Comprehensive Services in Low-Resource Settings: Ethiopia

In 2010, CHANGE conducted a study tour in Ethiopia and identified some effective practices and obstacles in providing comprehensive services in low-resource settings.

Health Extension Program

As the core of the country’s comprehensive and integrated strategy to improve health outcomes, the Ethiopian government’s health extension program provides a successful example of how health services can be integrated with limited resources. The program, which is supported by international NGOs—some of which are funded in part by U.S. foreign assistance—trains young women to serve their communities by providing basic health care services and referrals.

The program’s core curriculum consists of 16 packages that focus on the following:

• disease prevention and control, including HIV/TB/malaria education, prevention, and counseling;
• family health, including maternal and child health, family planning, immunization, and nutrition;
• hygiene and environmental health, including personal hygiene, proper latrine construction, building of smoke-free stoves, and rodent and insect control.

Of the 16 million homes reached, the program has converted six million homes into “model homes” that successfully implement all of the packages. There are 2,900 health extension posts in the Amhara region alone.

Community-based programs

The Family Guidance Association of Ethiopia (FGAE) provides integrated and comprehensive services through community-based reproductive health agendts, . The programs include a fully-staffed sexual and reproductive health clinic, HIV and STI testing and counseling, an on-site pharmacy, and community-building youth services. FGAE has identified critical gaps to achieving a fully integrated and comprehensive system. For example, a clinic that currently provides HIV testing and counseling and provides referrals for HIV treatment is not providing referrals for family planning services.

Rural Development Programs

The Amhara Women’s Association (AWA) is an example of an integrated program that is taking a multi-sectoral approach to addressing the underlying causes of gender inequality and barriers to women’s health. AWA is working with Pathfinder International—Ethiopia and the Amhara Development Association (ADA) to support girls who try to avoid early marriage. In 2010 alone, they were responsible for cancelling 135 early marriages in one district. In addition, the program helps support girls in continuing their education, helps young women start income-generating activities, administers family planning and immunization awareness programs, and works with health extension workers and traditional birth attendants to ensure women have the safest labor and deliveries possible. AWA is also working extensively with communities on gender mainstreaming, including counseling couples on how to reduce women’s work load.

Amhara Development Association

The ADA is a grassroots nonprofit organization that links sexual and reproductive health issues with the larger development context through their Community-based Reproductive Health Program. It also works on larger related issues like road construction, skills-based training, and natural resource preservation. The ADA works to address all the health needs of a population including promoting and providing family planning services, reducing maternal and infant morbidity and mortality, reducing the incidence of HIV/AIDS and other STIs, and eradicating harmful traditional practices. To accomplish this, ADA works with other stakeholders like government entities and NGOs to provide support and engage the local communities through conducting training, with a particular emphasis on targeting hard to reach populations.

Read the complete study tour report

Watch the full-length video