Assessment of the Training of the First Intake of Health Extension Workers

Kitaw, Yayehyirad; Ye-Ebiyo, Yemane; Said, Amir; Desta, H; Teklehaimanot, Awash

doi:10.4314/ejhd.v21i3.10053

Cited by 21 publications

(18 citation statements)

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“…The rapid expansion of Ethiopia's Health Services Extension Programme was enabled by a strategy in which theoretical training was offered through training institutions run by the Ministry of Education, and practical training was offered at health centres (Kitaw et al . ; Bilal et al . ).…”

Section: Resultsmentioning

confidence: 95%

Implementing large‐scale programmes to optimise the health workforce in low‐ and middle‐income settings: a multicountry case study synthesis

Gopinathan

Lewin

Glenton

2014

Tropical Med Int Health

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Abstractobjectives To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low-and middle-income countries.methods We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework -a comprehensive list of factors that may influence the implementation of health system interventions -was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies.results Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment.conclusions Existing weaknesses in health systems may undermine the implementation of largescale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout.

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Section: Resultsmentioning

confidence: 95%

Implementing large‐scale programmes to optimise the health workforce in low‐ and middle‐income settings: a multicountry case study synthesis

Gopinathan

Lewin

Glenton

2014

Tropical Med Int Health

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“…Although many aspects of primary healthcare are normally provided by low-level professionals or lay persons with training, it is the quality of training that determines the quality of service and performance of the program [34,35]. The training of HEWs for 1 year on the 17 HEP packages may be inadequate to attain the required knowledge and skills leading to delivery of poor quality services and bypassing of the primary care by users [35,36]. The multitasking by providing 17 service packages by HEWs could affect the availability of services, resulting in inefficiencies of some of the program components [37].…”

Section: Human Resource Capacitymentioning

confidence: 99%

Human resource development for a community-based health extension program: a case study from Ethiopia

2013

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IntroductionEthiopia 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.Case descriptionThe 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.Discussion and evaluationThe 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.ConclusionsThis 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.

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“…The selection, training curriculum, training facilities, kebele orientation, pay consistency, and employment security of an initial round of 2,700 HEWs trained in 2004 in 11 technical and vocational education institutes/centers was found to be very poor 44. In addition, the housing facilities associated with health posts where HEWs were assigned were lacking, and infrastructure problems including safe water, toilet facilities, transport, and communication were highlighted as meriting investigation and remedy 40.…”

Section: Community Health Worker Programs At National Scalementioning

confidence: 99%

Community Health Workers in Global Health: Scale and Scalability

Liu

Sullivan

Khan

et al. 2011

Mount Sinai J Medicine

123

131

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Community health worker programs have emerged as one of the most effective strategies to address human resources for health shortages while improving access to and quality of primary healthcare. Many developing countries have succeeded in deploying community health worker programs in recognition of the potential of community health workers to identify, refer, and in many cases treat illnesses at the household level. However, challenges in program design and sustainability are expanded when such programs are expanded at scale, particularly with regard to systems management and integration with primary health facilities. Several nongovernmental organizations provide cases of innovation on management of community health worker programs that could support a sustainable system that is capable of being expanded without being stressed in its functionality nor effectiveness--therefore, providing for stronger scalability. This paper explores community health worker programs that have been deployed at national scale, as well as scalable innovations found in successful nongovernmental organization-run community health worker programs. In exploration of strategies to ensure sustainable community health worker programs at scale, we reconcile scaling constraints and scalable innovations by mapping strengths of nongovernmental organizations' community health worker programs to the challenges faced by programs currently deployed at national scale.

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Assessment of the Training of the First Intake of Health Extension Workers

Cited by 21 publications

References 1 publication

Implementing large‐scale programmes to optimise the health workforce in low‐ and middle‐income settings: a multicountry case study synthesis

Implementing large‐scale programmes to optimise the health workforce in low‐ and middle‐income settings: a multicountry case study synthesis

Human resource development for a community-based health extension program: a case study from Ethiopia

Community Health Workers in Global Health: Scale and Scalability

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