Call for Additional Human Resource for the Health Extension Program in Ethiopia: The need to reduce burden from community health workers


The Ethiopian government launched the Health Extension Program (HEP) in 2003 as a local solution to expand provision of primary health care and increase community participation and utilization of health programs and services. The HEP trained and deployed over 30,000 female health workers to rural towns and villages to provide 17 different packages of basic health services.


Image source: UNICEF Ethiopia

Health Extension workers (HEW) receive a year long training and work in pairs at health posts throughout the country, with each health post having a catchment area of 5,000 inhabitants on average. This translates into 1 HEW per 2,500 people, which is well above the recommended community worker to population ratio. This high catchment area per health post requires tremendous multitasking on the side of the HEWs who need to deliver all the 17 health service packages that constitute the HEP. This high burden on HEWs has been linked to poor quality of work, poor treatment of clients, burnout, and general underutilization of services offered through the HEP. These issues highlight the need to increase the human resource capacity of the program to reduce the workload from HEWs and ensure continued success. Given that this is a government-funded program, the Ethiopian government, specifically the Federal Ministry of Health, should prioritize scaling up the number of HEWs by undertaking more recruitments and training. National and international partners should also actively engage in such efforts by offering the required technical assistance.

Since its integration into the health system over 10 years ago, the HEP has significantly contributed to the health sector development in Ethiopia. Following the implementation of this program, the country has witnessed expansion in immunization coverage, sharp decline in child and maternal health, and increase in contraception use and family planning. Thus, it is of the utmost importance for the aforementioned stakeholders to realize the human resource challenges of the HEP and address it in a timely fashion to improve and sustain the impact of the program.


2 Responses to “Call for Additional Human Resource for the Health Extension Program in Ethiopia: The need to reduce burden from community health workers”

  1. spak13 Says:

    This is a great post and a reminder of the importance of promoting sustainability through community-led efforts for primary health care. In addition to alleviating health worker burden and contributing significantly to the community’s health, this can also have synergistic benefits for the workers’ livelihoods, self esteem, and community cohesiveness. These additional benefits can be framed in a way that shows other sectors how important it is to invest in health programs. Presenting these results in a persuasive manner might also enhance the likelihood of gaining assistance from national and international partners, which this post mentions is important. Thanks for posting.

  2. eonyang1 Says:

    I agree with the blog that more numbers of Health Extension Workers (HEWs), who elsewhere could be referred to as Community Health Workers, are needed in Ethiopia. Apart from increasing the number of HEWs, short-term retraining would be a morale booster to these workers. Ethiopia has made huge strides in the provision of primary health care – I wonder what the terms of HEWs are like – for example do they get annual vacation days?, how is their compensation?, etc. Money for expanding the Health Extension Program(HEP) could be diverted from the huge financing that goes into hospitals – the government will get more value (in terms of the health of its population) for its money by investing more on primary health care. This is likely to attract opposition from the hospital-centric proponents in the MOH, but I believe, because the government had already made the bold decision to go ahead with the HEP, they should now forge ahead by increasing the HEWs for the greater good of the health of the people of Ethiopia.

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