Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study

Human Resources for Health

Roman Blanco¹  GeertJan Dinant²  Mark Spigt³  Araya Medhanyie¹ 

[1] Department of Medicine, University of Alcala de Henares, Madrid, Spain;CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands;Department of General Practice, Tromso University, Tromso, Norway

关键词: Maternal health care;    Primary health care;    Antenatal care;    Health extension workers;    Community health workers;   

Others  :  822630
DOI  :  10.1186/1478-4491-10-44

 received in 2012-01-13, accepted in 2012-11-04,  发布年份 2012

【 摘 要 】

Background

In recognition of the critical shortage of human resources within health services, community health workers have been trained and deployed to provide primary health care in developing countries. However, very few studies have investigated whether these health workers can provide good quality of care. This study investigated the knowledge and performance of health extension workers (HEWs) on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care.

Methods

In conducting this research, a cross-sectional study was performed. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Descriptive statistics was used and a composite score of knowledge of HEWs was made and interpreted based on the Ethiopian education scoring system.

Results

Almost half of the respondents had at least 5 years of work experience as a HEW. More than half (27 (54%)) of the HEWs had poor knowledge on contents of antenatal care counseling, and the majority (44 (88%)) had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructures like water supply, electricity, and waiting rooms for women in labor. On average within 6 months, a HEW assisted in 5.8 births. Only a few births (10%) were assisted at the health posts, the majority (82%) were assisted at home and only 20% of HEWs received professional assistance from a midwife.

Conclusion

Considering the poor knowledge of HEWs, poorly equipped health posts, and poor referral systems, it is difficult for HEWs to play a key role in improving health facility deliveries, skilled birth attendance, and on-time referral through early identification of danger signs. Hence, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their knowledge and competencies, while creating appropriate working conditions.

【 授权许可】

   
2012 Medhanyie et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO, UNICEF, UNFPA, World Bank: Trends in maternal mortality 1990–2008. Geneva: World Health Organization, United Nations Children Fund, United Nations Population Fund and The World Bank; 2010.
• [2]Ronsmans C, Graham WJ: Maternal mortality: who, when, where, and why. Lancet 2006, 368:1189-1200.
• [3]Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375:1609-1623.
• [4]Central Statistical Agency (Ethiopia) and ORC Macro: Ethiopia Demographic and Health Survey 2005. MD: Central Statistical Agency and ORC Macro, Addis Ababa and Calverton; 2006.
• [5]Central Statistical Agency (Ethiopia) and ORC Macro: Ethiopia Demographic and Health Survey 2011. MD: Central Statistical Agency and ORC Macro, Addis Ababa and Calverton; 2012.
• [6]UN: United Nations Millennium Declaration A/55/L.2. New York, NY: United Nations; 2000.
• [7]World Health Organization: Reduction of maternal mortality. A joint WHO/ UNFPA/UNICEF/World Bank statement. Geneva: WHO; 1999.
• [8]World Health Organization, United Nations Children’s Fund: Report of the International Conference on Primary Health Care. Alma Ata: USSR; 1978:6-12.
• [9]Christopher JB, Le May A, Lewin S, Ross DA: Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health 2011, 9:27. BioMed Central Full Text
• [10]Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB: Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 2010, (3):CD004015.
• [11]Lehmann U, Sanders D: Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: WHO Department for Health; 2007.
• [12]Federal Ministry of Health of Ethiopia: Health Sector Development Program III (2005/6-2009/10). Addis Ababa: Federal Ministry of Health of Ethiopia Planning and program department; 2005.
• [13]Koblinsky M, Tain F, Gaym A, Karim A, Carnell M, Tesfaye S: Responding to the challenge-The Ethiopian Health Extension Programme and back up support for maternal health care. Ethiop J Health Dev 2010, 24(Special Issue 1):105-109.
• [14]Abraha MW, Nigatu TH: Modeling trends of health and health related indicators in Ethiopia (1995–2008): a time-series study. Health Res Policy Syst 2009, 7:29. BioMed Central Full Text
• [15]Medhanyie A, Spigt M, Kifle Y, Schaay N, Sanders D, Blanco R, GeertJan D, Berhane Y: The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Serv Res 2012, 12:352. BioMed Central Full Text
• [16]Ordinioha B, Onyenaporo C: Experience with the use of community health extension workers in primary care, in a private rural health care institution in South-South Nigeria. Ann Afr Med 2010, 9:240-245.
• [17]Ijadunola KT, Ijadunola MY, Esimai OA, Abiona TC: New paradigm old thinking: the case for emergency obstetric care in the prevention of maternal mortality in Nigeria. BMC Women’s Health 2010, 10:6. BioMed Central Full Text
• [18]Perez F, Ba H, Dastagire SG, Altmann M: The role of community health workers in improving child health programmes in Mali. BMC Int Health Hum Rights 2009, 9:28. BioMed Central Full Text
• [19]Alam K, Tasneem S, Oliveras E: Retention of female volunteer community health workers in Dhaka urban slums: a case–control study. Health Policy Plan 2012, 27(6):474-486.
• [20]Central Statistical Agency of Ethiopia: Ethiopia national census first draft report 2007. Addis Ababa: Central Statistics Agency; 2008.
• [21]Episurveyor[http://www.episurveyor.org/user/index] webcite
• [22]Earth Institute: Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: A Policy White Paper. Washington, DC: mHealth Alliance; 2010.
• [23]Teklehaimanot A, Kitaw Y, G/yohannes A, Girma S, Seyoum A, Desta H, Ye-Ebiyo Y: Study of working conditions of Health Extension Workers in Ethiopia. Ethiop J Health Dev 2007, 21:246-259.