ABSTRACT
Background: Considerable improvement in maternal healthcare use has been observed since the inception of the health extension program (HEP) in Ethiopia in 2003. Objective: This paper evaluates the influence of HEP outreach strategies on maternal healthcare use. Method: Cross-sectional survey of 2;916 women with children 0 to 11 months from Amhara; Oromiya; Southern Nations; Nationalities and People's; and Tigray regions; obtained between December 2008 and January 2009; were analyzed using regression models to assess the impacts of HEP strategies on maternal health outcomes. Result: The analyses found that communities (i.e.; kebeles) with relatively high prevalence of model families; higher rate of household visits by health extension workers; and higher rate of household visits by voluntary community health workers were associated with improved antenatal care use; tetanus toxoid vaccination coverage; and receiving postnatal care visits; but the strategies were not associated with deliveries attended by health professionals. Conclusion: Although the impacts of HEP strategies on maternal healthcare use were statistically significant; they were not optimum to reach the maternal mortality reduction targets of the government of Ethiopia. The HEP needs to review and strengthen its community based strategies in order to reach its goals
Subject(s)
Health Policy , Information Seeking Behavior , Maternal WelfareABSTRACT
Background: Responding to challenges in achieving Millennium Development Goals (MDG); the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive; promotive and select curative health interventions through paid community level health extension workers. Objective: To explore Ethiopia's progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program. Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP. Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32skilled birth attendant use by 2010 but only about 12use was found in the four most populated regions of the country in 2009. Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions; such as misoprostol for active management of third stage of labor; immediate postpartum visits; and improved coordination from community to referral level