Ethiopia’s health extension workers use of work time on duty: time and motion study

Abstract

Ethiopia implemented an innovative community-based health program, called the health extension program, to enhance access to basic health promotion, disease prevention and selected curative services by establishing health posts in every village, also called kebeles, with average of 5000 people, staffed with two health extension workers (HEWs). This time and motion study was done to estimate the amount of time that HEWs spend on various work duties and to explore differences in urban compared with rural settings and among regions. A total of 44 HEWs were observed for 21 consecutive days, and time and motion data were collected using tablet computers. On average, HEWs were on duty for 15.5 days out of the 21 days of observation period, and on average, they stayed on duty for about 6 hours per day. Out of the total observed work time, the percentages of total time spent on various activities were as follows: providing health education or services (12.8%); participating in meetings and giving trainings (9.3%); conducting community mapping and mobilization (0.8%); recordkeeping, reporting, managing family folders (13.2%); managing commodities and supplies (1.3%); receiving supervision (3.2%); receiving training (1.6%); travel between work activities (15.5%); waiting for clients in the health post (or health centre in urban settings) (24.9%); building relationships in the community (13.3%); and other activities that could not be meaningfully categorized (4%). The proportion of time spent on different activities and the total time worked varied significantly between rural and urban areas and among the regions (at P < 0.05). Findings of this study indicate that only a minority of HEW time is spent on providing health education and services, and substantial time is spent waiting for clients. The efficiency of the HEW model may be improved by creating more demand for services or by redesigning service delivery modalities.

Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia

“…The community-based cross-sectional study was conducted using the Health Extension Worker (HEW) network to identify cases. HEWs are predominately female, and are recruited from the communities they serve to expand access to basic health promotion, disease prevention and selected curative health services [ 20 ]. The HEWs searched for patients affected by LF and podoconiosis in their community catchment areas, with two HEWs covering a population of approximately 5,000 people [ 20 ].…”

Unit Costing of Health Extension Worker Activities in Ethiopia: A Model for Managers at the District and Health Facility Level

“…Health Extension Workers Time Motion Study. 15 - 17 The work activities of two HEWs in 22 Woredas (for a total of 44 HEWs) were observed for a period of 21 consecutive days between April and June 2014. Each day, observers recorded activities continuously beginning with the HEW’s first work-related task of the day upon arrival and ending when the HEW completed the last work-related task of the day before leaving for the day.…”

“… 19 , 20 For a complete description of the TMS methods and results, please refer to Ethiopia’s health extension workers use of work time on duty: time and motion study. 17 …”

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas

“…Other demand side barriers included delay in seeking care due to the need to obtain husbands' permission and financial support, the perceived cost and real cost of travel, particularly due to costs associated with referral of severely ill children to a further facility and repeated travel due to health post closure [21]. Supply-side barriers included frequent stock-outs of medicines and other necessary supplies, service interruption and inconsistent operating hours at health posts [24]. Further, it showed that HEWs had poor skills and confidence [25], especially when managing and treating newborns [26], lack of local government ownership and lack of accountability for both the CBNC and iCCM programs, and inconsistent supervision and monitoring.…”