Ethiopia's Human Resources for Health Programme

Ethiopia's Human Resources for Health Programme: Country Case Study

GHWA Task Force on Scaling Up Education and Training for Health Workers


Ethiopia suffers from an acute shortage of health workers at every level, and rural areas, in which 85% of the population live, have been particularly chronically under-served. In working out the best approach to tackle health workforce issues, the Ministry of Health calculated that 60-80% of the country’s annual mortality rate is due to preventable communicable diseases such as malaria, pneumonia and TB. HIV and AIDS are also growing concerns. They therefore chose to begin by focussing on community level provision, initiating the Health Extension Programme in 2004. This is outlined in the current Health Sector Development Plan (2005-10), which focuses on both human resource development and the construction and rehabilitation of facilities. The Health Extension Programme aims to train 30,000 new

Health Extension Workers (HEWs) to work at local health posts and to provide a package of essential interventions to meet needs at this level. To train the HEWs, a trainingof-trainers approach was used: 700 faculty members were trained in regional workshops by 85 master trainers, and they in turn are now delivering the one-year course. A national network of 37 existing vocational institutes is being used for this purpose. Five thousand additional health officers will be trained by 2009; they will supervise the HEWs and provide more specialist care for those needing referral. Twenty hospitals are currently involved in hands-on training programmes for the health officers. Some improvement has been observed in health indicators over the last five years, for example, infant mortality in 2005 was 77 per 1000, down from 97 in 2000. However, this can not be attributed to the HEWs because the first graduates of the programme were only deployed in 2005. More time is needed before their impact can be fully evaluated. Scale-up is now being widened to include the expansion of pre-service education and training capacity for doctors and nurses. By 2009, Ethiopia aims to increase its annual medical student intake from 250 to 1,000, and to train an additional 5,000 health officers. The new St. Paul’s Millennium Medical School, and medical faculties at Bahir Dar and Haromaya Universities, were opened in 2007 to assist with this. They will use an accelerated curriculum focussing on training doctors to meet Ethiopia’s health needs. In planning and implementing this phased approach to scale up, strong political leadership from the Ministry of Health, cross-government cooperation, financial support and effective collaboration with development partners has been essential. Due to uncertainties regarding financing, three cost scenarios have been modelled: one to fully implement the Health Extension Programme, one to increase the coverage of health centres and one to reach the MDGs. Scale-up efforts include plans to strengthen Ethiopia’s health system monitoring and evaluation. Incentive packages, career ladders and training are being included in the Health Extension Programme budget. Early evaluations have analysed HEWs living conditions, resources and supervision – all factors that affect the retention of the health workforce and therefore the maximising of returns on investment in education and training. Complementary efforts are being made to improve the management of the health system. Through the Civil Service Reform Programme regional authorities are developing health workforce management plans, and a simultaneous expansion of primary health care infrastructure is taking place to ensure there are enough posts to allow newly trained staff to enter the labour force.

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