Assessment of the extent and determinants of functionality of health extension workers in East Gojjam Zone, Amharra Regional State, Ethiopia.
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Date
2009-06
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Addis Abeba University
Abstract
Background –Previous studies have identified factors affecting Health Service Extension
Program implementation as well as working conditions of Health Extension Workers in
Ethiopia. Most of the studies conducted were qualitative and none of them raised the question to
what extent HEWs are functional and what are its determinants. The present matched case
control study was conducted to evaluate risk factors for functionality of HEWs after a crosssectional
census
survey determination of extent of HEWs functionality.
Objective- A study was undertaken to determine the extent of HEWs functionality and to
evaluate determinants of functionality of HEWs in East Gojjam Zone, Amharra National
Regional State.
Method- A population based matched case control study after a cross sectional preliminary
census survey was conducted in East Gojjam Zone from March to May 2009. A total of 632
health extension workers were included in the cross sectional census survey. All of the (n=25)eligible cases (nonfunctional HEWs) in the zone were included in the study. Two randomly
selected controls [(n=50)(functional HEWs)] working from 2003 to 2008 in the same zone from
which the cases were enrolled were matched for each case for age, service year, marital status
and woreda of the case. Data collection instruments of separately designed self administered and
interview based structured questionnaire were used for the cross sectional and matched case
control studies respectively
.
Result- Over all non functional prevalence of HEWS in East Gojjam Zone was 4 %( n=25) The
final multivariable model identified health institution support (adjusted matched odds ratio
[Adj.mOR=40, 95% CI=4.5_360]), selection pattern [Adj.mOR=11.2, 95% CI=1.3_98.9], and
Future aspiration,[Adj.mOR=2.1 95% CI=1.3_57], as independent determinants of functionality
of HEWs after adjusting for other variables in the model.
Conclusion- In general functionality of HEWs was found to be encouraging. The majority
(96% n=607) were functional where as 4 %( n=25) were non-functional. HEWs are doing better
the family health, personal hygiene and environmental sanitation and health education services
but communicable disease prevention and control service needs more effort. Health institution
support, selection pattern and future aspiration had been identified as independent determinants
of HEWs functionality. The program need to employ many qualified HRH for training,
supervision and support. Therefore, the real cost of scaling up HEP, including the additional
qualified HRH for supervision and training, should not be neglected. Moreover the need for
career structure for HEWs is a high concern.
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Keywords
Health extension workers