Bezabih, Sefihun (2007) Assessment of Factors that Affect the Implementation of Health Extension Program in Wolayita Zone, SNNPR. Masters thesis, Addis Ababa University.
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Abstract
Background: The Health Service Extension Programme (HSEP) is introduced during the second phase of Ethiopia’s Health Sector Development Programme (HSDP), since 2002/3, as a new initiative community based health care delivery system aimed at provision of essential services to reach the people at the grassroots level. According to the HSDP all rural Kebeles will be covered with HSEP to achieve universal primary health care coverage. The modalities for HSEP implementation include an outreach programme run by female health extension workers (HEWs), two per kebele serving 5000 people. Currently greater than 17,563 HEWs are deployed in rural kebeles all over the country. Objective: To assess factors that affect the implementation of health service extension program in Wolayita zone, Southern Nation and Nationalities People Region (SNNPR). Methods: This community based cross-sectional study was conducted from March to April 2007 in 9 kebeles of Wolayita zone in SNNPR. A total of ninety six HEWs and 790 community respondents were included in the study. Result: Ninety six HEWs working in 96 peasant associations involved in study and 82 ( 86%) of them were found in age between 18-29 and with mean age of 24years and 44% were selected for training by Woreda council & kebeles’ leaders jointly and 37 were selected by District health office and 17 by the community. All have been in the programme for more than 18 months. A large number, 94%, of HEWs reported as they provided ante natal care services, out of which 84(94.8%) of them attended delivery at home or at health post and provided post partum care. Only 17 (17.7%) of HEWs had started providing immunization service at their health post. More than 90% of them had the recommended type of Family planning methods such as oral contraceptives, Depo-Provera and condoms and 71 HEWs claimed to have Drugs for Health posts such as ORS, anti malaria drugs & Ergometrine and delivery& emergency kit. Family planning and immunization services at outreach level were stated to be the best performed activities among the health extension packages while activities related to delivery and isolation of human and animal residence are reported to be among the difficult activities to implement. All health extension workers reported working closely with the different types of community health workers such as community based reproductive health workers (CBRH) ,community health agent & community health promoters. Nearly one third of health extension workers raised the need for upgrading and the identified areas of health extension package which need additional refresher course such as managing delivery and services related to HIV/AIDS specifically VCT. All reported to have problems to travel to health center and district health offices and 19(20%) of them reported of having no job description and only 5 (5.2%) of HEWs complained of their salary not paid on time. Majority , 73, of the HEWs were supervised at least once in the last six months and 90 reported regularly their monthly activities to either the health center or district health offices and nearly half of HEWs complained that they usually do not get feedback for their report. Information was also gathered from790 household heads comprising 470 (59.5%) females and 320 (40.5%) males. Among the household respondents 646 (90.4%) prefer HEWs to be selected from their own village and 695 (88%) agree that the HEWs being female. HEWs had visited 494 (60%) households at least once with in the last 3 months prior to investigation and the major issues discussed, based on their frequency, were about environmental sanitation including clean house & pit latrine, family planning, prevention of malaria, immunization, and HIV/AIDS prevention.Two hundred ninety three respondents claimed to receive family planning service from HEWs in the last six months. Majority of, 632, households possess pit latrine during interview and 73% (460) stated that advice was given by HEWs to do so. Seven hundred twenty seven (92%) of the household respondents stated to be satisfied with the service provided by HEWs. Since the assignment of HEWs specially introducing new practice of environmental sanitation and constructing pit latrine, personal hygiene such as hand washing with soap or ash, HIV/AIDS prevention and VCT, isolation of animals, immunization, ANC, PNC, and home visit. Community discussants suggested the district health office should avail logistics and drugs that are needed for health post in order to increase provision of curative services beside the dominant prevention activities. Conclusions: There is encouraging effort done by health extension worker to provide health service to the less privileged segment of rural population. There is a strong support and satisfaction from community members for the service provided by the HEWs. Large majority of HEWs are providing preventive services as intended by HSDP and services such as family planning and vaccination at outreach level, pit latrine construction, anti natal care, home visit, and post natal care are well performed. Services related to delivery, isolation of human and animal residence, HIV/AIDS need further effort. Concern is very much reflected on HEWs in-service training as well as future career. Lack and shortage of basic drugs, that are recommended for a health post, poor and inadequate managerial and technical support, problems related to residential house (problems of attending labor during night time) are observed weaknesses. Integration between sectors and presence of community health workers in the kebele found to be opportunity to implement health extension program and strengthen intersect oral collaboration program. Recommendation: Involvement of community in selection and recruitment can increase service utilization and community participation in program implementation. Presence of residential house for health extension worker can increase service utilization and health extension worker acceptance by the community. Timely response to social and psychological need of health extension worker such as arrangement of up grading programmes based on their performance and year served can decrease drop out rate. Regular supportive supervision and follow up of the health extension worker, construction of residential house and timely supply of the available logistics will increase the motivation of the HEWs and facilitates the provision of quality services.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 13 Jul 2018 11:50 |
| Last Modified: | 13 Jul 2018 11:50 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7462 |
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