Abstract
BackgroundEthiopia 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.MethodsWe 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.FindingsThe 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.ConclusionThe 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.
Highlights
Ethiopia has been implementing a community health extension program (HEP) since 2003
The objective of this study is to identify successes and challenges in the implementation of the HEP in Ethiopia, find out initiatives undertaken to improve program challenges, and develop a framework, based on the review and synthesis, which may assist the country in strengthening its community HEP toward universal coverage for primary healthcare services
The findings of the review and synthesis are organized and presented according to the objectives of the review: successes and challenges of the HEP over time; interventions to improve the implementation of the HEP; gaps that remain to be addressed by the HEP; and, framework to improve the implementation of the HEP toward universal coverage of primary healthcare services
Summary
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. The Alma-Ata Declaration of 1978 identified primary health care (PHC) as the key approach to the attainment of the goal of “Health for All”. The implementation of the PHC approach relies on health workers, including community health workers (CHWs). Community health worker embraces a variety of community health aides. They are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community. CHWs represent an important health resource with a potential to provide a reasonable level of health care [1]
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