Urban health extension program model housing and household visits improved the utilization of health Services in Urban Ethiopia: a community-based cross-sectional study

BACKGROUND: The government of Ethiopia launched an innovative program called Urban Health Extension Program (UHEP) in 2009, aims to produce better health outcomes to the urban populations using urban health extension professionals (UHE-ps) by enabling households to implement most health intervention packages designed by the government, which is referred to as model households (practice and implement at least 75% of the training provided by UHE-ps on UHEP packages). The objective of this study was to assess health service use and its associated factors. METHODS: A community-based cross-sectional study was conducted to assess the health service use in Addis Ababa. Structured questionnaires were filled out by 1086 women, and a binary logistic regression was performed. RESULTS: Urban health extension professionals performed home visits to 57.1% (95% CI (confidence interval) =54.2 to 59.8%) of the households. Mothers who had heard of the program (had information about UHEP) were 2.13 times more likely to visit the health center (HC) (AOR (adjusted odds ratio) =2.13, 95% CI = 1.36 to 3.32) than mothers who had not heard of the program. Mothers from model households were 2.12 times more likely to visit the HC (AOR = 2.12, 95% CI = 1.16 to 3.88) than mothers from non-model households. Mothers whose households were visited by the UHE-ps were 1.89 times more likely to visit the HC (AOR = 1.89, 95% CI = 1.22 to 2.94) than mothers whose households were not visited. Similarly, mothers who were in the reproductive age group (18 to 49 years) were 1.74 times more likely to visit the HC (AOR = 1.74, 95%CI = 1.12 to 2.71) than mothers above 49 years old. CONCLUSIONS: Model households and mothers in the reproductive age group exhibited significant associations with health service use. Sustaining the practices of graduated and certified model households is essential to maximize the benefits of the UHEP’s activities regarding health service use. Regular home visits to both model and non-model households are essential to scale up health service use and design re-graduation or other sustainable options for already graduated households.