IFGH 2012: Turning the HEAT up for Community Health Workers

January 27, 2012

Authors: Long, L-A

Author Affiliations:International Development Office, The Open University

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses

Presented as – Oral Presentation


Despite major progress, Ethiopia’s health care system is one of Sub-Sahara Africa’s least developed and its underfive and maternal mortality rates remain among the highest on the continent. To help address this issue the Ethiopian government launched an ambitious programme in 2004 to train 34,382 Level III Health Extension Workers (HEWs) deployed in more than 15,000 rural communities. However despite several strengths, the training had drawbacks, including variability in how the curriculum was implemented, and inadequate coverage of maternal/child health topics; and insufficient acquisition of practical skills.


In partnership with the Federal Ministry of Health, The Open University, UNICEF, AMREF and the WHO, launched the Level IV upgrading HEW pilot in February 2011. Known as HEAT (Health Education and Training in Africa) it is a “blended learning” methodology of tutor-directed self-study and hands-on practical skills training. The pilot has trained 57 Ethiopian health experts in the development of a 13-module curriculum (emphasis on maternal/child health); trained 120 tutors and 38 programme coordinators in six regions; and registered 1,182 HEWs.

Lessons learned:

Some Level III students were inadequately prepared to fully benefit from the self-study-based approach of Level IV – many started with relatively poor academic backgrounds; long distances between the Health Science Colleges and the HEWs’ places of work, prevented HSC trainers from having sufficient contact with students.

Next steps:

A full evaluation of the pilot begins shortly. Potentially 5,000 more HEWs are joining the programme in 2012/13. HEAT and partners are discussing with eight more countries in Sub Saharan Africa, and India and Bangladesh to roll out the HEAT programme. Research based on the Mental Health learning resources begins shortly; discussions are underway to develop and extend the Water & Sanitation learning resources to other countries; a randomized control pilot based on a mobile application is under development.


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