Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in implementation of the HEP and its outputs is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia.
We used data from the 2019 National HEP assessment conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data was collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), 7,043 women from 7,122 Households. This study focused on selected input, service delivery, and service coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions.
We found wide interregional disparities in HEP implementation. Developing regional states (DRS) had significantly availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40, and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There are also significant disparities in HEP implementation among DRS in proportion of household visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services is relatively high.
There exist significant interregional disparities in HEP implementation in Ethiopia. The level of disparity among DRS is also remarkable. If the country is to achieve UHC, it is important that these disparities are addressed systematically and strategically. This calls for further attention in all regions, in general, and a tailored approach in DRS, in particular.