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Key Challenges in Ethiopia’s Health Extension Programme:
Lessons from the Field
Camille BoostromCentre for Global Health, TCD
• 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
Map: António Martins
Figure: GHWA
Photo: Morgana Wingard
“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”
Health Extension Programme
• 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: Hans Brekling
U5MR has decreased from 123 in 2005 to 88 in 2011
Photo: Gates Foundation
Photo: Maren Jones
Use of modern contraceptives:14% of married women in 2005
increased to 28% in 2011
Photo: Peter Duncan Jones
2005 – 38% children underweight 2011 – decreased to 29%
Photo: UNICEF Canada
2005 – 47% of children were stunted2011 – decreased somewhat to 44%
• 2005 – 6% of babies delivered by a health professional
• 2011 – 10% delivered by a health professional – Urban: 51%– Rural: 5%
Photo: Indrias Getachew
Photo: UNICEF Canada
Work Overload
• 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?
Photo: One.org
Regional Inequity
Photo: AMREF Canada
• 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
• Improve training of supervisors to include more human resource management skills• Implement care group model within existing supervision structure