National Assessment of the Health Extension Program in Ethiopia: Study Protocol and Key Outputs

The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services. However, this program is not comprehensively evaluated.

The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584)_, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179) from 62 randomly selected woredas. As part of the comprehensive assessment.

The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards.

The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 2020-2035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers.