A Case Study from Ethiopia
The Health Extension Program (HEP)
By Habtamu Argaw (MD,MPH)
NHSDE, WHO/Ethiopia
Innovative Education and scale up forrural 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 andsupport,
–Sructure of MOH (limited tocentral/regional level, none atdistrict level)
–Maintained vertical programs
•Renewed efforts (1993) and yet duringHSDP I (1997-2000/1), EHSP didn’t reachthe people at grass roots level.
HEP
•Target of universal PHC coverage by 2009/10
•HEP introduced in 2003 (HSDP II)
–Aim
–Creating healthy environment andhealthful 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.
HEP
Implemented by two salaried staff at each
Kebele,Health Extension Workers (HEW)
•HEWs are Female (exceptions)
•HEWs are recruited from the samekebele
•HEWs are trained for a year atTechnical and Vocational Educationand 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.
HEP
Approaches to HEP delivery
HEW uses the following approaches
Model family
Community based health packages
HP based services
HEW required to spend 75% oftheir time in the outreach activityby 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 key
Partners 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 nationalhealth 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