Video Spotlight

"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.

Maryse C. Kok, Aschenaki Z. Kea, Daniel G. Datiko, Jacqueline E.W. Broerse, Marjolein Dieleman, Miriam Taegtmeyer and Olivia Tulloch

In 2004, the Government of Ethiopia introduced the Health Extension Programme (HEP), a free primary health care package with four components: disease prevention and control, family health, hygiene and environmental sanitation, and health education and communication. A female cadre of salaried community health workers (CHWs) called health extension workers (HEWs) was introduced nationally. HEWs are linked to the community through a network of community volunteers, who are members of the health development army (HDA). The HDA was introduced in 2012, officially replacing other community-based workers such as health promoters and traditional birth attendants (TBAs). 

Evidence from CHW programmes worldwide has identified several factors, related to programme design, that can influence CHW performance. These include CHW task definition, human resource management (including training, supervision and incentives for CHWs), quality assurance processes, resources and logistics and CHWs’ links with the community and health sector. 

The importance of CHWs’ relationships for performance is accentuated by the nature of their work (CHWs as facilitators of community agency) and their intermediary position between the community and the rest of the health system. However, in-depth evidence is lacking on which factors hinder or facilitate relationships. The authors conducted qualitative research in southern Ethiopia to identify facilitators of and barriers to interpersonal relationships between HEWs and actors in the community and health sector and, where possible, their impact on HEW performance in maternal health.

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