Urban HEWs use new strategies to help Addis Ababa's homeless people

In Ethiopia's capital community-based approaches have changed attitudes to homeless people and mental health

Esayas is homeless. As a young man, he was imprisoned and tortured by the Derg, the communist regime that ruled Ethiopia from 1974 to 1987. He had a breakdown, and upon his release, with no family support, spent days wandering the streets. Now aged 45, his health is slowly recovering. "I had a little mental disturbance, I was not sociable. But now I've improved," he says.

His lifeline was Sister Zinash Hailemariam, 28, an award-winning HEW who has transformed the lives of some of Addis Ababa's most vulnerable people. She points to Esayas' new refuge – a small bed sheltered by a rickety structure of corrugated iron and plastic sheeting, which she renovated with funds and manpower from the local community. They all know Esayas and often bring him food. "This is a huge change," she says. "Before, there were piles of dirt inside. There's more to do, but it's a lot better."


Hailemariam is part of Safe Home, a collaboration between Addis Ababa University and UK-based King's Health Partners, that aims to harness the local expertise of urban HEWs by training them to support homeless, mentally ill people. In countries where mental health is not yet integrated into primary healthcare, and resources are limited, community-based approaches are a promising starting point.

"For patients like Esayas, medication is not enough," says project lead Dr Abebaw Fekadu. "You have to get them out, and give them skills and livelihood activities. Then they can engage with life a bit more."

The long-term plan is to develop HEW-led rehabilitation in communities, but Hailemariam's neighbourhood is already reaping the rewards of her work. She identified a man who "used to spend day and night in a drainage pipe. He got rained on and there was sewage everywhere; he was absolutely unkempt. But after a week in hospital, he was clean, in clean hospital pyjamas and I was really happy about that."

Some names have been changed

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