Case study

Extending the fight against malaria in Ethiopia

Supporting rural health workers to combat malaria

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Almaz is 24 years old and has been working as a Health Extension Worker (HEW) for the last three years, in her own village which is more than an hour’s drive from the nearest small town.

“The work is very hard, I have to work long hours and walk long distances but I am proud to be serving my community and have seen real changes in their health,” she says.

Almaz is one of more than 34,000 HEWs who have been trained and deployed to deliver a ‘package’ of basic services to their communities, including the prevention, diagnosis and treatment of malaria, family planning and immunisation.

Ten years ago, only two-thirds of Ethiopians had access to health services. Rural areas, in particular, suffered from a lack of medical facilities and health workers. There was a critical need to bring healthcare to more of Ethiopia’s people. And over the last five years, the Health Extension Programme (HEP), the flagship programme of the Ethiopian ministry of health, has aimed to do just that.

At the centre of the HEP are female health workers like Almaz who operate within local communities. In each rural “kebele” (a community of about 5,000 people), two women who have completed tenth grade are selected to become Health Extension Workers.

This national programme has helped to deliver real improvements in people’s health including reducing the previously devastating impact of malaria. The HEWs teach their communities about how to prevent malaria and to seek help when they have a fever.

They have also been trained and equipped to test people for malaria at the community level, which ensures correct diagnosis and treatment. Additionally, in the last five years more than 35 million insecticide-treated nets have been distributed across the country, which are reducing the numbers of people becoming infected.

Getting healthcare to communities

The UK is supporting the Health Extension Programme through a contribution to the government of Ethiopia district level ‘block grant’, which pays for the delivery of services. This block grant is used by districts across the country to deliver priority services, including health and education, to its communities.

UK funding is currently supporting more than 3,900 Health Extension Workers to deliver health services to around nine million people. Additionally, the British Government provides direct support to the Ethiopian ministry of health to help it to deliver its ambitious plans to meet all of the health related MDG targets by 2015, including those on malaria.

Facts and stats

The latest World Health Organisation rapid impact assessment in four main regions in Ethiopia shows that between 2001-2004 (annual average) and 2007, confirmed malaria outpatient cases decreased by 67%, malaria admissions by 54%, and malaria deaths by 55%.

The government of Ethiopia’s next five year plan includes efforts to further increase utilisation of ITNs and strengthen diagnosis and treatment of malaria.

Published 22 December 2010