Abstract
Background: Health extension workers (HEWs) are the frontline health workers for Ethiopia's primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs' pre-service education and practices. The aim of this study was to identify gaps in HEWs' practices and recommend changes in their training and scope of practice. Methods: A cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared. Results: A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%-57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7-97.2%) perceived themselves as competent and proficient in performing tasks in all program areas. Conclusion: HEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs' scope of practice, update pre-service education curricula and prioritize in-service training modules.
| Original language | English |
|---|---|
| Article number | 839 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | BMC Health Services Research |
| Volume | 17 |
| DOIs | |
| Publication status | Published - 20 Dec 2017 |
Funding
We would like to acknowledge the Federal Ministry of Health of Ethiopia for their guidance and inputs into the conduct of the study, particularly Azeb Admasu, Wogayehu Lema and Asegid Samuel. We are also grateful to Professor Judith T. Fullerton for her critical review of the manuscript. Finally, we would like to acknowledge the study participants, the data collectors and supervisors. This work is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Cooperative Agreement AID-663-A-12-00008. The contents are the responsibility of authors and do not necessarily reflect the views of USAID or the United States Government. USAID provided support in the form of salaries for all authors, but did not have any additional role in the study design, data collection and analysis, interpretation of the data, or preparation of the manuscript. Study participants did not receive financial incentives for their participation in the study.
Keywords
- Community health worker
- Ethiopia
- Health extension program
- Health extension worker
- In-service training
- Pre-service education
- Scope of practice
- Task analysis