Primary Healthcare in Practice: Provision of preventive and basic curative care at the community level through health extension workers

The key strategy of the Health Sector Development Program (HSDP) in Ethiopia is the implementation of the Health Extension Program, with over 34,000 female health extension workers (HEW) being already trained and deployed in health posts in rural areas, therefore reaching the complete coverage of the country. HEWs are the first point of contact of the community with the health system, delivering integrated preventive, promotive and basic curative health services, with a special focus on maternal and child health. The aim is to ensure continuity of care throughout the lifecycle (adolescence, pregnancy, childbirth, postnatal period, and childhood) and also between places of care giving (households and communities, outpatient and outreach services, and clinical-care settings), having wide implications for the achievement of the Millennium Development Goals (MDG). In fact, two out of eight MDGs are targeted at mothers and children: this is testament to the significant proportion of the global burden of disease they suffer and to the huge inequities in the magnitude and distribution of their burden. The focus on those conditions that disproportionally affect the poor should, in turn, help to strengthen the equity focus of health policies. Improvements are already apparent in key indicators. For example, 2011 Ethiopia Demographic and Health Survey (EDHS) shows an overall increase in family planning coverage in rural areas, with an increase  in contraceptive prevalence (from 11% in 2005 to 23% in 2011) and a decrease in total fertility rate (from 6 to 5.5 in the same period) which are more marked than in urban areas. Of note is the fact that HEP started in 2004 and its full-scale implementation has been recently completed, so it is expected that its high-impact and cost-effective interventions will have full effects over the coming years, strengthening the current positive trend towards achievement of the MDGs.