Ayachyol, 23, is one of the midwifery students at the Gambella Teachers
Enhancing the Competence of Low and Mid-Level Health Workforce in Ethiopia
The Health Extension Program (HEP) in Ethiopia aims to improve primary health care services in rural areas, where over 80% of the population resides. Health extensions workers (HEW) are trained in essential interventions, then are deployed to serve villages (kebeles) at the health post level, the primary health care tier of Ethiopia’s public health care delivery system.
Since its introduction in 2004, the HEP has trained more than 38,000 HEWs. In 2008, the Ministry of Health (MOH) and Amref Health Africa conducted a national assessment which identified the need to upgrade the competencies of HEWs. With support from GlaxoSmithKline’s (GSK) Reinvestment Programme, Amref Health Africa worked with the MOH, Regional Health Bureaus (RHB) and Health Science Colleges (HSC) to upgrade the credentials of low to mid-level HEWs. GSK has supported Amref Ethiopia HRH programs since 2012. To date, GSK has supported a total of four Amref HRH projects with both national and regional focuses.
Despite several strengths, the level III training of HEWs had serious drawbacks upon assessment in 2015. This included variability in how the curriculum was implemented, attrition, shortage of learning materials in some locations, overstretched instructors, inadequate coverage of maternal/child health topics, and insufficient acquisition of practical skills. Additionally, the Midwifery database and records showed that as of 2015, Ethiopia had 4,725 midwives for a population of 85 million giving a ratio of 1: 17,989. The World Health Organization (WHO) recommends a ratio of one midwife for a population of 5,000. This indicates that there is a critical shortage of midwives to provide maternal and neonatal services to the growing population of women of childbirth age.
Accordingly, the goal of the five-year GSK ‘Enhancing the Competence of Low and Mid-Level Health Workforce in Ethiopia’ project was to improve the quality and quantity of low and mid-level health workers in Ethiopia. More specifically, the project aimed to: