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As part of the Government of Ethiopia's Health Extension Programme, IDP works to improve access to health-care for isolated, rural communities by re-equipping run-down hospitals and health centres in remote parts of the country where medical facilities are scarce.  This increases the capacity of local medical staff to respond to the urgent need for health care among the local population.

Widespread poverty along with general low income levels of the population, low education levels (especially among women), inadequate access to clean water and sanitation facilities and poor access to health services have contributed to the high burden of ill-health in Ethiopia

Ethiopia suffers from an acute shortage of health workers at every level and rural areas, where 85% of the population live, are particularly chronically under-served.  In working out the best approach to tackle health workforce issues, the Ministry of Health calculated that 60-80% of the country’s annual mortality rate is due to preventable communicable diseases such as malaria, pneumonia and TB.  HIV and AIDS are also growing concerns.  They therefore chose to begin by focussing on community level provision, initiating the Health Extension Programme in 2004.  This is outlined in the current Health Sector Development Plan (2005-10), which focuses on both human resource development and the construction and rehabilitation of facilities.

The Health Extension Programme is a government priority; it was developed and is being implemented by the Federal Ministry of Health in collaboration with the Ministry of Education.  Implementation began in 2004 as part of the national health plan and is ongoing.  It was initiated as a totally government-financed programme, demonstrating the commitment of the state.

The Health Extension Programme aims to improve primary health services in rural areas through an innovative community-based approach that focuses on prevention, healthy living and basic curative care.  It has, therefore, introduced a new cadre of health worker, Health Extension Workers (HEWs), and defined a package of essential interventions for them to deliver from village health posts. 

But HEWs are not the only focus of scale-up plans: the programme is also expanding the number of health officers (this cadre was stopped in the late 1990s) to provide clinical service in health centres and to play a leadership role at woreda, zonal and regional level, and at district hospitals, to meet demands in the community for higher care.  The number of doctors is also being increased in recognition of the escalated demand for specialised care that will be created with improved access to primary health care services.  More generally, the intention is to increase the number of all cadres across the board, including nurses, midwives and support workers such as lab technicians, pharmacy assistants and other paramedical staff.

Its specific goals are to:

  • educate and deploy 30,000 HEWs to achieve a ration of 1 HEW per 2,500 population;

  • educate and deploy an additional 5,000 health officers (by mid 2008 4,068 were under training);

  • increase the annual enrolment of medical students from 250 to 1,000 (some will be trained in a new saccelerated course, and a target would be set for each category of medical student in the new national Human Resources for Health strategy);

  • increase the ratio of midwives per population of women of reproductive age from 1:13,388 to 1:6,759;

  • expand physical health service infrastructure at the primary health care level by constructing or upgrading 15,000 health posts and 3,200 health centres by 2010.

  Expected Outcome of the programme
  Doctor / population ration
(with 10% attrition rate)
1 : 15,000
1 : 8,000
  Ethiopia population
94 million
106 million

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  Hospital to population ratio  
  • 139 hospitals for 77 million people
    (1 per 550,000); 36 hospitals are in the capital

  • many hospitals are over 150 kms from the population

  • there are only 2 hospital beds per 10,000 population in Ethiopia
Health centre expansion
  • Majority of the population currently depend on 650 health centres (1 per 138,000) and 700 Health Officers (3 years clinical and public health training).

  • Plans to build 3000 health centres and train 500 Health Officers by 2012 to try to reach Millennium Development Goals.

  • IDP is providing basic medical equipment from the UK - such as beds, trolleys, ventilators and diagnostic equipment - to re-stock new and rehabilitated health centres in rural Ethiopia.
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