IFGH 2012: Key Challenges in Ethiopia’s Health Extension Programme: Lessons from the Field

January 30, 2012

Posted by Irish Forum for Global Health | Conference Abstracts

Authors: Boostrom C.

Author Affiliations:Centre for Global Health, Trinity College Dublin

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Presentation


In order to address severe shortages of health workers in rural areas, Ethiopia launched The Health ExtensionProgramme (HEP) in 2003. Thus far, 33,000 female Health Extension Workers (HEWs) have been deployed, with a ratio of 1 HEW per 2500 population. HEWs focus on four key areas: hygiene and environmental sanitation, family health services, disease prevention and control, and health education and communication.

Major Challenges:

Based on experience in the field, the three major challenges in the HEP are as follows. 1) HEWs are increasingly overburdened with work. This is particularly the case with the recent roll out of community case management byHEWs for treatment of the major causes of under five mortality. 2) There are major discrepancies in the implementation of the HEP throughout Ethiopia’s nine regions. The four major regions have received strong financial and logistical support from the federal government, whereas the five emerging regions are still far behind. 3) Supportive supervision has been difficult to implement and maintain, due to inadequate training for supervisors, an almost entirely checklist-based system, and low motivation among supervisors.

Next Steps:

Very little is being done to address HEWs’ workload, therefore research ought to be carried out on the skills, workload, and population that it is feasible for each HEW to attain and maintain so that future policies and standards within the HEP can reflect this. Greater financial and logistical support is needed in Ethiopia’s five emerging regions in order to increase equity in access to the HEP throughout the country. A new model of supervision is being piloted in two of the country’s major regions which aims to streamline the process and improve the performance of bothHEWs and their supervisors. Results from operations research on this supervision model will be available next year.



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