A Case Study from Ethiopia

The Health Extension Program (HEP)

By Habtamu Argaw (MD,MPH)NHSDE, WHO/Ethiopia

Innovative Education and scale up for rural health

workers

The HEP and Reasons Behind its Introduction

• PHC adopted since 1970‘s, • Aimed to universal coverage, • Used CHWs and CHS, but failed due to;–Remuneration/incentives and support, –Sructure of MOH (limited to central/regional level, none at district level) –Maintained vertical programs

• Renewed efforts (1993) and yet during HSDP I (1997-2000/1), EHSP didn’t reach the people at grass roots level.

HEP• Target of universal PHC coverage by

2009/10• HEP introduced in 2003 (HSDP II) –Aim–Creating healthy environment and healthful living (esp. Preventive, promotive, and health awareness)

–Make available EHSP at grass root (Kebele & HH) as a package targeting HH (mothers and women) through HH visit, health education and demonstration.

HEPImplemented by two salaried staff at each

Kebele,Health Extension Workers (HEW) • HEWs are Female (exceptions)• HEWs are recruited from the same kebele• HEWs are trained for a year at Technical and Vocational Education and Training Centers. (TVET).

HEP Covers 16 health extension packages in 3 areas;

1.Disease Prevention and Control. – HIV/AIDS/STI and TB prevention/control – Malaria prevention/control - First Aid and emergency

2.Family Health Service.– Maternal and child health - Family planning -

Immunization– Adolescent reproductive health - Nutrition

3.Hygiene and Environmental Sanitation.– Excreta disposal - Solid and liquid waste

disposal– Water supply and safety - Food hygiene and safety

measures– Healthy home environment -Control of insects and

rodents– Personal hygiene

IEC as cross cutting approach.

HEPApproaches to HEP delivery

HEW uses the following approachesModel family Community based health packages HP based services

HEW required to spend 75% of their time in the outreach activity by going from home to home

Progress

17,653 (59%) HEW trained and deployed

7,000 to be trained each year until end 2009

9914 (66%) of HP constructed by June 2007

Strong political commitment is keyPartners joining hands TWG established to support Health represented in local administration (Cabinet)

Many Challenges

• Recruitment – Lack of adherence to rural recruitemnt

• Training and skills development, – Limited skills (esp. skilled delivery)

• Supplies and equipment – Not yet fullfiled– New needs emerging (transport, bags etc)

• Supervision.– DHMT not capable of giving effective

support– Roles for HC limited

• Other problems– Career development– Transfer– Recognition and support from other HRH

Points for discussion and action

System wide linkage and Integration to national health system including referral system

Linkage with national HRH system

Focus of basic training (priority)

Large number of trainees vs. skills training

Free HEP in contrast to private sector linkage