Health Extension Program (HEP)

HEP is an innovative community based health care delivery system aimed at providing essential promotive and preventive health services. It was introduced in recognition of failure of essential health services to reach communities in remote parts of Ethiopia.


HEP services are customized to fit the needs, demands and expectation of the pastoralist, agrarian and urban population. It is considered as the most important institutional framework for achieving the Millennium Development Goals (MDGs).

The objectives of the HEP are to:

  • Shift health care resources from predominantly urban to rural areas, where the majority of the country’s population resides;
  • Improve access and equity of essential health services at the village and household levels in line with the decentralization process;
  • Ensure ownership and participation by increasing health awareness, knowledge and skills among community members;
  • Promote gender equality in accessing health services;
  • Improve the utilization of peripheral health services by bridging the gap between the communities and health facilities through Health Extension Workers (HEWs);
  • Reduce maternal and child mortality and
  • Promote healthy life style.

HEP provides health services in three primary areas:

  • Hygiene and Environmental Sanitation
  • Diseases Prevention and Control
  • Family Health Services

 

These three packages include various intervention services such as:

· Prevention of HIV/AIDS, STDs and TB; malaria prevention and control; first aid emergency measures; maternal, new born and child health; family planning; immunization, nutrition, adolescent reproductive health; excreta disposal; solid and liquid waste disposal water supply; food hygiene and safety measures; healthy home environment; control of insects and rodents; personal hygiene; health education and communication.

Pilot implementation was launched in 5 regions in 2002/2003 (GC) and encouraging results were seen in terms of community’s acceptance and demand for services provided through HEP. By mid-2008/09, the FMoH has successfully deployed over 30,000 health extension workers throughout Ethiopia. As a result, improvements were seen in construction and utilization of latrines, utilization rate of contraceptives and vaccination services.

Health Extension Approaches

HEWs are required to spend 75% of their time conducting outreach activities by going from house to house. During these visits, HEWs are expected to teach by example e.g. by helping mothers care for newborns, cook nutritious means, construction of latrines and disposal of pits. HEW utilizes three approaches: Model Families, Community Based Health Packages and Health Posts.


Model Family

HEWs identify and train model families that have acceptance and credibility in the community as early adopters of desirable health practices to become role models in line with health extension packages. Model families help diffuse health messages leading to the adoption of the desired practices and behaviors by the community.


Community Based Health Packages

HEWs communicate health messages by involving the community from the planning stage all the way through evaluation. HEWs utilize Women and Youth Associations, schools and traditional associations such as idir, mehaber and ekub to coordinate and organize events where the community participates by providing money, supplies and labor.


Health Posts

At the health posts, HEWs provide antenatal care, child delivery, immunization, growth monitoring, nutritional advice, family planning and referral services to the general population within the kebele.