title: Women health extension workers: Capacities, opportunities and challenges to use eHealth to strengthen equitable health systems in Southern Ethiopia.
abstract: This study assesses the feasibility of female health extension workers (HEWs) using eHealth within their core duties, supporting both the design and capacity building for an eHealth system project focussed initially on tuberculosis, maternal child health, and gender equity.
  
  
  
  Health extension workers, Health Centre Heads, District Health Officers, Zonal Health Department and Regional Health Bureau representatives in Southern Ethiopia.
  
  
  
  The study was undertaken in Southern Ethiopia with three districts in Sidama zone (population of 3.5 million) and one district in Gedeo zone (control zone with similar health service coverage and population density).
  
  
  
  Mixed method baseline data collection was undertaken, using quantitative questionnaires (n = 57) and purposively sampled qualitative face-to-face semi-structured interviews (n = 10) and focus group discussions (n = 3).
  
  
  
  Themes were identified relating to HEW commitment and role, supervision, and performance management. The Health Management Information System (HMIS) was seen as important by all participants, but with challenges of information quality, accuracy, reliability and timeliness. Participants' perceptions varied by group regarding the purpose and benefits of HMIS as well as the potential of an eHealth system. Mobile phones were used regularly by all participants.
  
  
  
  eHealth technology presents a new opportunity for the Ethiopian health system to improve data quality and community health. Front-line female HEWs are a critical bridge between communities and health systems. Empowering HEWs, supporting them and responding to the challenges they face will be an important part of ensuring the sustainability and responsiveness of eHealth strategies. Findings have informed the subsequent eHealth technology design and implementation, capacity strengthening approach, supervision, and performance management approach.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK; Karolinska Institutet, Stockholm, Sweden. John.Dusabe-Richards@lstmed.ac.uk.
authors.forename: John N
authors.initials: JN
authors.lastname: Dusabe-Richards
authors.forename: Hayley Teshome
authors.initials: HT
authors.lastname: Tesfaye
authors.forename: Jarso
authors.initials: J
authors.lastname: Mekonnen
authors.forename: Aschenaki
authors.initials: A
authors.lastname: Kea
authors.forename: Sally
authors.initials: S
authors.lastname: Theobald
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Datiko
mesh_terms: D057191:Capacity Building; D003150:Community Health Workers / Q000523:psychology / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration*; D005002:Ethiopia; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D036301:Qualitative Research; D017216:Telemedicine