Ethiopia has made substantial progress in improving health outcomes during the last decade and
is on track to achieve some of the health Millennium Development Goals. Innovative strategies
to improve household behaviors and coverage of basic health care services contributed to
Ethiopia’s achievements, and the Health Extension Program (HEP) remains the core of such
innovations and provides a model for countries struggling to improve health outcomes in a
resource-constrained setting.
Introduced in 2003, initially in agrarian communities and subsequently tailored and scaled up
into the pastoral and urban communities, the HEP was developed by the Government of Ethiopia
to be the main vehicle for achieving universal coverage of primary health care. The HEP is fully
integrated into the broader health system and is part and parcel of the Primary Health Care Unit
structure. The program delivers 16 clearly defined packages of preventive, promotive, and basic
curative services. All services delivered under the program are free and available to everyone.
The Health Extension Workers (HEWs) are the key players in the program. They are all female,
10th grade high school graduates, recruited from the community with the active participation of
the community. They are trained for one full year and then deployed back into the community to
promote health and provide services at the village level. Two HEWs are paired to serve 3,000 to
5,000 people and serve at a health post. Much of their time is devoted to home visits and
outreach. Over 35,000 HEWs are recruited, trained, and deployed to the villages. Over 15,000
health posts have been constructed and equipped with the active participation and contribution of
the community.