Initial community perspectives on the Health Service Extension Programme in Welkait, Ethiopia (original) (raw)
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2020
Background: Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services. Methods: We conducted a qualitative study in six districts in the Sidama zone, which included focus group discussions (FGDs) with HEWs, women and men from the community and semi-structured interviews with HEWs; key informants working in programme management, health service delivery and supervision of HEWs; mothers; and traditional birth attendants. Respondents were asked about facilitators and barriers regarding HEWs' relationships with the community and health sector. Interviews and FGDs were reco...
BMC Health Services Research
Background: The Health Extension Program (HEP) is one of the most innovative community based health program launched by the Ethiopian Federal Ministry of Health to make health services accessible to rural communities by setting-out women Health Extension Workers (HEWs) in rural Health Posts. The HEWs are premised to provide basic, largely preventive, primary health services to rural villages and the program gives special attention to children and mothers. The objective of the study was to assess the contribution made by the Health Extension Workers in maternal and child health care service delivery in Dale district, southern Ethiopia. Methods: Using a community based cross-sectional data; the study assessed the status of mother's health service utilization and estimated the role of HEWs in maternal and child health care delivery. Mothers of reproductive age (15-49), having at least one under-five age child, were eligible for the study. The total sample size was 617 and systemic random sampling method was used to select the study subjects from each randomly selected kebeles (lower administrative units). Structured questionnaire was applied to collect data through interviewing of the selected mothers and the data were analysed using SPSS version 16 statistical software. Results: Health Posts are important health care delivery settings and their share from the overall service delivery of ANC, Family planning and child treatment services were pivotal. However, overall service coverage of ANC (four and more visits), delivery and PNC services were low in the district as compared to the national status; and the input from the HEWs, in this regard, was unsatisfactory. The number of home visits was also inadequate for the necessary support of the mothers. The results of the multiple logistic regression indicated that mothers who listen to the radio (AOR 4.62; CI 1.66-12.85) and who had received information about the MCH services by HEWs (AOR 2.09; CI 1. 06-4.14) were significantly associated with good MCH service utilization status. Conclusion: Health Extension Workers can improve their role in the MCH service delivery in the district by delivering appropriate information about the different available services to the mothers at the community and household level. All concerned bodies, including federal, regional and local governments should support the efforts of HEWs and need to address the challenges for poor performance areas of the HEWs in MCH service delivery.
Human Resources for Health, 2015
Background: Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services. Methods: We conducted a qualitative study in six districts in the Sidama zone, which included focus group discussions (FGDs) with HEWs, women and men from the community and semi-structured interviews with HEWs; key informants working in programme management, health service delivery and supervision of HEWs; mothers; and traditional birth attendants. Respondents were asked about facilitators and barriers regarding HEWs' relationships with the community and health sector. Interviews and FGDs were recorded, transcribed, translated, coded and thematically analysed. Results: HEWs were selected by their communities, which enhanced trust and engagement between them. Relationships were facilitated by programme design elements related to support, referral, supervision, training, monitoring and accountability. Trust, communication and dialogue and expectations influenced the strength of relationships. From the community side, the health development army supported HEWs in liaising with community members. From the health sector side, top-down supervision and inadequate training possibilities hampered relationships and demotivated HEWs. Health professionals, administrators, HEWs and communities occasionally met to monitor HEW and programme performance. Expectations from the community and health sector regarding HEWs' tasks sometimes differed, negatively affecting motivation and satisfaction of HEWs. Conclusion: HEWs' relationships with the community and health sector can be constrained as a result of inadequate support systems, lack of trust, communication and dialogue and differing expectations. Clearly defined roles at all levels and standardized support, monitoring and accountability, referral, supervision and training, which are executed regularly with clear communication lines, could improve dialogue and trust between HEWs and actors from the community and health sector. This is important to increase HEW performance and maximize the value of HEWs' unique position.
BMC Health Services Research, 2013
Background: Although mothers are the fundamental unit of interventions in Health Extension Program in Ethiopia, their experiences and satisfactions with the service remain unstudied. Therefore, this study was aimed to assess mothers' experiences and satisfaction with health extension service. Methods: A community based cross sectional study was conducted in Jimma Zone, Oromiya, Ethiopia. Three hundred Seventy-nine mothers were participated in the study. The study was conducted in four randomly selected rural villages. Systematic sampling technique was used to identify respondents. As part of the data collection process, four focus group discussions were conducted with mothers. SPSS 17.0 and ATLASti.4.1. Softwares were used for data analysis. Results: One hundred Sixty nine (51.7%) of the respondents had an experience of interactions with health extension workers during one year prior to the survey, while 271 (71.5%) of them reported that they received visits from health extension workers during the same period. 298 (78.6%) of the respondents received information at least on one of the Health extension packages. In fact, they had better exposure to personal hygiene and environmental sanitation packages. Even though health extension program is being run by female workers alone, it was believed that the involvement of men is vital to the success of the program. Mothers thought that men are more courageous and professionally competent to deal with complex matters. They also tended to criticize health extension program for lacking curative services and health extension workers are less competent. The greater emphasis laid on outreach services was not supported. 286 (75.5%) of the respondents rated their relationship with health extension workers as positive. Similarly, higher satisfaction was reported though the program has problems. Age, perceived skill to diagnose community problems, perceived respect, involvement of husband and being recognized as a model family were significantly predicted satisfactions with health extension services. Conclusions: Most mothers had good relationship, were satisfied with and had positive attitude towards health extension program though the program was criticized for not including curative services and the less attention given to static services at health post. Stakeholders are required to reconsider these issues.
