title: Human resource development for a community-based health extension program: a case study from Ethiopia.
abstract: BACKGROUND
  Ethiopia is one of the sub-Saharan countries most affected by high disease burden, aggravated by a shortage and imbalance of human resources, geographical distance, and socioeconomic factors. In 2004, the government introduced the Health Extension Program (HEP), a primary care delivery strategy, to address the challenges and achieve the World Health Organization Millennium Development Goals (MDGs) within a context of limited resources.
  
  
  METHODS
  The health system was reformed to create a platform for integration and institutionalization of the HEP with appropriate human capacity, infrastructure, and management structures. Human resources were developed through training of female health workers recruited from their prospective villages, designed to limit the high staff turnover and address gender, social and cultural factors in order to provide services acceptable to each community. The service delivery modalities include household, community and health facility care. Thus, the most basic health post infrastructure, designed to rapidly and cost-effectively scale up HEP, was built in each village. In line with the country's decentralized management system, the HEP service delivery is under the jurisdiction of the district authorities.
  
  
  RESULTS
  The nationwide implementation of HEP progressed in line with its target goals. In all, 40 training institutions were established, and over 30,000 Health Extension Workers have been trained and deployed to approximately 15,000 villages. The potential health service coverage reached 92.1% in 2011, up from 64% in 2004. While most health indicators have improved, performance in skilled delivery and postnatal care has not been satisfactory. While HEP is considered the most important institutional framework for achieving the health MDGs in Ethiopia, quality of service, utilization rate, access and referral linkage to emergency obstetric care, management, and evaluation of the program are the key challenges that need immediate attention.
  
  
  CONCLUSIONS
  This article describes the strategies, human resource developments, service delivery modalities, progress in service coverage, and the challenges in the implementation of the HEP. The Ethiopian approach of revitalization of primary care through innovative, locally appropriate and acceptable strategies will provide important lessons to other poorly resourced countries. It is hoped that the approaches and strategies described in this paper will aid in that process.
authors: Center for National Health Development in Ethiopia, Columbia University, Bole Sub City, Kebele 06, H No 447, PO Box 664, Code 1250, Addis Ababa, Ethiopia. ht2170@columbia.edu
authors: Hailay D
authors: HD
authors: Teklehaimanot
authors: Awash
authors: A
authors: Teklehaimanot
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005380:Financing, Government; D063005:Health Information Systems; D006284:Health Plan Implementation; D006293:Health Promotion; D006280:Health Workforce; D006801:Humans; D008297:Male; D009313:National Health Programs; D011057:Politics; D011203:Poverty; D011314:Preventive Health Services; D011320:Primary Health Care / Q000458:organization & administration*; D013192:Staff Development / Q000379:methods*; D014944:World Health Organization
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