Key Challenges in Ethiopia’s
Health Extension Programme:
Lessons from the Field
Camille Boostrom
Centre for Global Health, TCD
Map: António Martins
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Population 90 million
1.1 million sq km
Population growth rate 2.9%
85% live in rural areas where infrastructure is poor
23% live on less than $1 per day
Adult literacy 36%
Life expectancy 56 years
MOH – 60 to 80% of mortality rate is due to preventable diseases
Figure: GHWA
Photo: Morgana Wingard
Health Extension Programme
“A package of basic and essential promotive,
preventive and selected curative health
services, targeting households in the
community, based on the principles of
primary health care to improve the health
status of families with their full participation,
using local technologies and the skill and
wisdom of the communities”
Photo: Hans Brekling
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Began in 2004
Have now trained 35,000 HEWs (majority female)
1 year of training
Eligibility: 18 years old / Completed 10th grade
Salary varies by region – 45 to 63 USD per month
Photo: Gates Foundation
U5MR has decreased from
123 in 2005 to 88 in 2011
Photo: Maren Jones
Use of modern contraceptives:
14% of married women in 2005
increased to 28% in 2011
2005 – 38% children underweight
2011 – decreased to 29%
Photo: Peter Duncan Jones
2005 – 47% of children were stunted
2011 – decreased somewhat to 44%
Photo: UNICEF Canada
• 2005 – 6% of babies
delivered by a health
professional
• 2011 – 10% delivered
by a health professional
– Urban: 51%
– Rural: 5%
Photo: Indrias Getachew
Work Overload
Photo: UNICEF Canada
Photo: One.org
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2007 evaluation – half of HEWs felt that their pay was inadequate for their workload
So what is a fair and realistic workload for 2 HEWs serving a population of 5000?
How can volunteers working under HEWs further ease their burden?
How can we ensure that HEWs deliver high quality care in priority areas, instead of
continually increasing their burden of work?
Regional Inequity
Photo: AMREF Canada
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Lower ratio of HEWs / population
MOH needs to invest more resources in the 5 emerging regions
Find innovative ways of adapting the HEP model so that it will work in a context of
pastoralist / nomadic populations
Supervision
• Supportive supervision has
been difficult to implement
and maintain
• 1 supervisor for 10 HEWs
• Supervisors are nurses or
environmental health
professionals, only trained for
two months
• Supervision is based on a
checklist
• Separate supervision for the
HEP and for CCM
• MOH developing a model
integrating these two and will
be testing it in the coming
months
Photo: Indrias Getachew
Photo: Lancet
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Improve training of supervisors to include more human resource management skills
Implement care group model within existing supervision structure