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Global Health Econ Sustain Clinician’s attitude toward health extension program

positively correlated with participation in HEP review meetings, home visits, being married, and non-medical doctors
but negatively correlated with willingness to work in HEP, older age, female, and degree holder clinicians. Three factors,
focusing on knowledge, skill, and the impact of HEP, were found and fall under the second-generation HEP framework.
Therefore, strengthening HEP guidelines is essential to ensuring the delivery of sustainable and pro-poor HEP.

Keywords: Clinician; Attitude; Health Extension Program; Ethiopia

1. Introduction and sending reports to the district health office. Not only
the health center but also hospital staff are responsible for
In the past two decades, Ethiopia has made remarkable supporting the program by providing training, preparing
advancements in family and community health care review meetings, offering field supervision, and involving
(Jakovljevic et al., 2021; Kok et al., 2015a), most of which other related activities (Mathewos et al., 2017).
can be attributed to the establishment of the health
extension program (HEP), which was first launched in 2003 Although there is a link between HEP and a high level
in agrarian settings (Assefa et al., 2019; Workie & Ramana, of clinician involvement, the knowledge and attitude
2013). The HEP was established to meet international of clinicians toward HEP have not been researched.
declarations and ensure fair distribution and accessibility Therefore, the objective of this study was to assess clinician
of the basic health services for all citizens (Antwi et al., knowledge and attitude using valid measurement tools and
2017). In Ethiopia, HEP is a community-based health- factors associated with the latent scales.
care delivery strategy that focuses on disease prevention
and health promotion with minimal curative care, and 2. Methodology
its main goal is to distribute healthcare services equally 2.1. Study setting
through family- and community-centered approaches
(“HEP Good Draft Strategy,” n.d.). To achieve this, the Ethiopia’s nine regions and two city administrations, with
HEP encompasses 18 components organized into four a combined population of more than 100 million, are
major packages designed to fulfill the program’s objectives home to roughly 17,000 HP, 4,000 HCs, and 400 public
(Workie & Ramana, 2013). hospitals (Resource & Directorate, 2019). The nation
operates under a three-tier health system. The primary
The program is primarily executed by female paid staff, health care unit (PHCU), which includes a primary
known as health extension workers (HEWs) (“Ethiopia hospital (PH), HC, and HPs, provides care to the vast
Good Practice,” 2010). So far, about 39,000 HEWs have majority of the population. The second and third tiers
been deployed in 17,000 health posts, with the goal of consist of general and referral hospitals, which focus
placing two HEWs in each health post (HP) (Workie primarily on curative services (Republic, 2019; Resource
& Ramana, 2013). All-level health sectors, teaching & Directorate, 2019). Initially only present in four regions,
institutions, political leaders, and international partners the HEP later expanded to the rest of the nation and has
have been involved in the implementation of HEP reform been integrated into the public health system rather than
and evaluation document (2010). Until 2008, the woreda operating as a standalone program (Bilal et al., 2005). In
health office was responsible for providing technical and accordance with this structure, the technical staff at PHs,
administrative support for HEP. This responsibility was district health administrations, and HCs, including nurses,
transferred to graduates of the environmental health midwives, HOs, and MDs (Resource & Directorate, 2019),
science program based in woreda. Finally, follow-up and are responsible for providing guidance to the HEP (Ameha
evaluation of the program were shifted to health center et al., 2014; Bilal, 2009; Fetene et al., 2016; Teklehaimanot
(HC) technical staff, or clinicians, which includes nurses, & Teklehaimanot, 2013). Each HP is staffed by two HEWs
health officers (HO), midwives, and medical doctors (MD) and typically serves 3000 – 5000 people (Assefa et al.,
(Medhanyie et al., 2015). 2019). The data for this study were gathered in June 2019.
Clinicians are responsible for preparing plans, providing
technical and administrative support for HP, data collection 2.2. Study design and sample size
and analysis, and providing on-the-job training for HEWs. To collect information from clinicians working in public
Their duties also include sharing the best experience facilities (HCs and hospitals), a cross-sectional study
among HPs in the catchment, assisting in HP outreach design was used. Since there was no prior research on this
efforts, assigning staff to HPs, evaluating HP performance, subject, the sample size calculation was decided based on

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/ghes.0887