GETAW TADESSE GEBREYOHANES, GODFREY BAHIIGWA, SAMSON JEMANEH
International Food Policy Research Institute (IFPRI), Ethiopia
Ethiopia's health care policy aims at accelerating the expansion of primary health coverage through a comprehensive Health Extension Service (HES) as one of the most effective framework to achieve the MDGs. Disease prevention and control, family health, hygiene and environmental sanitation, and health education are focus areas of the HES which is implemented through recruitment and training of Health Extension Workers(HEWs) who are expected to devote 50 to 75% of their time to household and community outreach services on raising awareness of communities on reproductive health, maternal and child care and sanitation. However, it is not yet clear how these interventions are successful in shaping the maternal and sexual behaviours of rural households in pastoral areas where access to health service, social institutions and basic infrastructure are very limited. In this paper, we applied propensity score matching and double difference analysis on two period panel data collected from Afar region of Ethiopia to estimate the average treatment effect on the treated (ATET) of the health output and outcome indicators in the HEW intervention and non-intervention localities. Empirical findings from propensity score matching model and double difference models seem to confirm that families living in the health extension intervention areas have better awareness of HIV transmission ways, safe sex practices, and importance of child delivery at health facilities. The results further showed that mothers in the treated areas are more likely to follow child immunisation programs compared to areas not reached by the HEWs. Similar results were obtained from our analysis on sanitation and hygiene output and outcome indicators. The research provided some useful insights on how the HES currently being implemented through trained HEWs is helping to improve maternal and child health outcomes as well as sanitation and environmental health outcomes in pastoral areas of Ethiopia.
Keywords: Health extension service, health extension workers, maternal and child health, sanitation and environmental health, sexual and reproductive health