The Health Extension Program (HEP) is a groundbreaking health service delivery initiative that centers its attention on the prevention and control of communicable diseases that account for more that 70% of the health problems in Ethiopia. The program was spearheaded and implemented by the Ethiopian Ministry of Health, which enlists the cooperation of local communities in its efforts at providing sufficient and equitable access to various health services. By establishing better health infrastructure systems and pooling together a staff of Health Extension Workers (HEWs), the HEP aims to provide every Ethiopian rural community with some of the most basic yet necessary health services.
To effectively execute the program, the Ethiopian government joined hands with the Earth Institute at Columbia University to form an international non-governmental agency, the Center for National Health Development in Ethiopia (CNHDE). As the Country Coordinator of the CNHDE, Dr. Yemane Ye-ebiyo Yihdego works closely with the other officers of the organization to provide technical assistance in the implementation of the HEP, train health workers, observe and evaluate the status of the program, and provide an independent assessment of the HEP’s progress to the Ethiopian government and other involved parties.
With quite an ambitious goal propelling the CNHDE, challenges on the job are a matter of course for Dr. Yihdego. Financing is one of the HEP’s largest concerns, and however devoted the Ethiopian government is to the cause of providing universal basic health services to its local communities, the financial requirements of the project are as sizable as the initiative itself. “Training 30,000 health extension workers, constructing 15,000 health posts, and providing the supplies and equipment is an enormous task,” Dr. Yihdego explains. “Although the Ethiopian government is committed to making it work, the resource challenges will be considerable to the full scale implementation of the program.” He also observed that the current capacity of Ethiopia’s health system is insufficient in effectively supervising the activities of the HEWs, whom the CNHDE must also attend to. “Planning the career structure of the health extension is also a challenge, as the HEWs should see a better future to keep them motivated.”
Yet these very challenges do not prevent Dr. Yihdego from assuming a position of healthy optimism. “Training of the HEWs has gone very well so far. In the last three years, more than 17,000 of them have been trained and deployed to the villages. 7,000 more will complete their education by the end of 2007, bringing the total deployment to about 25,000 by 2008.” He also points out that at this moment, the HEP managed to bring basic health services and education to over 8,000 rural villages in the country and the CNHDE played an important part in providing technical assistance to the program.
Dr. Yihdego is quick to identify community participation as a crucial factor in the HEP’s steady progress. “The HEWs are part of the community leadership, and planning community health is being made at the village level with the full participation of the village leaders. Empowering communities to participate in the decision-making process of their own health is a new and innovative initiative in this country,” he said. It satisfies him, too, to find visible results coming from the program’s efforts. “I have seen some villages where none of the households had their pit latrines. Just two years after the implementation of the HEP, however, 100% of those households finally have their own pit latrines,” he said. “More than 80% of the participating households now use their insecticide-treated nets properly as a result of the health education provided by the HEWs.”
Before being appointed as the CNHDE’s Country Coordinator last July 2004, Dr. Yihdego served as an expert in malaria prevention in Ethiopia’s Ministry of Health. He earned his Bachelor’s Degree in Biology in Ethiopia, and proceeded to the Harvard School of Public Health for his Master’s and Doctoral degrees.
Although Dr. Yihdego believes that his professional future will still be dedicated to the field of public health, management, and research, he understands that there is much that remains to be done to improve Ethiopia’s health sector and to ensure the HEP’s success. “Ultimately, the HEP is expected to achieve universal coverage of the most basic preventive and promotive health services in the country,” he said. “We hope to achieve close to 100% coverage of many of the key preventive services, such as family planning, immunization, normal delivery, safer waste disposal, nutrition education, and food safety, as well as some key curative aspects, such as treating malaria, child diarrhea, and upper respiratory infections. When combined, all of these will have a significant impact on community health and child survival.”
