The HEPCAPS projects — Developing the Long-Term Capability of Ethiopia’s Health Extension Program Platform – work with Ethiopia’s, Federal Ministry of Health to develop strategies to improve outcomes and sustainability in primary care service delivery. HEPCAPS is directed by Peter Berman, Professor of the Practice of Global Health Systems and Economics at the Harvard T.H. Chan School of Public Health. Professor Elizabeth Bradley of Yale University’s Global Health Leadership Institute partners on the projects, as well as JSI Research and Training Institute. A team of researchers from all three organizations has worked closely together. HEPCAPS is funded by the Bill & Melinda Gates Foundation.
The Ethiopian Health Extension Program
The Health Extension Program (HEP) platform is the Government of Ethiopia’s main vehicle for reaching people in the rural areas of Ethiopia with a basic package of evidence-based effective health care services. The HEP platform utilizes a relatively low-tech frontline worker based in a simple health facility which becomes the engine of implementation for a range of priority health interventions. The Health Extension Worker (HEW) also develops community engagement and capacities through linked community health promoters with the aim of reaching all citizens. HEWs are linked to primary health care units (clinics) and further tiers of the health care delivery system.
The HEP is a relatively new initiative to physically and socially expand the health care delivery system to increase access to good quality basic services that can save lives and improve functioning. The HEP has already demonstrated significant improvements in the coverage of some services.
- Reduction in under 5 mortality from 123 per 1,000 to 101 per 1,000 (2004/05 and 2009/10)
- Reduction in maternal mortality from 673 per 100,000 in 2005/06 to 590 per 100,000 in 2009/10
- Increase in the percent of births attended by a skilled attendant from 16% to 25% (2006/07 and 2009/10)
- Decrease in the percent of the population without access to safe water from 47.6% to 31.5% (2006/07 and 2009/10)
- Increase in the percent of HIV/AIDS patients receiving antiretrovirals from 37.1% to 70% (2006/07 and 2009/10)
Although Ethiopia has achieved rapid progress is establishing access to services and health gain, some concerns remain about Ethiopia’s capacity to scale up and sustain the initial successes in terms of effectiveness, quality and overall efficiency of the HEP platform. In addition, given rapid economic growth in Ethiopia and other social developments, dramatic changes in the disease burden and health service delivery needs and demands can be expected, requiring flexibility and adaptability in the HEP platform over time.
The Federal Ministry of Health (FMOH) of the Government of Ethiopia (GoE) is interested in acting early avoid these pitfalls. It seeks to conceptualize and plan to the long-term capability of the HEP. HEPCAPS support these efforts.
The HEPCAPS Project
The overall objective of HEPCAPS is to sustain and increase achievements in priority primary care health outcomes and equity through Ethiopia’s HEP Platform. Specifically, HEPCAPS provides support for a collaborative program with the FMOH, GoE, to:
- Developing the diagnostics needed to identify the challenges facing the FMOH in sustaining the HEP over a 10-20 year time horizon.
- Formulating a conceptual and operational framework underpinning a strategy to develop the long-term capacity of the HEP.
- Establish a committee to focus on medium-to-long-term visioning with the FMOH and other stakeholders for HEP platform capability and sustainability.
- Collaborative policy and strategy development to transform concepts and vision into feasible and locally-owned plans, including scoping and initiating steps for moving into implementation.
- Design, demonstrate, and evaluate innovative strategies to improve primary care performance and adapt to changing conditions for a sustainable future primary care system.
The HEP platform also holds promise to spread lessons learned to other countries on the African continent about how to implement and maintain a large-scale health care extension service and community linked service delivery model. In short, ensuring the long-term capability of the HEP platform is of vital importance for sustaining decreases in maternal, neonatal, and child mortality and morbidity in Ethiopia and potentially the region.
Achievements to Date
The HEPCAPS1 project ended on January 31, 2013, after a year of successful collaboration and visioning with the FMOH. Key results included:
- Completion of a situation analysis, which included several weeks of in-depth field assessments and over 50 key informant interviews (Report also available below)
- Review of global experiences in the development of primary care systems, including in-depth literature reviews and a two-day convening in Boston to share experiences across countries (Report also available below)
- Regular feedback and engagement through the work of the visioning committee and ongoing correspondence
- Presentation and refinement of proposed strategies through existing coordination mechanisms, including the Ethiopian Annual Review Meeting (ARM) in October 2012
The development of plans for follow-on activities are underway during the first half of 2013.