Ethiopia Health Extension Program

As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia s Health Extension Program (HEP) has contributed to the country s move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia s experiences of HEP when designing their own path to UHC. HEP is one of the government s UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of health development army ? to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country s move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

This book reviews Ethiopia's experiences in designing and implementing its Health Extension Program, assesses its contribution to the country;s progress towards Universal Health Coverage (UHC), and summarizes lessons that are relevant to other countries when they design their own path to UHC.

Although Ethiopia has made steady progress in health outcomes over the past 10 years, some health challenges remain, particularly those related to maternal health. In part this may be linked to the insufficient number of health professionals providing maternal care services, particularly in the rural parts of the country.

Health indicators particularly on child health and malaria in Ethiopia have improved significantly in recent years, with the next challenge now focused on improving maternal health indicators. Improvements in Child health and Malaria in particular can be attributed to strong government commitment towards health results in the country, reflected in a number of notable policies and programs related to Human Resources for Health (HRH), in particular the health extension worker program. However, indicators related to maternal health, remain problematic. Ethiopia has one of the lowest levels of assisted deliveries in the region. Although increases in the number of health workers particularly in rural areas may have contributed to improving access to some health services, it is in the government's interest to further improve the stock, distribution and performance of relevant health workers in Ethiopia, particularly to bring about improvement in access to maternal health services for the poor. This document reviews the current HRH situation in Ethiopia, summarizes the evidence on population use of select health services, and offers relevant policy options to assist the government finalize its new Human Resources Strategy and address remaining health challenges.

Perry, James F. Phillips, Meike Schleiff, Melissa Sherry, Rita Thapa, Kebede Worku

Revitalizing Health for All examines thirteen cases of efforts to implement CPHC reforms from around the globe including Australia, Brazil, Democratic Republic of Congo, Iran, South Africa, and more.

Despite recent progress, malnutrition remains a severe problem in Ethiopia. This report provides the findings from an in-depth data-based analysis of malnutrition in Ethiopia and its causes.