The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study

Araya Medhanyie, Mark Spigt, Yohannes Kifle, Nikki Schaay, David Sanders, Roman Blanco, Dinant GeertJan, Yemane Berhane, Araya Medhanyie, Mark Spigt, Yohannes Kifle, Nikki Schaay, David Sanders, Roman Blanco, Dinant GeertJan, Yemane Berhane

Abstract

Background: Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services.

Methods: A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women's utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous national survey from 2005. In addition, we investigated the association between several variables and utilization of maternal health services using logistic regression analysis.

Results: HEWs have contributed substantially to the improvement in women's utilization of family planning, antenatal care and HIV testing. However, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant. Women who were literate (OR, 1.85), listened to the radio (OR, 1.45), had income generating activities (OR, 1.43) and had been working towards graduation or graduated as model family (OR, 2.13) were more likely to demonstrate good utilization of maternal health services. A model family is by definition a family which has fulfilled all the packages of the HEP.

Conclusions: The HEWs seem to have substantial contribution in several aspects of utilization of maternal health services but their insignificant contribution in improving health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards. For example, strengthening HEWs' support for pregnant women for birth planning and preparedness and referral from HEWs to midwives at health centers should be strengthened. In addition, women's participation in income generating activities, access to radio and education could be targets for future interventions.

References

    1. Schaay N, Sanders D. In: Health Systems Trust. Barron P, Roma-Reardon J, editor. South African Health Review 2008, Durban; 2008. International Perspective on Primary Health Care Over the Past 30 Years. .
    1. Lewin S, Dick J, Pond P, Zwarenstein M, Aja GN, van Wyk B, Bosch-Capblanch X, Patrick M. Lay health workers in primary and community health care. Cochrane Database Syst Rev. 2005. p. CD004015.
    1. Federal Ministry of Health of Ethiopia. Health Extension Program in Ethiopia Profile. Addis Ababa: Health Extension and Education center. Ministry of Health; 2007.
    1. Federal Ministry of Health of Ethiopia. Essential Health Services Package for Ethiopia. Addis Ababa: Ministry of Health; 2005.
    1. Datiko DG, Lindtorn B. Health Extension Workers improve Tuberculosis case detection and treatment success in southern Ethiopia. A community randomized trial. PLoS One. 2009;4(5):e5443. doi: 10.1371/journal.phone.0005443.
    1. Federal Ministry of Health of Ethiopia. Health Sector Development Programme III. Addis Ababa: Annual performance report, Ministry of health; 2010.
    1. Federal Ministry of Health of Ethiopia. Health Sector Development Program III (2005/6-2009/10) Addis Ababa: Planning and program department, Ministry of Health; 2005.
    1. Koblinsky M, Tain F, Gaym A, Karim A, Carnell M, Tesfaye S. Responding to the challenge—The Ethiopian Health Extension Programme and back up support for maternal health care. Ethiop J Health Dev. 2010;24(Special Issue 1):105–109.
    1. Central Statistical Agency of Ethiopia. Ethiopia national census first draft report 2007. Addis Ababa: Centeral Statistics Agency; 2008.
    1. Central Statistical Agency [Ethiopia] and ORC Macro. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland: Central Statistical Agency and ORC Macro; 2006.
    1. Kitaw Y, Ye-Ebiyo Y, Said A, Desta H, Teklehaimanot A. Assessment of the training of the first intake of Health Extension Workers. Ethiop J Health Dev. 2007;21(3):232–239.
    1. Abraha MW, Nigatu TH. Modeling trends of health and health related indicators in Ethiopia (1995–2008): a time-series study. Health Res Policy Syst. 2009;7:29. doi: 10.1186/1478-4505-7-29.
    1. Ergano K, Getachew M, Seyum D, Negash K. Determinants of community based maternal health care service utilization in South Omo pastoral areas of Ethiopia. J Med Medical Sci. 2012;3(2):112–121.
    1. Assefa Y, Jerene D, Lulseged S, Ooms G, Van Damme W. Rapid scale-up of antiretroviral treatment in Ethiopia: success and system-wide effects. PLoS Med. 2009;6(4):e1000056. doi: 10.1371/journal.pmed.1000056.
    1. Negusse H, Mc Auliffe E, MacLachlan M. Initial community perspectives on the Health Service Extension Programme in Welkait, Ethiopia. Hum Resour Health. 2007;5:21. doi: 10.1186/1478-4491-5-21.
    1. Teklehaimanot A, Kitaw Y, G/yohannes A, Girma S, Seyoum A, Desta H, Ye-Ebiyo. Study of working conditions of Health Extension Workers in Ethiopia. Ethiop J Health Dev. 2007;21(3):246–259.
    1. Wahed T. Healthcare and cultural practices during pregnancy and childbirth in Korail, a slum in Dhaka, Bangladesh. Manoshi Research Brief. Dhaka, Bangladesh: ICDDR and BRAC; 2009. p. 1.
    1. Wahed T. Beyond the inception phase of the birthing centers: acceptance within the community. Manoshi Research Brief. Dhaka, Bangladesh: ICDDR and BRAC; 2009. p. 2.
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–1299. doi: 10.1016/S0140-6736(06)69381-1.
    1. Dudley L, Hviding K, Paulsen E. The effectiveness of policies promoting facility-based deliveries in reducing maternal and infant morbidity and mortality in low and middle-income countries. Cochrane Database Syst Rev. 2009. p. CD007918.
    1. World Health Organization, United Nations Children’s Fund. Report of the International Conference on Primary Health Care. USSR: Alma Ata; 1978. pp. 6–12.
    1. World Health Organization. Report on the review of Primary Health Care in the African region. Brazzaville, Republic of Congo: WHO Regional Office for Africa; 2008.
    1. World Health Organization. The world health report 2008: Primary health care now more than ever. Geneva: World Health Organization; 2008.

Source: PubMed

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