The Urban Health Extension Program of Ethiopia: Service delivery related lessons from implementation

Context and purpose: In 2009, the government of Ethiopia has initiated the Urban Health Extension Program to expand the coverage of community-level health services to the urban population. The organizing principle of the... [ view full abstract ]

Context and purpose: In 2009, the government of Ethiopia has initiated the Urban Health Extension Program to expand the coverage of community-level health services to the urban population. The organizing principle of the program is the provision of 'household-centered' public health services. This article presents service delivery related lessons from the implementation of program.
Methods: Review of the program related reports and deliberations, proceedings of consultative workshops, field observations and interviews were conducted to produce a synthesis report that has been validated by 'expert panels'.
Results: The design of the Urban Health Extension Program of Ethiopia was modeled on the rural health extension program and therefore was not contextualized to the complex nature of urban environment and heterogeneity. Unlike the rural, the heterogeneity of urban population required appropriate targeting of clients and households based on geographic locations, health risks and socio-economic conditions. The service providers were not equipped with the urban life style, urban governance and planning systems. Most urban health challenges and risks fall outside the mandate of the ministry of health. Urban population are mobile and most of them spend the day out of their residential houses which makes 'house-hold centered' service delivery a critical challenge. It was learned that technology, a readily available resource, was not fully utilized.
Conclusion: The urban health extension program of Ethiopia must be contextualized into the complex nature of urban life style and heterogeneity. In urban settings, partnership with other sectors (including the private sector) is critical since most health risks in urban settings fall outside the mandate of the ministry of health. Models should be developed to target clients and households based on their spatial distribution, risk behaviors and socio-economic factors. Technology, an abundantly available resource in urban areas, need to be fully harnessed to improve service delivery.