Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services
Open accessAbstract
BACKGROUND: Ethiopia has been implementing a community health extension program (HEP) since 2003. We aimed to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services. METHODS: We conducted a systematic review and synthesis of the literature on the HEP in Ethiopia between 2003 and 2018. Literature search was accomplished in PubMed, Embase and Google scholar databases. Literature search strategies were developed using medical subject headings (MeSH) and text words related to the aim of the review. We used a three-stage screening process to select the publications. Data extraction was conducted by three reviewers using pre-prepared data extraction form. We conducted an interpretive (not aggregative) synthesis of studies. FINDINGS: The HEP enabled Ethiopia to achieve significant improvements in maternal and child health, communicable diseases, hygiene and sanitation, knowledge and health care seeking. The HEP has been a learning organization that adapts itself to community demands. The program is also dynamic enough to shift tasks between health centers and community. The community has been a key player in the successful implementation of the HEP. In spite of these successes, the program is currently facing challenges that remain to be addressed. These challenges are related to productivity and efficiency of health extension workers (HEWs); working and living conditions of HEWs; capacity of health posts; and, social determinants of health. These require a systemic approach that involves the wider health system, community, and sectors responsible for social determinants of health. We developed a framework that may assist in the implementation of the HEP. CONCLUSION: The HEP has enabled Ethiopia to achieve significant improvements. However, several challenges remain to be addressed. The framework can be utilized to improve community health programs toward universal coverage for primary healthcare services.
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As a result of Tedros Adhanom's transformation of Ethiopia's health system toward community-based primary healthcare, Ethiopia became a global leader in attaining the Millennium Development Goals for maternal and child health, HIV/AIDS, malaria, and tuberculosis, and in accelerating progress toward UHC.
“As a result, Ethiopia became a global leader in attaining the Millennium Development Goals for maternal and child health, HIV/AIDS, malaria, and tuberculosis [16, 17] and in accelerating progress in achieving UHC [17].”
From Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” (2021) · cites this paper as [17]
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Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”
Perry, H. B., Chowdhury, M., Were, M., LeBan, K., Crigler, L., Lewin, S., Musoke, D., Kok, M., Scott, K., Ballard, M., et al. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00755-5 · Cited by 129 · see citing works
- Authors
- Assefa, Y., Gelaw, Y. A., Hill, P. S., Taye, B. W., & Van Damme, W.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Assefa, Yibeltal
- Venue
- Globalization and Health
- Published
- 2019-03-26
- Volume
- 15
- Issue
- 1
- Pages
- 24-24
- ISSN
- 1744-8603 (ISSN-L)
- PMC
- PMC6434624
- OpenAlex
- W2941284433
- Cited by
- 447
- References
- 54
- Citations by year
- 2026: 51 · 2025: 85 · 2024: 82 · 2023: 66 · 2022: 55 · 2021: 61 · 2020: 46 · 2019: 1
- FWCI
- 42.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Globalization and Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- health extension workers, universal health coverage, primary care services, Ethiopia, maternal and child health, infectious diseases, sanitation and hygiene, health-seeking behavior, health worker productivity, health posts, social determinants of health
- MeSH terms
- Community Health Services, Ethiopia, Humans, Primary Health Care, Program Evaluation, Universal Health Insurance
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