Impact of the National Health Extension Program on Maternal and Newborn Health Behaviors and Practices

Background: The Health Extension Program is Ethiopia’s primary means to provide MNCH interventions to the community. Since 2004, it established over 14,000 health posts, trained and deployed over 34,000 female health extension workers (HEWs) to provide services to 15.5 million households. HEWs spend 75% of their time conducting household visits, training families to adopt desirable health practices, serve as ‘models’ in their neighborhood, and mobilize communities to participate in the expansion of HEP services.  Some model-family members serve as volunteer community health promoters (CHPs) assisting HEWs to provide services.

Methods: Data from 200 randomly selected communities in 115 districts were collected at two points in time. Dose-response relationship is sought by testing whether higher increases in HEP strategy intensities in communities are associated with higher improvements in health outcomes in those communities.

Results: The household-visit rates by HEWs, household-visit rates by CHPs, and prevalence of model-families—i.e., the three community-level HEP strategy intensity measures—increased (p<0.001) from 34%, 20%, and 10%, respectively, in December 2009 to 75%, 62%, and 30%, respectively, in December 2011. As expected, the increases in program intensities were associated with improvements in the health outcomes. For example, multi-level models indicate that 10-percentage-points increase in the prevalence of model-families in a community is associated with 20-, 15-, and 11-percentage-points increases (at p<.05) in antenatal care, postnatal care, and measles vaccination rates in those communities. Impact of HEP on institutional deliveries, deliveries assisted by health professionals, and on newborn health care practices is minimal.

Conclusion: The HEP strategies should be intensified in all communities while strategies to improve institutional deliveries, deliveries assisted by trained professionals and newborn health practices need special attention