Assessment of Functionality of Health Extension Workers and Its Determinants in East Gojam, Northwest Ethiopia: A Comparative Cross-Sectional Study

Abstract

Introduction: Programs promoting primary healthcare using Health Extension Workers are crucial to improve cost-effectiveness of healthcare, reaching large numbers of underserved people with expansion of high-impact basic healthcare services at grass-root levels in developing countries. Hence, this study attempted to assess Health Extension Workers functionality and its determinants of Health Extension Workers in Ethiopia. Methods: A facility-based comparative cross-sectional study was conducted in eight randomly selected districts of east Gojam zone, Northwest Ethiopia in 2012. The study was cross-checked by facility observation using checklists. A total of 375 Health Extension Workers were included in the study. The questionnaire was designed using the job description of Health Extension Workers; the level of functionality was measured by using functionality score scaling technique and scores were given ranging from 0-2 in multi-interval scale with a minimum of zero if an activity had not been performed at all times and maximum of two if the activity was performed regularly. The average score of one for an item was taken if the activity was performed occasionally and those scored below the mean were considered non-functional and otherwise functional. Univariate, chi-square test and multivariate analyses were done. Ethical clearance was obtained from Research and Ethical Committee of Debremarkos University. Results and discussion: The majority of Health Extension Workers (86.3%, n= 297) were functional. The overall non-functional rate was 13.7% (n=47). Health institutions support, regular drug supply, selection pattern and future job aspiration were found to be the determinants of functionality using logistic regression. Conclusion: The functionality of Health Extension Workers was encouraging. Family health, personal hygiene and environmental sanitation, health education and promotion services were well being done by Health Extension Workers. Stakeholders must deploy qualified health personnel for training, supervision and support, and promote development of career structure in line with Health Extension Workers' future job aspiration.