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Review
. 2023 Apr;33(Spec Iss 1):75-84.
doi: 10.4314/ejhs.v33i1.8S.

Relevance of the Health Extension Program to the current Health Needs and Evolving Demands of Rural Ethiopia: A Mixed-Method Analysis

Wasihun Andualem Gobezie  1   2 , Girmay Medhin  1   3 , Mulusew G Jebena  4 , Mekdes Demissie  5   6 , Yibeltal Kiflie Alemayehu  1   7   8 , Alula M Teklu  1 , Girma Azene  1 , Tegene Legese Dadi  1   9 , Million Tesfaye  4
Affiliations
Review

Relevance of the Health Extension Program to the current Health Needs and Evolving Demands of Rural Ethiopia: A Mixed-Method Analysis

Wasihun Andualem Gobezie et al. Ethiop J Health Sci. 2023 Apr.

Abstract

Background: Ethiopia has been implementing a health extension program (HEP) to respond to the high maternal and child mortality in rural communities. HEP has brought tremendous contributions to improved access and coverage of primary healthcare in the last 15 years. Despite its attributions, attention to HEP has declined in recent years due to several reasons. This study is designed to explore HEP's relevance to the current healthcare needs of the rural communities.

Methods: This study is a nested cross-sectional mixed-method to the overall HEP's evaluation between March and May 2019. Descriptive statistics were used on qualitative and quantitative assessment. A literature review supplemented the assessment. A representative quantitative sample of 11,746 women, men, and young girls; a qualitative sample of 268 key informants from Kebele administrators, HEWs, program people in the health system and focus groups from community leaders, men and women from 185 Kebeles in 62 woredas were selected. A thematic approach was used for qualitative analysis.

Results: Rural communities and program managers asserted that HEP's service packages with the existing service delivery modalities were relevant. Eighty-two percent of men and women and 77% of young girls confirmed this relevance. Besides the existing packages, additional curative services for adults and children were recommended with emphasis on the pastoralist community. HEP's service uptake has declined as over 86% of targeted rural communities bypassed HPs due to unavailability of services and capacity problems of HEWs.

Conclusion: The current HEP packages with the existing service delivery modalities are still relevant to the rural communities' health needs. However, on-going changes to address the evolving demands of the targeted rural communities are crucial.

Keywords: Relevance; evolving demands; health extension program; health needs; rural Ethiopians.

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Figures

Figure 2
Figure 2
Mapping of current rural HEP service packages to the disease burden, data from literature, GDB 2019 Note: The numbers in the parentheses are ranks in the global burden of disease (GBD) list that cause most death and disabilities
Figure 3
Figure 3
Percentage of household members who have ever visited a HP that recommended additional services in response to their health needs, HEP quantitative data, 2019
Figure 4
Figure 4
Percentage of household (HH) members who had perceived agreement on the appropriateness of HEWs' service provision at the HH level. (Data from national HEP quantitative survey, 2019)
Figure 1
Figure 1
Framework for appropriateness or relevance of humanitarian programs (26)
See this image and copyright information in PMC

References

    1. Ministry of Health, author. Health sector development program (HSDP) II, (EFY 1995 - 1997) MoH; 2002.
    1. Ministry of Health, author. Health service extension programme: implementation guideline. MoH; 2005.
    1. Bekele A, Kefale M, Tadesse M. Preliminary assessment of the implementation of the health services extension program: the case of southern Ethiopia. The Ethiopian Journal of Health Development. 2008;22(3)
    1. Chaya N. Poor access to health Services: Ways Ethiopia is overcoming it. Res Comment. 2007;2(2):1–6.
    1. World Health Organization, author. International Conference on Primary Health Care. Alma-Ata: USSR; 1978. Declaration of Alma-Ata; pp. 6–12.

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