
5. Community outreach activities
Cittadinanza’s projects promote community outreach activities aimed at early identification of cases at risk of developmental disabilities or neurological problems and encourage referral to available healthcare services.
At the same time, other information and outreach activities are carried out in communities with a focus on early childhood development (ECD), disability prevention, childhood protection, mental health, and epilepsy.
In many communities, these activities are also carried out through well-attended collective moments, such as traditional coffee ceremonies, which become opportunities to promote greater awareness on the rights of people with disabilities and the importance of access to healthcare services.
6. Strengthening the response to gender-based violence (GBV)
Cittadinanza contributes to the strengthening of gender-based violence response services at St. Luke’s Catholic Hospital, supporting the development of counselling and integrated care of women and girls who have survived violence.
The intervention focuses on strengthening the skills of health and psychosocial personnel involved in case management through training, supervision, and methodological support activities, with the aim of improving the quality of care offered to women and girls.
At the same time, Cittadinanza promotes the improvement of coordination between the different services involved in the response to gender-based violence — health, social and institutional levels — promoting the development of collaborative mechanisms. The activities also include the monitoring of survivors’ needs and the analysis of the services available in the area, in order to identify critical issues in managing cases and promote continuous improvement to services.
7. Research and systematization of experiences
Over the years, Cittadinanza has also promoted research and systematization of experiences activities, with the aim of improving the quality of interventions and contributing to the development of knowledge in the context of mental health, gender-based violence and disability.
These activities include two studies carried out on the subject of suicide, one dedicated to the analysis of the suicidal behaviour of patients in the emergency room and the Mental Health clinic at St. Luke’s Catholic Hospital, and one on the relationship between gender-based violence and suicide, carried out in collaboration with three hospitals in the area.
Through collaboration with St. Luke’s Catholic Hospital in Waliso, the Vision Community Based Rehabilitation Association (VCBRA) and other local partners, Cittadinanza contributes to the strengthening of mental health services, rehabilitation and support for people with mental health issues and children with disabilities in the rural zones of the Oromia region.
Results achieved in Ethiopia
About 600 patients each year are followed by the Physiotherapy clinic at St. Luke’s Catholic Hospital, and about 25% of these patients are children with disabilities.
Thanks to the Community-Based Rehabilitation programme, 150 boys and girls with disabilities benefit annually from its support, and about 85% of them are under the age of 15.
A total of 150 children followed by Community-Based Rehabilitation programmes benefit from support regarding medical visits, pharmacological treatments and assistive devices, school and hygienic-sanitary supplies, and a targeted nutritional programme with distribution of food packages.
Every year the Mental Health clinic carries out over 5,000 visits, with an average of about 250 new patients every quarter. About 30% of the patients followed are diagnosed with epilepsy.
Moreover, 150 patients per quarter benefit from the free distribution of psychiatric and anti-epileptic drugs, and 30% of these patients are under the age of 18.with epilepsy treated with free medicine
Every year, 150 caregivers take part in training sessions on disability, care, and child protection, as well as receiving psychosocial support and counselling designed to strengthen parenting skills and support the emotional wellbeing of families.
At the same time, 20 families receive support in setting up income-generating activities, with the aim of strengthening the financial independence of these households.
Support is also provided to five community savings and credit groups, which enable families to access small loans and develop local economic initiatives.
Five awareness-raising groups are active within schools, involving over 500 students each year in the communities of Dilella, Tulu Bolo, Goro, Chitu, and Waliso.
At the same time, 250 people — including parents, teachers, and local authorities — take part in training courses on disability and inclusion.
In total, over 4,000 people from rural communities around Waliso take part each year in awareness-raising and information initiatives organised by the programme.
Training and strengthening of local know-how: every year, around 100 health and community workers take part in training, supervision and skills-sharing programmes on disability, mental health, and epilepsy.
About 600 patients each year are followed by the Physiotherapy clinic at St. Luke’s Catholic Hospital, and about 25% of these patients are children with disabilities.
Thanks to the Community-Based Rehabilitation programme, 150 boys and girls with disabilities benefit annually from its support, and about 85% of them are under the age of 15.
A total of 150 children followed by Community-Based Rehabilitation programmes benefit from support regarding medical visits, pharmacological treatments and assistive devices, school and hygienic-sanitary supplies, and a targeted nutritional programme with distribution of food packages.
Every year the Mental Health clinic carries out over 5,000 visits, with an average of about 250 new patients every quarter. About 30% of the patients followed are diagnosed with epilepsy.
Moreover, 150 patients per quarter benefit from the free distribution of psychiatric and anti-epileptic drugs, and 30% of these patients are under the age of 18.with epilepsy treated with free medicine
Every year, 150 caregivers take part in training sessions on disability, care, and child protection, as well as receiving psychosocial support and counselling designed to strengthen parenting skills and support the emotional wellbeing of families.
At the same time, 20 families receive support in setting up income-generating activities, with the aim of strengthening the financial independence of these households.
Support is also provided tofive community savings and credit groups, which enable families to access small loans and develop local economic initiatives.
Five awareness-raising groups are active within schools, involving over 500 students each year in the communities of Dilella, Tulu Bolo, Goro, Chitu, and Waliso.
At the same time, 250 people — including parents, teachers, and local authorities — take part in training courses on disability and inclusion.
In total, over 4,000 people from rural communities around Waliso take part each year in awareness-raising and information initiatives organised by the programme.
Training and strengthening of local know-how: every year, around 100 health and community workers take part in training, supervision and skills-sharing programmes on disability, mental health, and epilepsy.
