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Innovative Education and scale up for rural health workers

Innovative Education and scale up for rural health workers. A Case Study from Ethiopia The Health Extension Program (HEP) By Habtamu Argaw (MD,MPH) NHSDE, WHO/Ethiopia. The HEP and Reasons Behind its Introduction. PHC adopted since 1970‘s, Aimed to universal coverage,

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Innovative Education and scale up for rural health workers

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  1. Innovative Education and scale up for rural health workers A Case Study from Ethiopia The Health Extension Program (HEP) By Habtamu Argaw (MD,MPH) NHSDE, WHO/Ethiopia

  2. The HEP and Reasons Behind its Introduction • PHC adopted since 1970‘s, • Aimed to universal coverage, • Used CHWs and CHS, but failed due to; • Remuneration/incentives and support, • Sructure of MOH (limited to central/regional level, none at district level) • Maintained vertical programs • Renewed efforts (1993) and yet during HSDP I (1997-2000/1), EHSP didn’t reach the people at grass roots level.

  3. HEP • Target of universal PHC coverage by 2009/10 • HEP introduced in 2003 (HSDP II) • Aim • Creating healthy environment and healthful living (esp. Preventive, promotive, and health awareness) • Make available EHSP at grass root (Kebele & HH) as a package targeting HH (mothers and women) through HH visit, health education and demonstration.

  4. HEP Implemented by two salaried staff at each Kebele,Health Extension Workers (HEW) • HEWs are Female (exceptions) • HEWs are recruited from the same kebele • HEWs are trained for a year at Technical and Vocational Education and Training Centers. (TVET).

  5. HEP Covers 16 health extension packages in 3 areas; • Disease Prevention and Control. • HIV/AIDS/STI and TB prevention/control • Malaria prevention/control - First Aid and emergency • Family Health Service. • Maternal and child health - Family planning - Immunization • Adolescent reproductive health - Nutrition • Hygiene and Environmental Sanitation. • Excreta disposal - Solid and liquid waste disposal • Water supply and safety - Food hygiene and safety measures • Healthy home environment -Control of insects and rodents • Personal hygiene • IEC as cross cutting approach.

  6. HEP • Approaches to HEP delivery • HEW uses the following approaches • Model family • Community based health packages • HP based services • HEW required to spend 75% of their time in the outreach activity by going from home to home

  7. Progress • 17,653 (59%) HEW trained and deployed • 7,000 to be trained each year until end 2009 • 9914 (66%) of HP constructed by June 2007 • Strong political commitment is key • Partners joining hands • TWG established to support • Health represented in local administration (Cabinet)

  8. Many Challenges • Recruitment • Lack of adherence to rural recruitemnt • Training and skills development, • Limited skills (esp. skilled delivery) • Supplies and equipment • Not yet fullfiled • New needs emerging (transport, bags etc) • Supervision. • DHMT not capable of giving effective support • Roles for HC limited • Other problems • Career development • Transfer • Recognition and support from other HRH

  9. Points for discussion and action • System wide linkage and Integration to national health system including referral system • Linkage with national HRH system • Focus of basic training (priority) • Large number of trainees vs. skills training • Free HEP in contrast to private sector linkage

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