Case study

MDG 6 - Bringing care to communities in Ethiopia

An innovative health workers’ scheme has completely transformed the face of health care across rural Ethiopia.

Ethiopia: Preventing HIV in newborns - Fatuma Nuru on her first visit to a health clinic for prenatal care. Picture: IntraHealth International Ethiopia

Ethiopia: Preventing HIV in newborns - Fatuma Nuru on her first visit to a health clinic for prenatal care. Picture: IntraHealth International Ethiopia

An innovative health workers scheme has completely transformed the face of healthcare across rural Ethiopia. Village health extension workers have been trained to deliver basic services to their communities through a Health Extension Program (HEP) that includes information, education and services including on immunisation, family planning, nutrition and sanitation, as well as malaria prevention, diagnosis and treatment. Family planning coverage has doubled over the last five years, and it is estimated that the incidence of malaria has been reduced by half.

Ten years ago, only two thirds of Ethiopians had access to healthcare services, and the country faced a critical need to bring healthcare to some 68 million people across rural Ethiopia. Only US$16 per person each year is available to spend on health care in Ethiopia. This story shows that focusing on cost effective solutions can deliver real results.

The education, training, and retention of the health extension workers are key elements of this success. Over 38,000 (mostly female) workers have been trained and deployed to all regions of the country to deliver the HEP ‘package’ of services. Two workers, each of whom has completed a one-year training course, work in each rural kebele (a village of about 5,000 people). Nine million households (63%) now have access to the HEP.

The female workers are well placed to deliver the program, since they are able to gain the trust of local women and even to serve as role models to them. The program also provides career opportunities to women and increases their status within their communities.

The HEP is having a real impact on the health of communities it is reaching. Statistics show a 73% reduction in malaria cases and a 62% decrease in deaths of children under 5 in HEP villages. In 2010, 1.5 million more children were vaccinated against killer diseases, as compared to 2005. An estimated 1.4 million more women are using contraceptives in 2010 than in 2005. In addition, more than 35 million insecticide treated bed nets for malaria prevention have been distributed. These statistics indicate that Ethiopia is on the way to achieving MDG 6.

A healthcare worker newly trained to counsel HIV-positive mothers has stated:

“Now I see pregnant women differently. When I find an HIV-positive pregnant woman, I will be sad just like any other person, but my frustration for not providing a solution is gone now. I am capable of counseling for HIV testing and keeping the mother in medical follow-up toward institutional delivery, which most women in our area are not willing to do. This way I can make a difference in one’s family life.”

Key facts

Since 2004, the Ethiopian Federal Ministry of Health has implemented the Health Extension Program (HEP) in an effort to reach Ethiopia’s largely rural population with health services.

The HEP focuses on providing cost effective basic health services in an accessible and equitable manner to reach all segments of the population, with special attention to mothers and children.

Health extension workers are trained and deployed in kebeles across the country.

Workers provide information, education and services on hygiene and environmental sanitation, disease prevention and control (including HIV and AIDS), tuberculosis and malaria, and family health services.

Health workers are based in rudimentary ‘health posts’ (small 2 room buildings) and carry out their work through community meetings and by visiting families in their homes.

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Updates to this page

Published 19 September 2011