Going the Extra Mile

How health extension workers are bringing essential services and information to hard-to-reach communities in Ethiopia

Dinkinesh Ayele Lambebo and Mebiratu Meskele, parents to five children, live in rural Damot Pulasa in Southern Nations, Nationalities, and People’s Region (SNNPR) in Ethiopia. When Dinkinesh delivered her first three children – now ages 13, 15, and 18 – there were a limited number of health workers and health facilities at the time and access to care was difficult. All three were delivered at home, which can be dangerous without having a skilled health worker available to address delivery complications for the mother or baby.  

“I gave birth to my first three children at home, because I was not aware,” said Dinkinesh. “I was not aware of how to raise healthy children; I didn’t even know how to breastfeed my baby.”

In the past five years, USAID has supported more than four million deliveries assisted by skilled birth attendants in Ethiopia. USAID’s efforts to increase access to care is part of a wider collaboration with the Government of Ethiopia and is implemented by trained health extension workers who promote healthy behaviors, increase access to health information, and encourage parents to seek care. 

“People have … awareness and they are giving birth in health centers. In the past they used to do home delivery,” said Adanech Moges Anjulo, a health extension worker at Damot Pulasa Woreda Health Office. “But now, everything has improved after the coming of this education.” 

At community-level health posts within the kebles, or districts, health extension workers like Adanech share relevant health information. Dinkinesh first heard about the importance of giving birth at a health center at one of these health post gatherings. 

The tools used for health education vary. From a mobile app called Hulu Betena — an Amharic term meaning All with Health — that has customized maternal health information and videos for expecting or new parents, to flip charts with visuals for easy comprehension, to radio programs with messaging on healthy behaviors like the importance of visiting a health center for prenatal, delivery, and antenatal care.

“The advantage of the mobile app is that it provides the information to many people in a short time,” said Adanech. “The radio also reaches a mass audience fast. And if the video is available people watch it.” 

In addition to leading community education, health extension workers even go door-to-door with health awareness and education. The efforts to reach community members with health information mean that parents like Dinkinesh and Mebiratu can learn about available and recommended health services at a health post as well as in their own home in the presence of their extended family. 

The tools used to deliver the message may differ, but the strong emphasis on seeking maternal, newborn, and child health care remains the same. 

“It teaches us when to visit the health center, and where to go, who to go to first, what to prepare,” says Dinkinesh. “Currently when we give birth at health centers, the placenta is removed faster. And if there is bleeding or any complication, giving birth at a health center benefits us.”

In Ethiopia, health extension workers are not only educators, they are trained service providers too. They can administer certain primary health services such as routine childhood immunizations, family planning services, and malaria prevention and treatment for children. Adanech spends her mornings providing health services and her afternoons going to households to give health education. 

“Today I gave family planning services to mothers. I have examined children who have a fever, and pregnant women have come for ANC [antenatal care] follow-up. In the afternoon, I go home to home to teach them to use bed nets to prevent malaria. I raise awareness to let them maintain the hygiene of their kids,” said Adanech.

By investing in health extension workers, USAID ensures that tailored solutions connect people who live in hard-to-reach settings with essential health services that can improve outcomes for parents and their children. 

Dinkinesh acknowledges the differences in how she raises her two youngest children thanks to the health and nutrition education she received from health extension workers, like the importance of exclusive breastfeeding for six months.

“And after I gave birth until the age of 6 months, I didn’t give them anything except breast milk. After they reached 6 months, I started to give [them] additional food.”

“I improved a lot. I raised my later two kids better than the older ones. I hope, based on what we learnt, everybody would give birth at a health center. Because I benefited, I wish everyone could benefit.”

USAID has partnered with the Government of Ethiopia for almost 20 years to increase access to quality health services. Since the inception of the Health Extension Worker program, USAID has supported nearly all of the 42,000 health extension workers nationally with in-service training programs, which continue to ensure quality primary health care services are accessible throughout the country. 

Learn more about USAID’s work to prevent child and maternal deaths in a newly released strategic framework, Preventing Child and Maternal Deaths: A Framework for Action in a Changing World.

--

ABOUT THE AUTHOR: USAID’s Office of Maternal and Child Health and Nutrition works to ensure that all women and children have the same chance of a healthy life, regardless of where they live or are born.