Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study

PURPOSE: Ethiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia. PATIENTS AND METHODS: A community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services. RESULTS: The utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8–63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21–0.63), housewives (AOR=0.36, 95% Cl=0.20–0.64), merchants (AOR=0.08, 95% Cl=0.03–0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73–6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02–2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22–3.18) were factors significantly associated with the utilization of urban health extension services. CONCLUSION: The overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants’ perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.