Sustaining health extension programme

Elizabeth Mengistu
Needless to mention, health is one of the decisive factors that have irreplaceable roles in countries economic growth. The relation between health and economy has long been and remains central to any development plans.

Good health, at individual level, decreases rates of illness and risks of chronic diseases, lowers health care costs, saves the number of days lose in sick leaves, improved efficiency and productivity and raise savings.

Improving nation's health status at national level gains valuable rewards. It enhances retention of nations' health; increases workforce productivity, steps up economic growth, improves quality of life, and at the end of the day, accelerates national wealth.

Realizing this fact, since the twentieth century, in order to manage health related issues, ease the burden of diseases and in turn, improving people's lives, various efforts have been made at international, regional and national levels. Consequently, remarkable improvements have been exhibited. As evidences indicate, though the outbreak of new virulent diseases is challenging the efforts, it has been possible to detect and monitor some of the infectious diseases which were once the chief fatal cases for human beings. For instance, eradication of polio and smallpox, the decline in malaria and infant mortality at global level and in several parts of Africa, are some of the actual impacts of the efforts and these days achievements.

As part of these efforts,during the past few years,through designing a Health Sector Development Programme (HSDP),Ethiopia has been carrying out various activities. Especially, in its Health Extension Programme (HEP), which is an innovative community based health care delivery system that works at the primary health care unit level, it has been possible to register remarkable achievements.

In relation to this programme, Public Relations and Communication Director with the Ministry of Health, Ahmed Imano said the major health problems of the country are largely preventable communicable diseases. Though the nature of illness and their severity varies from disease to disease, the outcomes are expressed in three ways as: severe agony and frequent absence from the work places, disablement that leads productive people to unproductive, and death.

Especially, children, mothers and elderly people, because they are delicate and their immunity systems are weak due to a variety of reasons, are more vulnerable to various health problems and are exposed to such endings, he said.

“Out of the total major health problems that the population has faced, 85 per cent are preventable communicable diseases. Therefore, to end this and improve nations' health status, designing a new policy that emphasizes at disease prevention and health promotion strategy was decisive,” he said.

Commonly, the majority of the people give due attention to treatment rather than prevention. They give very little focus on preventing diseases and promoting health. In the same way, when the outcome of the newly designed policy evaluated, one can say that it could have focused on treatments rather than prevention. Thus, the strategy should have been changed.

Hence, to improve nations’ health through prevention, reaching the majority of the population, changing their attitude, making them part of the strategy and letting them focus on early prevention strategy, was crucial. In connection with this objective, Health Extension Programme (HEP) was introduced in 2002/03, he added.

The Programme, which comprises sixteen Health Extension Packages, is designed to introduce the necessary health and health related issues to the general public and provide services at kebele level. It is also organized by health posts, and female Health Extension Workers (HEWs) who are responsible for providing health post, run house to house visits and deal with individuals, as he stated.

Concerning the reasons behind HEWs be merely female, Ahmed said,
women are the foundation of any family and are the most influential members of the community. Female, to facilitate effective communication with mothers, discuss any issues freely, are more preferable agents than male workers.

Therefore, female students who have completed tenth grade are recruited as frontline health care staff, after taking a one year training on the HEP’s 16 packages. In accordance with this, in every kebele with 5,000 residents, one health post is built, and two female HEWs are assigned, as he stated.

However, the strategy was not implemented all over the country at once. Instead, pilot projects were executed in about 240 kebeles of Oromia,Amhara, Tigray, and Dire-Dawa towns for a year. Subsequently, because the testing showed impressive successes, the strategy is expanded to other states, after Technical and Vocational, Education and Training Centres (TVET) are constructed.

Especially, HEWs being recruited from the communities in which they reside, speak the language and know closely the social and cultural values of the community, and thus HEWs gained acceptance and made the strategy fruitful, he added.

According to Ahmed, trainees are selected, from the communities by community leaders, representatives of Woreda Health Office, and the necessary HEWs training have been assigned through out the country, particularly in the rural areas.

The Health Extension Package training curriculum was developed by the Ministry of Health in close collaboration with the Ministry of Education.

However, the strategy that was designed to serve the rural community, who settled in stable manner, was not suitable for the pastoralist communities. Especially, the number of educated females being few and their way of living being unstable has hindered the strategy not to be implemented effectively. However, in 2007, by preparing the package with their language and assigning mobile HEWs, including male HEWs, good result has been gained in strengthening the programme and, he said.

“The programme has been registering considerable improvements in the health status of the rural communities. Hence, based on the preceding experience, in 2007 Urban Health Extension programme is designed for urban communities,” he said. To facilitate the programme, female nurses, who graduated in diploma, have been trained in some of the Extension Health Programmes to reach out the public through woredas and kebeles health centres.

By doing so, since 2003, in both rural and urban communities, integrated efforts have been made. As a result,including the 5,080 urban HEWs, the number of HEWs in the country has now reached 39 thousand and the number of rural health posts have also exceeded over 14,800. In the same way, in all states, new health posts and health centres have been built, he said.

According to Ahmed, the programme has yielded impressive achievements in extending health care services across the country. It has also been able to train over 11 million model households, who take care of themselves in the use of health programmes, environmental and personal hygiene, serve as models for others and work with HEWs collaboratively.

Similarly, as of last year by organizing front line Health Development Army, changes have been observed in transferring knowledge smoothly and increasing people's participation. Above all,, this strategy has helped in promoting health issues timely and contributed for combating preventable communicable diseases.

For instance,a person with repeated coughing were informed to visit clinics and on the same way pregnant mothers advised to get prenatal services. Thus, while the number of TB patients who visited clinics is increased, the rate of TB epidemic and malaria is declining. Maternal mortality, though did not show reduction as expected, the rate which was 1,040 per 100,000 fifteen years ago has also been dropped sharply to 590. In addition, provision and use of family planning is increased, infant death which occurred due to insufficient care, lack of vaccination and malnutrition has come down during the past five years from nearly 203 to 101 per thousand.

Pregnant mothers have been given access to maternity clinics and though not all, most are conducting prenatal cares in clinics to know how to keep themselves and their babies healthy during pregnancy. To make the services accessible to all, it has been possible to build over 2,800 health posts allover the country while providing them with the necessary medical equipments, health workers, including ambulances for all woredas.

The Health Extension Programme though has yielded impressive changes in country's health care system, the achievements are largely attributable to female, Ahmed remarked.