Lessons from Health Service Extension Program in Ethiopia

In recent months, global attention to the strengthening of health systems in developing countries has increased dramatically. The Ebola outbreak in the three countries most affected by this epidemic, Guinea, Sierra Leone, and Liberia, illustrated that the problem must be tackled as a matter of urgency. Currently, the spotlight is on building infrastructures and improving access to medicine, but we should also remember to focus on developing a strong health workforce.

Before the first health policy in 1993, Ethiopia, was struggling with weak health care system and infrastructure. Besides the lack of economic growth and investment in health, the country also suffered from a brain drain that had started in the late 1970s. It is not surprising that this led to skewed service availability within the country – rural populations had little or no access to health services.

As part of its new policy, the government implemented the Health Extension Program (HEP), which trained and assigned local health workers to rural communities. As a result, there were low rates of infectious diseases, child mortality was reduced, and raised awareness about family planning (UNICEF 2013). In addition, this program was successful because it- focused on ownership; partnerships; capacity building, and system- wide collaborations.

The government was also able to avoid the issue of mistrust and lack of information, by recruiting health workers based on their residence and language skills. Plus, they were only trained to deal with disease burdens in their communities; so the time and cost of training was very modest. Given the issue of limited resources, governments that want to adopt this program should absolutely pay attention to this characteristic of the program.

So far, the HEP has illustrated that it is an effective and low-cost tool, which means it could be rolled out across the region. The WHO, has also expressed its support to countries that are working on developing national policies on strengthening health workforce; so it might be easy to ask the organization for technical advise, on how to transfer or develop a similar program like the one in Ethiopia.

Thanks to the recent outbreak of Ebola, the issue of straightening health systems will definitely be on the radar for a very long time. Thus, this is a great opportunity to start advocating for better health service delivery in rural communities. And advocates should definitely encourage governments to develop or adopt effective and low-cost health extension service programs.


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