Key Challenges in Ethiopia

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Key Challenges in Ethiopias Health Extension
Programme Lessons from the Field

• Camille Boostrom
• Centre for Global Health, TCD

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Map António Martins

• 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

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Figure GHWA
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Photo Morgana Wingard
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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
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Photo Hans Brekling

• 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

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Photo Gates Foundation

• U5MR has decreased from
• 123 in 2005 to 88 in 2011

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Photo Maren Jones
Use of modern contraceptives 14 of married
women in 2005 increased to 28 in 2011
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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
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• 2005 6 of babies delivered by a health
  professional
• 2011 10 delivered by a health professional
• Urban 51
• Rural 5

Photo Indrias Getachew
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Work Overload
Photo UNICEF Canada
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Photo One.org

• 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?

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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

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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
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Photo Lancet

• Improve training of supervisors to include more
  human resource management skills
• Implement care group model within existing
  supervision structure

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