Has Community Participation and Intersectoral Collaboration Enhanced Due to Health Extension Workers in Ethiopia – Qualitative Assessment

Background: Health Extension Program (HEP) is an innovative community based health care delivery system aimed at providing essential promotive and preventive health services. HEP services are customized to fit the needs, demands and expectation of the population. HEP provides health services: Hygiene and Environmental Sanitation, Diseases Prevention and Control, and Family Health Services. This programme is implemented through new cadre of health personnel - Health Extension Workers (HEWs).  HEW utilizes three approaches: Health Posts, Model Families, and Community Based Health Packages to enhance the community participation (CP) and Intersectoral Collaboration (IC).

Objectives: To assess the contribution of HEWs in enhancing CP and IC for health.

Methods: Qualitative data was collected using interview guide from various sources.  9 FGDs of HEWs, 8 FGDs of CHVs, 8 indepth interviews (IDIs) of KHC members, 3 IDIs of District Health Extension managers and 1 Zonal HE  Supervisor in Jimma Zone in December 2009. 

Results:  Pertaining to CP and intersectoral action for health, HEWs work with social, cultural, religious and administrative structures available in the kebele. The HEWs use religious leaders to initiate individuals and families in the kebeles to make use of available modern health facilities. Supplies and technical support are being provided by the HEWs to CHVs is commendable. However, except for schools and to some extent agricultural development agents working with the HEWs at the kebele level there is no much intersectoral action for health in the Jimma Zone. Supervisors from the zonal and woreda levels reported that IC for health is non-existent at higher levels.

Conclusions: IC for health existed at the kebele level. However, the absence of IC at higher levels will ultimately affect what is happening at the village level.