Impact of voluntary community health workers on improving utilization of reproductive, maternal, and child health services in Ethiopia

Since 2003, the Ethiopian government is implementing the health extension program (HEP) to improve access to promotive, preventive and limited curative services to nearly 50 percent of the population who live more than 10 kilometers from a health facility. The program recruits female health extension workers (HEWs), provides them with 1-year training, establishes a health post in a community or kebele of about 5,000 people, and places two HEWs in one health post. Voluntary community health workers (vCHWs) are also mobilized by the program in selected areas to assist the HEWs.

A survey recently conducted by ‘The Last 10 Kilometers Project' in the four largest region of the country will be used to assess the impact of the vCHWs on reproductive, maternal, and child health (RMCH) behavioral outcomes by observing the association between the natural variation of the program intensity and the concentration of vCHWs, measured at the kebele-level, and RMCH behavioral outcomes, measured at the individual-level. The intensity of the program in 203 kebeles is defined by the number and the duration of the presence of HEWs and vCHWs in the community. The RMCH behavioral outcomes are obtained from 4,060 women in reproductive age; 2,436 women with 0 – 11 month-old infants; and 2,030 women with 12 – 23 month-old children. Multi-level models are used for the analysis. The analysis accounts for non-random program placement and other confounding factors. The findings will have implications for the role of vCHWs for public health programs in resource poor settings.