Abstract
BackgroundEven though the urban health extension program (HEP) has been implemented since 2009, little was known about its implementation, experience and challenges. Therefore, this study was aimed at exploring the implementation, experience, and challenges of the urban HEP.MethodsA qualitative case study was conducted in Addis Ababa from November 15 to December 29, 2017. The study participants were recruited purposefully. The parent populations were health extension professionals (HEPs). However, health post supervisors, health development army leaders (HDAs), Addis Ababa city HEP administrators, and other community members were also involved in the study. Four focus group discussions and 31 in-depth and key informant interviews were conducted. Data were transcribed verbatim, translated into the English, and analyzed by an inductive thematic analysis approach using Atlas ti7.1 software.ResultThe study found that there were 15 health service packages of the urban HEP delivered to the community based on the need of the households. The strategies for the program implementation were provision of trainings, home visitation, creation of model households, strengthening of HDAs, supervision and reporting, referral and feedback, and social and community mobilization. However, program implementation was challenged by the health system related challenges (health service package and delivery, workload of HEPs, shortage of trained HEPs, lack of regular supervision or monitoring, lack of logistical or motivational support, poor supply chain management, dissatisfaction of HEPs, assigning of more than expected households for HEPs, etc.), multisectoral related and community related challenges (HDAs need of incentives, and lack of graduating model households as per the plan, etc.).ConclusionsAlthough the program had a significant contribution to the health of community, it was affected by different challenges that underscore the need to develop different strategies and taking of actions. Therefore, the district health office, health centers and stakeholders from different sectors should have to support and motivate the HEPs and HDAs, and work together with them for successful implementation of the program.
Highlights
Even though the urban health extension program (HEP) has been implemented since 2009, little was known about its implementation, experience and challenges
The major themes were implementation of urban HEP and program fidelity, strategies used to facilitate the implementation of the Urban HEP, and the challenges for the successful implementation of urban HEP
This study found that the Health Developmental Army (HDA) played a significant role in program implementation, and strengthening them was used as a strategy
Summary
Even though the urban health extension program (HEP) has been implemented since 2009, little was known about its implementation, experience and challenges. The program was initially launched in 2003 to enhance preventive and promotive health care aspects in four agrarian regions (i.e., rural population) through delivering 16 health extension packages under four thematic areas: Hygiene and environmental sanitation; disease prevention and control; family health services; and health education and communication. The rural HEP is implemented by health extension workers (HEWs), while the urban health extension program (UHEP) is implemented by urban HEWs, named as Health Extension Professionals (HEP). These professionals are clinical nurses (i.e., diploma) and who taken a three months pre-service training on the basics of HEP and packages [4, 5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
