Influence of the health extension program on environmental sanitation in Ethiopia

Improving access to safe drinking water and household possession and use of sanitary latrine, the two most important measures of environmental sanitation, are among the priorities of the health extension program (HEP) implemented by the Ethiopian Government. Recent studies indicate that access to safe water and use of pit latrine has increased due to the HEP. This paper examines the contribution of the different components of the HEP that are critical to improve environmental sanitation.

The female health extension workers (HEWs), the nucleus of the HEP, provide promotive, preventive and limited curative services to a population of about 5,000 people through fixed and outreach activities. The major HEP components that are expected to augment and sustain HEP activities are fostering community participation with non-health sector leaders' involvement in health care services; use of voluntary community health workers (vCHWs); and training of model families to augment and sustain the activities of the HEWs.

The variations in implementing the different components of the HEP in 203 randomly selected communities are measured and their relationship with safe drinking water and sanitary latrine use in 7,000 households in those communities is observed. Multi-level regression analysis is used for the purpose. The preliminary analyses suggest that community participation, as measurement by non-health sector leaders' participation in planning and monitoring health services, model families and vCHWs in the communities are important correlates of household use of safe drinking water and sanitary construction and use. The findings indicate use of HEP model to promote environmental sanitation is effective in rural Ethiopian settings which has implications for similar programs elsewhere.