Integrating Community Volunteers and Health Extension Workers to Increase Scalability and Sustainability of the Core Group Polio Project in Ethiopia

The Core Group Polio Program-Ethiopia (CGPPE) works with 12 local partner organizations in remote areas of Ethiopia to conduct polio immunization and surveillance activities in an effort to eradicate the virus. In 2008, the CGPPE began an initiative to integrate the polio surveillance and immunization activities of CGPPE-trained community volunteers (CVs) and government-employed health extension workers (HEWs) to strengthen its ties with the government health system at the implementation level and increase scalability and sustainability.  CGPPE has trained 1162 active volunteers who serve in 54 districts across 7 regions, conducting 15,918 house-to-house visits and reaching 2,039,905 children under 15 annually. These CVs now report directly to their local HEWs, meeting monthly to plan and coordinate their immunization and surveillance activities for the benefit of their communities and the polio eradication effort. The HEWs motivate the CVs through training, encouragement, and supervision in the form of feedback and review meetings. A qualitative evaluation demonstrated a strong partnership that has legitimized the role of the CV within the community and enabled CVs to connect HEWs to the local community, resulting in a greater number of community members seeking out preventative health services.  The partnership has also extended health services and surveillance coverage. Suggestions for future improvement include progressive integration of CV and HEW activities through creation of a formal association of CVs and the establishment of a clear structure between the CVs, HEWs, and district health officials; provision of adequate supplies; and implementation of a sustained incentive program based on performance.  Based on these findings, FY12 planning includes weather-related supplies and more structured supervision utilizing supervisor checklists with regular review at the district level.  These changes, along with further implementation of the recommendations should result in a more lasting and effective program that can extend beyond the eradication of polio.