Identifying gaps in the practices of rural extention workers in Ethiopia: a task analysis study

Journal Article
(Published December, 2017)
Desta, F.A. (Author),
Shifa, G.T. (Author),
Dagoye, D.W. (Author),
Carr, C. (Author),
Van Roosmalen, J. (Author),
Stekelenburg, J. (Author),
Nedi, A.B. (Author),
Kols, A. (Author),
Kim, Y.M. (Author)
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Health extension workers (HEWs) are the frontline health workers for Ethiopia's primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs' pre-service education and practices. The aim of this study was to identify gaps in HEWs' practices and recommend changes in their training and scope of practice.  A cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. 82 HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared. HEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs’ scope of practice, update pre-service education curricula and prioritize in-service training modules.

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Desta FA, Shifa GT, Dagoye DW, Carr C, Van Roosmalen J, Stekelenburg J, et al. Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study. BMC Health Serv Res. 2017;17(1):839.