The Women Leading the Transformation of Community Health

A community health worker monitors a new mother and her baby in Ethiopia. Credit: JSI Ethiopia

Across the rolling hills of rural Ethiopia, the village health leader (VHL) is a familiar and trusted face. She represents a strategic bridge between the families she knows and the formal health care system. Her mission is simple but profound: to ensure that no woman in her village faces the journey of pregnancy and childbirth alone.

Celebrating a Landmark Achievement

Global statistics offer a sobering reminder of the work ahead: every two minutes, a woman dies from pregnancy or childbirth-related complications, with 280,000 lives lost annually. Most of these women die from causes that are entirely preventable when the right care is available at the right time.

However, the story coming out of Ethiopia today is one of hope and measurable success, propelled by the dedicated work of frontline health workers like VHLs. According to the recently released 2024–2025 Ethiopia Demographic and Health Survey, facility-based births reached 61% across the country, compared to 5% in 2000. This dramatic increase represents millions of mothers who brought life into the world in a safe and supported environment. While there is work to do to ensure high-quality care for every mother, this gain is a testament to the power of a government-led primary care transformation that puts the community at its center.

Co-Creating Solutions for Better Health

For over 30 years, JSI has worked hand-in-hand with the Ethiopian Ministry of Health to co-create solutions that bring care closer to where women live. We focused on expanding the community health network by recruiting and strengthening the capacity of program managers and health workers (also an entirely female cadre of Ethiopia’s health system). These are the three transformative changes:

1. Digitizing the Frontline: We scaled the electronic community health information system (eCHIS) across 434 districts and 8,011 health posts in 2024, training over 5,000 frontline community health workers who registered 25 million households to date. This digital transformation of community health has reduced administrative burden and provided workers with immediate access to decision support tools, while also tripling first antenatal care visits and retaining 22% more women on maternal care continuum than in areas not using eCHIS.

2. Upskilling VHLs: To further expand access to lifesaving care for mothers, we supported the recruitment and training of VHLs to provide essential community care for women and children. They deliver lifesaving medications to prevent heavy maternal bleeding after birth and chlorhexidine for cord care for babies born at home. These community heroes are bringing care closer to their communities while connecting people to health facilities. Institutional deliveries increased by 15% in areas supported by VHLs, proving that strong community voices encourage women to seek skilled birth attendance in health facilities.

3. Connecting Communities to Care: JSI helped establish Networks of Care, an approach that connects health workers from village health posts to larger health centers and hospitals for support and skills development. These trusted relationships boosted health worker capacity and confidence, resulting in 30% increase in women completing eight or more antenatal care visits and contributing to a 34% reduction in perinatal mortality in supported districts.

Changing Lives Through Community Care

Community health workers and village volunteers are the backbone of many health systems. These women are often mothers themselves, juggling their own family’s health while safeguarding their neighbors. Addressing their needs and strengthening their resilience is key to ensuring every childbirth is a safe and positive experience.

At JSI, we are inspired by the measurable impact we see every day in Ethiopia and other countries we serve. This journey reminds us that when we co-design solutions with the people who use them, we not only improve health but also transform lives.