The Health Extension Program in Ethiopia

• Main Authors: Workie, Netsanet W, Ramana, Gandham NV
• Format: Publication
• Language: English
• Published: World Bank, Washington, DC 01.01.2013
• Subjects: access to health services; access to primary health care; Adolescent reproductive health; aged; aggressive; agricultural development; AIDS; basic health care; basic health services; birth attendants; breastfeeding; burden of disease; caesarean sections; capacity building; center for health; certification; child health; child morbidity; child mortality; clinics; cold chains; Communicable diseases; Community Health; community participation; competencies; Contraceptive Prevalence; contraceptive use; contraceptives; counseling; decision making; developing countries; disability; dissemination; drugs; economic growth; essential commodities; essential health services; essential medicines; expenditures; families; family health; family planning; fertility; fertility rate; General Health System; government leadership; gross domestic product; health care; health care coverage; health care facilities; health care services; health centers; health clinics; health education; Health Expenditure; Health Extension; health facilities; Health Financing; Health Indicators; Health Infrastructure; health initiatives; Health Insurance; health interventions; health management; health messages; health outcomes; health policy; health posts; health problems; health professionals; health sector; health sector reform; health service; health service providers; health services; health status; Health System; health system strengthening; health systems; Health Workers; health workforce; healthy life; HIV; home visits; hospital; Hospital beds; hospitals; household level; human capital; human resources; hygiene; ill health; illnesses; immunization; income; Infant; Infant mortality; Infant mortality rate; infants; information system; Information systems; injuries; integration; interpersonal communication; large population; leprosy; Life expectancy; limited resources; live births; local community; malaria; management of health; married women; maternal health; maternal mortality; maternal mortality ratio; medical equipment; medical services; medical supplies; medicines; Millennium Development Goals; Ministry of Education; Ministry of Health; modern contraceptive methods; modern family; modern family planning; modern family planning methods; morbidity; mortality; mother; mother-to-child; mother-to-child transmission; national level; Needs Assessment; newborn; newborn care; normal deliveries; number of children; nurses; nutrition; nutritional deficiencies; occupational health; oral rehydration therapy; patient; patients; personal hygiene; Pharmacies; Physician; Physicians; plan of action; population indicators; populous country; postnatal care; pregnancy; pregnant women; prenatal care; primary care; primary health care; primary health care facilities; primary health care services; primary health facilities; primary health services; Progress; promoting gender equality; provision of care; provision of services; Public Health; public health programs; public service; quality of health; quality of services; referral services; referral system; referral systems; regional hospital; religious institutions; reproductive health; reproductive health services; resource constraints; resource mobilization; respect; role models; rural areas; rural communities; rural population; safe drinking water; safe motherhood; safety measures; sanitation; screening; service delivery; service delivery points; service provision; sexually transmitted infections; social networks; socioeconomic differences; Sustainable Development; technical skills; tetanus; traditional birth attendants; tuberculosis; tuberculosis prevention; under-five mortality; UNFPA; universal access; urban areas; urban communities; user fees; vaccination; vaccines; vocational education; waste; waste disposal; Workers

Ethiopia has made substantial progress in improving health outcomes during the last decade and is on track to achieve some of the health Millennium Development Goals. Innovative strategies to improve household behaviors and coverage of basic health care services contributed to Ethiopia's achievements, and the Health Extension Program (HEP) remains the core of such innovations and provides a model for countries struggling to improve health outcomes in a resource-constrained setting. The program rests on an accelerated expansion of basic health infrastructure and local human resources with required skills to scale-up delivery of high-impact interventions focusing on improving the supply of and enhancing demand for a well-defined package of essential promotive, preventive, and curative health services. The objectives of the case study are to provide a detailed description of (a) the context for the introduction of the program; (b) the scope of the service package delivered under the program; and (c) the institutional arrangements and the links with the rest of the health system. The case study also summarizes and discusses the evidence of the program's achievements and the challenges to achieving universal primary health care coverage. The study also discusses the importance of political will and commitment in introducing such large-scale innovations in improving service delivery and mobilizing the community in a resource-constrained setting.