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

BACKGROUND: 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 pract...

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Autores principales: Desta, Firew Ayalew, Shifa, Girma Temam, Dagoye, Damtew WoldeMariam, Carr, Catherine, Van Roosmalen, Jos, Stekelenburg, Jelle, Nedi, Assefa Bulcha, Kols, Adrienne, Kim, Young Mi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738923/
https://www.ncbi.nlm.nih.gov/pubmed/29262806
http://dx.doi.org/10.1186/s12913-017-2804-0
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author Desta, Firew Ayalew
Shifa, Girma Temam
Dagoye, Damtew WoldeMariam
Carr, Catherine
Van Roosmalen, Jos
Stekelenburg, Jelle
Nedi, Assefa Bulcha
Kols, Adrienne
Kim, Young Mi
author_facet Desta, Firew Ayalew
Shifa, Girma Temam
Dagoye, Damtew WoldeMariam
Carr, Catherine
Van Roosmalen, Jos
Stekelenburg, Jelle
Nedi, Assefa Bulcha
Kols, Adrienne
Kim, Young Mi
author_sort Desta, Firew Ayalew
collection PubMed
description BACKGROUND: 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. METHODS: 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. 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. RESULTS: A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%–57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7–97.2%) perceived themselves as competent and proficient in performing tasks in all program areas. CONCLUSION: 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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spelling pubmed-57389232018-01-02 Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study Desta, Firew Ayalew Shifa, Girma Temam Dagoye, Damtew WoldeMariam Carr, Catherine Van Roosmalen, Jos Stekelenburg, Jelle Nedi, Assefa Bulcha Kols, Adrienne Kim, Young Mi BMC Health Serv Res Research Article BACKGROUND: 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. METHODS: 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. 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. RESULTS: A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%–57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7–97.2%) perceived themselves as competent and proficient in performing tasks in all program areas. CONCLUSION: 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. BioMed Central 2017-12-20 /pmc/articles/PMC5738923/ /pubmed/29262806 http://dx.doi.org/10.1186/s12913-017-2804-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Desta, Firew Ayalew
Shifa, Girma Temam
Dagoye, Damtew WoldeMariam
Carr, Catherine
Van Roosmalen, Jos
Stekelenburg, Jelle
Nedi, Assefa Bulcha
Kols, Adrienne
Kim, Young Mi
Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title_full Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title_fullStr Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title_full_unstemmed Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title_short Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
title_sort identifying gaps in the practices of rural health extension workers in ethiopia: a task analysis study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738923/
https://www.ncbi.nlm.nih.gov/pubmed/29262806
http://dx.doi.org/10.1186/s12913-017-2804-0
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