The community-based Health Extension Program significantly improved contraceptive utilization in West Gojjam Zone, Ethiopia

Abstract

BackgroundEthiopia has implemented a nationwide primary health program at grassroots level (known as the Health Extension Program) since 2003 to increase public access to basic health services. This study was conducted to assess whether households that fully implemented the Health Extension Program have improved current contraceptive use.MethodsA cross-sectional community-based survey was conducted to collect data from 1,320 mothers using a structured questionnaire. A multivariate logistic regression was used to identify the predictors of current contraceptive utilization. A propensity score analysis was used to determine the contribution of the Health Extension Program “model households” on current contraceptive utilization.ResultMothers from households which fully benefited from the Health Extension Program (“model households”) were 3.97 (adjusted odds ratio, 3.97; 95% confidence interval, 3.01–5.23) times more likely to use contraceptives compared with mothers from non-model households. Model household status contributed to 29.3% (t=7.08) of the increase in current contraceptive utilization.ConclusionThe Health Extension Program when implemented fully could help to increase the utilization of contraceptives in the rural community and improve family planning.

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

“…Despite encouraging reports of positive impact of HEP, 8,[22][23][24][25][26]52 the findings of this study show major deficiency in its overall performance. The scores across all domains were low, which could be due to their interdependence, where the capacity for service provision and financial systems influence the human resource development, the community engagement and service provision process that in turn affect the output and outcome dimension.…”

“…4 BSC has been implemented at the FMOH and federal hospitals levels and remains to be cascaded to all levels of the health system. HEP is one of the core components of HSDP, and although studies have documented the performance of the program on individual indicators, [22][23][24][25][26] there is limited evidence on integrated performance indices and scoring methodologies. 8 We developed a scoring methodology for performance evaluation of HEP based on the BSC approach 14,21 and generated performance indices using data obtained from nationwide HEP evaluation survey.…”

Model and Non-Model Mothers Are Similar Over Significant Aspects of Maternal-Child Health Behaviors in Rural Contexts of Central Ethiopia: Diffusing Healthy Behaviors

“…According to DOI theory, Social cognitive theory (SCT) and other behavioral theories, models (in this case, model families) were intended to exhibit healthier roles, practices, experiences that we needed others to give attention to, observe, adopt and later become advocate themselves. In this case, we purposely were supposed to invest resources over these models in a way we like others will most probably follow either because the target behavior has overtly conveyed benefits to the target audiences or become a new social norms to comply with [32,[34][35]. Nonetheless, system challenges were significantly responsible for similarities between the two groups though variations were expected.…”

“…Nonetheless, system challenges were significantly responsible for similarities between the two groups though variations were expected. The above theories (DOI and SCT) clearly specified complexity of the systems and incompatibility of service delivery outlets and mechanisms can pose critical hindrances to adoption of service (MCH) utilization and its further diffusion among members of target population in a given community [32,[34][35][36]. Finally, this study was not without limitations.…”

Knowledge and practice of health extension workers on drug provision for childhood illness in west Gojjam, Amhara, Northwest Ethiopia

“…Evidence shows that CHWs are often able to perform health service activities like counseling, health education, behavioral change communication, health promotion, screening, treatment, and referral for diseases [13][14][15]. In line with this, the implementation of the HEP has demonstrated promising achievements in increasing utilization of family planning, immunization, ANC services, and latrine; and improving knowledge and careseeking behaviour [10,[16][17][18][19][20][21]. However, the program did not establish a real success in reducing diarrhea and cough incidences, improving delivery and postnatal care services, and identifying the danger signs and symptoms and complications during pregnancy [10,[22][23][24][25][26][27].…”