Afar Region has one of the highest maternal mortality and morbidity rates in Ethiopia. The region has been without an accessible health service for its 90% pastoralist population (estimated at around 1.3 million people) until recently when APDA first established a mobile primary health service. Beginning in 1994 with a voluntary team of 34 health workers, APDA has been expanding the numbers and types of health workers who now cover almost 40% of the region on foot.

This includes 245 community health workers who provide health education and basic treatment, 161 women extension workers who are trained to mobilize communities and educate women about hygiene, nutrition, safe motherhood and stopping practices that harm women such as FGM (female genital mutilation), and traditional birth attendants who are trained to provide antenatal and postnatal care as well as perform clean deliveries. These teams of workers have provided some relief to the shocking situation of maternal and neonatal death and injury in this region. However, this model lacks the ability to refer mothers who require obstetrical emergency care. To begin to fill this need, APDA is building a centralized Women's Treatment Center which will link with waiting centers for high-risk mothers in each of eight surrounding health districts. The addition of these centers will require a total of twelve midwives : four for the Women's Treatment Center and one for each of the eight district waiting centers.

One By One will contribute to funding the training of the first two Afar midwives. The training will take place over a period of three years in a newly established nursing school in the region. Students will make a commitment to return to their communities after completing their training and work for a minimum of six years. The availability of trained midwives for the first time in this region is expected to play a very important role in preventing fistula through reducing the risk of obstructed labor.