PMID- 38012613
OWN - NLM
STAT- MEDLINE
DCOM- 20231130
LR  - 20231130
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Nov 27
TI  - Challenges and experience of the Ethiopian rural health extension program: 
      implications for reform and revitalization.
PG  - 1309
LID - 10.1186/s12913-023-10253-9 [doi]
LID - 1309
AB  - BACKGROUND: Despite remarkable gains over the past decade, mounting evidence 
      suggests that Ethiopia's rural health extension program (HEP) is facing serious 
      implementation challenges. We investigated the current and potential future 
      program design and implementation challenges of Ethiopia's rural HEP based on the 
      lived experiences of health extension workers (HEW) implementing the program at 
      the grassroots level. METHODS: We employed a longitudinal qualitative exploration 
      linked to a larger cluster-randomized trial (RCT) which was implemented in 282 
      villages randomly selected from 18 Kebeles of the Gedeo zone, southern Ethiopia. 
      Data were collected using in-depth interviews with key informants, focus group 
      discussion, and passive observation of program implementation. The data were 
      analyzed manually using a thematic framework analysis approach. Themes and 
      sub-themes were generated by condensing, summarizing, and synthesizing data 
      collected in the field in the form of extended notes and field observation 
      checklists. FINDINGS: Despite considerable gains in availing basic health 
      services to the rural population, HEP seems to suffer serious design and 
      implementation flaws that demand thoughtful and immediate adjustment. The design 
      constraints span from the number and type of intervention packages to the means 
      of dissemination (vehicle) as well as the target population emphasized. As such, 
      some low-cost high-impact interventions that were strongly desired by the 
      community were overlooked, while others were inappropriately packed. The means of 
      distribution - female health extension workers trained with basic prevention 
      skills, were lacking essential skills. They also had high burnout rates and with 
      little engagement with men, were repeatedly mentioned flaws of the program 
      demanding revitalization. Furthermore, the sheer structure of HEP precluded adult 
      and adolescent men, non-reproductive women, and the elderly. CONCLUSION: Despite 
      significant gains over the last couple of months, Ethiopia's rural HEP appears to 
      have reached a tipping point that requires a comprehensive revamp of the program 
      package, means of distribution, and target beneficiaries rather than the "usual" 
      tweaks to reap maximum benefits.
CI  - (c) 2023. The Author(s).
FAU - Zerfu, Taddese Alemu
AU  - Zerfu TA
AD  - International Food Policy Research Institute (IFPRI), Addis Ababa, Ethiopia.
AD  - College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
FAU - Tareke, Amare Abera
AU  - Tareke AA
AD  - Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo 
      University, P.O.Box 1149, Dessie, Ethiopia. amareabera8@gmail.com.
AD  - Department of Public Health, College of Medicine and Health Sciences, Wollo 
      University, Dessie, Ethiopia. amareabera8@gmail.com.
FAU - Biadgilign, Sibhatu
AU  - Biadgilign S
AD  - Independent Public Health Analyst and Research Consultant, PO.BOX 24414, Addis 
      Ababa, Ethiopia.
LA  - eng
PT  - Journal Article
DEP - 20231127
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Humans
MH  - Male
MH  - Ethiopia
MH  - *Health Promotion
MH  - *Rural Health
MH  - Rural Population
MH  - Women's Health
MH  - Qualitative Research
MH  - Longitudinal Studies
PMC - PMC10683286
OTO - NOTNLM
OT  - Challenges
OT  - Health extension program
OT  - Revitalization
COIS- The authors declare no competing interests.
EDAT- 2023/11/28 06:42
MHDA- 2023/11/29 06:42
PMCR- 2023/11/27
CRDT- 2023/11/28 00:02
PHST- 2022/04/20 00:00 [received]
PHST- 2023/10/30 00:00 [accepted]
PHST- 2023/11/29 06:42 [medline]
PHST- 2023/11/28 06:42 [pubmed]
PHST- 2023/11/28 00:02 [entrez]
PHST- 2023/11/27 00:00 [pmc-release]
AID - 10.1186/s12913-023-10253-9 [pii]
AID - 10253 [pii]
AID - 10.1186/s12913-023-10253-9 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2023 Nov 27;23(1):1309. doi: 10.1186/s12913-023-10253-9.