Impact of community based primary health care program in Ethiopia

This paper studies the impact of the health extension program (HEP) on the family planning, maternal and child health (FPM&CH) behaviors of women in mostly rural areas. Over the past six years, the community based program of the Ethiopian Government established about 15 thousand health posts, trained and placed two female health extension workers (HEWs) in each health post, to provide services to the rural population. With the responsibility of 500 households, the HEWs coordinate with grassroots-level association to foster community participation, train model families and voluntary community health workers (vCHWs) to demonstrate healthy behaviors, provide FPM&CH services through health post and outreach activities.

This study measures the variations in the scope, intensity and duration of the HEP in 203 randomly selected communities, i.e., the health post catchment areas, and examines their effect on the FPM&CH behaviors of a sample of 8,000 women in reproductive age living in those areas. A dose-response relationship—i.e., communities with higher intensity of the HEP are more likely to have women with better FPM&CH behaviors—is sought using multi-level regression analysis. The analysis accounts for selection bias due to non-random program expansion and other confounding factors. The preliminary analyses suggest that the expansion of the HEP is associated with improved FPM&CH behaviors, as expected. The findings have implications regarding the role of community health workers to foster community participation to improve primary health care services in resource poor settings.