Related News:

Problem solving on maternal health: Experience of Shebedino Quality Improvement Team in Ethiopia
05 December 2017

Towards a Community Health Worker Gender Action Framework
09 November 2017

What did we learn at the Inspiring Communities workshop?
17 June 2017

Revolutions in the economics of health systems: iHEA Congress 2017
13 June 2017

Inspiring communities in global health: Community Health Workers and Universal Health Coverage
26 May 2017

How does community health relate to wider development discourse?
08 May 2017

Agency Among Health Extension Workers in Ethiopia
11 April 2017

Emerging issues related to gender and community health workers
27 March 2017

Women in the changing world of community health work
17 March 2017

What does trust have to do with Community Health Workers and the Sustainable Development Goals?
06 March 2017

Community health workers – optimizing the benefits of their position between communities and the health sector
23 February 2017

Achieving Equity: Women at the interface of community health systems
15 February 2017

REACHOUT at the Kampala Community Health Worker conference
11 February 2017

Online discussion on community health workers: Join in
04 January 2017

Community health workers: great potential for resilient and responsive health systems
28 November 2016

Indigenous knowledge and intersectionality: “Incremental radicalism” and front line health workers
23 November 2016

REACHOUT at the 2016 Global Symposium on Health Systems Research
23 August 2016

Exploring lessons learnt from Close-to-Community Health Worker Programmes: A symposium
20 June 2016

How equitable are Community Health Worker programmes?
31 May 2016

How relationships shape community health workers’ performance in Ethiopia, Kenya, Malawi and Mozambique
13 May 2016

Embedding group supervision to ensure quality maternal health services in Shebedino District, Ethiopia
15 April 2016

Community engagement in Ethiopia: Efforts towards improved maternal health
29 March 2016

Practical training on e-health delivered by REACH Ethiopia
23 March 2016

Working with what we’ve got – an(other) reflection on human resources for health
16 February 2016

Webinar: Community health workers - the gender agenda #HSGGENDER
08 February 2016

Panel on community health workers at the Prince Mahidol Award Conference
07 January 2016

Putting the politics into international public health
05 January 2016

Quality improvement cycles to strengthen close-to-community services: REACHOUT reflections
10 December 2015

A learning agenda and “NICE guys”: reflections on capacity
16 November 2015

REACHOUT at the Canadian Conference on Global Health
03 November 2015

Alignment, engagement and collaboration: approaches to ensuring Quality Improvement is embedded
02 November 2015

Participation, perspectives and possibilities: Mobiles, Development and Global Health
29 October 2015

Why we use a group supervision approach in REACHOUT
22 September 2015

Global Strategy on Human Resources for Health: How can it support close-to-community providers?
10 September 2015

Announcing a new research collection on community health workers
08 September 2015

A REACHOUT update from Ethiopia
08 December 2014

Reflections on a visit to the Pregnant Women's Forum in Howoleso Kebele, Southern Ethiopia
21 November 2014

And the winner is...
29 October 2014

REACH Ethiopia nominated for the 2014 Kochon Prize
09 October 2014

Remote rural in Ethiopia
30 May 2014

Related Resources:

Find more resources relating to Ethiopia

Ethiopia: current situation

In 2004 Ethiopia launched its internationally acclaimed Health Extension Program, a national health policy which included community-based health interventions.  The aim of this strategy was to achieve universal coverage in primary health care for the rural population.  Female health extension workers were trained and paid by the government. They work in the community at ‘health posts’ covering populations of 5000 on average and delivering primary health services under sixteen separate health packages under the Health Extension Program. The health extension workers are supported by volunteer community health promoters, the ‘health development army’, who train ‘model families’ to implement health initiatives and to serve as role models or graduated households, showing the benefits to their village. The health development army links one model family to five other households. In Ethiopia, the community in general has benefited from political commitment to deliver primary health services to the community, but more is to be done to ensure universal coverage.

Ethiopia: health systems priorities and baseline knowledge gaps

Maternal and neonatal health is a national priority in Ethiopia. Only 34% of mothers receive antenatal care, and only 10% have a skilled attendant at delivery. Performance has remained low despite efforts to improve antenatal care and delivery outcomes. Knowledge gaps can be categorised as institutional (inadequate training and supervision, and no monitoring and evaluation mechanisms) and systematic (limited quality assurance, and weak referral systems). Inadequate monitoring and evaluation and data collection tools compromise the quality of documentation and leads under-use of existing data. It is likely that the large number of health-related packages during routine house-to-house visits and health post work could be a factor in the poor maternal health outcomes however there is no firm evidence on this yet.

Ethiopia: initial baseline capacity assessment

The providers work to deliver services under many constraints including limits on capacity, difficulties with logistics and supplies, and limited technical support. Although the health system is staffed with trained health workers there is need for further quality improvement.  Practitioners do not generally evaluate their performance or use local data to generate evidence to improve service delivery. They lack the research capacity and knowledge to conduct operational studies that could enhance their effectiveness. The main problem for maternal health provision in the community is a lack of capacity and inadequate technical skills among health extension workers and volunteer community health promoters. At the institutional level there are opportunities to improve human resource management and monitoring and evaluation mechanisms; and at the systems level there are opportunities to improve quality assurance and referral systems.


The health system of Ethiopia is organised in such a way that policy and decision makers are situated in the administrative part of the health sector, remote from the practitioners who provide health services to communities in need. Policy makers are generally public health practitioners with management training. They implement national policy but do not always have the knowledge or resources to tailor policy for different contexts to improve health service delivery.

Ethiopia: what REACHOUT research and capacity development will add

REACHOUT in Ethiopia will concentrate on known shortfalls in monitoring and evaluation, quality assurance, and human resource management that affect the delivery of maternal health services. We will develop the capacity of local researchers to work in partnership with providers and policy makers to develop a culture of operational research. REACHOUT aims to a) improve health care delivery by developing an evidence based framework, and b) improve access to a high quality service for pregnant women by using existing community health workers and volunteers.  REACHOUT will develop easy-to-administer strategies for human resource management tailored to the limited resources in Ethiopia. REACHOUT will also help to develop the evidence base to improve TB services in Ethiopia and national policy.


This project is funded by the European Union.
This project is funded by the European Union.