International Journal of Environmental Research and Public Health
Background: Health extension workers (HEWs) have substantial inputs to reduce maternal and newborn morbidity and mortality in Ethiopia. However, their perceptions and experiences were not well understood. Therefore, this study aimed to explore their perceptions and experiences on facilitators and barriers to maternal and newborn health services in Ethiopia. Methods: A descriptive qualitative study was conducted from 8–28 April 2021 in Oromia, Amhara and Southern Nation, Nationality, and People’s Regional State of Ethiopia. Focused group discussions were made with purposively selected 60 HEWs. The data were transcribed verbatim and translated into English. An inductive thematic analysis was carried out using Atlas ti.7.1. The findings were presented in major themes, categories, and sub-categories with supporting quote(s). Results: The findings were categorized into two major themes (i.e., facilitators and barriers) and seven sub-themes. Community-related facilitators encompass awaren...
Health Services Research and Managerial Epidemiology
Background: Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC). Methods: A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software. Results: The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244...
Africa Journal of Nursing and Midwifery, 2017
The purpose of this study was to identify the contributions made by the Health Extension Programme (HEP) to influence the utilisation of maternal healthcare services at primary healthcare units in the Mecha district, Ethiopia. A non-experimental quantitative descriptive research design was conducted. This was structured into four phases. In phase one the continuum of care and quality of documentation was audited from 975 antenatal cards documented in three health centres from 1 July 2010 to 30 June 2013. In phase two 304 women were interviewed about their knowledge on the available services, the quality of maternal healthcare provision and factors that hinder the utilisation of maternal healthcare services. In phase three the opinions of all midwives and health extension workers (HEWs) were obtained with self-administered questionnaires from three health centres and 15 health posts respectively. In phase four the guidelines were developed. The findings revealed that the continuum care of maternal healthcare services was ineffective; the quality of documentation was poor. The majority of respondents were more knowledgeable about other HEP packages than maternal healthcare services. The advocacy and dissemination of information about the maternal healthcare services proved to be inadequate. The relations between the clients and the healthcare providers at the health centres were unsatisfactory. Enyew and Dolamo The Contribution of a Health Extension Programme The study developed guidelines based on the findings. The study recommended that a strong antenatal care follow-up tracking mechanism be urgently provided, that providers be knowledgeable, that community midwives be trained and accredited to give skilled delivery at the health posts, and that the recording tools at the health post be reviewed and developed.
Human Resources for Health, 2013
Ethiopia is one of the sub-Saharan countries most affected by high disease burden, aggravated by a shortage and imbalance of human resources, geographical distance, and socioeconomic factors. In 2004, the government introduced the Health Extension Program (HEP), a primary care delivery strategy, to address the challenges and achieve the World Health Organization Millennium Development Goals (MDGs) within a context of limited resources. The health system was reformed to create a platform for integration and institutionalization of the HEP with appropriate human capacity, infrastructure, and management structures. Human resources were developed through training of female health workers recruited from their prospective villages, designed to limit the high staff turnover and address gender, social and cultural factors in order to provide services acceptable to each community. The service delivery modalities include household, community and health facility care. Thus, the most basic health post infrastructure, designed to rapidly and cost-effectively scale up HEP, was built in each village. In line with the country's decentralized management system, the HEP service delivery is under the jurisdiction of the district authorities. The nationwide implementation of HEP progressed in line with its target goals. In all, 40 training institutions were established, and over 30,000 Health Extension Workers have been trained and deployed to approximately 15,000 villages. The potential health service coverage reached 92.1% in 2011, up from 64% in 2004. While most health indicators have improved, performance in skilled delivery and postnatal care has not been satisfactory. While HEP is considered the most important institutional framework for achieving the health MDGs in Ethiopia, quality of service, utilization rate, access and referral linkage to emergency obstetric care, management, and evaluation of the program are the key challenges that need immediate attention. This article describes the strategies, human resource developments, service delivery modalities, progress in service coverage, and the challenges in the implementation of the HEP. The Ethiopian approach of revitalization of primary care through innovative, locally appropriate and acceptable strategies will provide important lessons to other poorly resourced countries. It is hoped that the approaches and strategies described in this paper will aid in that process.
2016
Background: An mHealth initiative that intends to improve maternal and child health care delivery was implemented in Abeshge and Ezha woreda of Guraghe zone of SNNPR of Ethiopia by Addis Ababa University with financial support from the WB and AFDB. The adoption of such new technology for intended purpose depends on the knowledge and attitude of front line health workers towards the technology as well as expected benefits and acceptance by the end users. An assessment of the knowledge, attitude, and performance of HEWs is important to improve and scale intervention. Objective: To assess the knowledge, attitude and performance of health extension workers’ towards mHealth intervention in two woredas of Guraghe zone of Ethiopia. Methods: A cross sectional survey was conducted among health extension workers who participated in mHealth intervention that was implemented from September 2012 – October 2014 in Abeshge and Ezha woreda of Guraghe zone of SNNPR of Ethiopia. A total of 77 partici...