ArticleHuman resources for health2015
A qualitative assessment of health extension workers' relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance.
Article in Human resources for health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers, 4 of them syntheses that pooled it.
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Who cites it
96 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Facilitators and barriers of healthcare financing modalities for universal maternal healthcare services in East Africa: a qualitative systematic review.BMC health services research · 2025Pooled it
- Workload and emerging challenges of community health workers in low- and middle-income countries: A mixed-methods systematic review.PloS one · 2023Pooled it
- Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review.BMJ global health · 2022Pooled it
- Contribution of women's development army to maternal and child health in Ethiopia: a systematic review of evidence.BMJ open · 2019Pooled it
- Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia.BMC public health · 2020Trial
- Factors affecting the implementation of the Health Extension Workers Programme in Kavango East Region, Namibia.Health SA = SA Gesondheid · 2026Article
- Mapping multilevel barriers impacting the performance of Ethiopia's Community-Based Health Extension Program: A scoping review.PloS one · 2026Article
- Capacity and performance of primary health care in Ethiopia: a novel mixed methods measurement in low-income country.BMC primary care · 2025Article
- Women's satisfaction with health extension services and its associated factors in Hawassa City, Sidama region, Southern Ethiopia.BMC women's health · 2025Article
- Article
- Multidimensional performance enablers of Ethiopian community-based health extension program: A scoping review.PloS one · 2025Article
- China's coordinated tripartite medical reform: strategic balancing of interests among pharmaceuticals, healthcare, and health insurance.Frontiers in public health · 2025Article
- Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges.BMC health services research · 2024Article
- Article
- Six Recommendations for Provider Behavior Change in Family Planning.Global health, science and practice · 2023Review
- Community Health Worker programmes' integration into national health systems: Scoping review.African journal of primary health care & family medicine · 2023Article
- Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study.Journal of general internal medicine · 2023Article
- Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia.PLOS global public health · 2023Article
- "Like a broom tied together": A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria.PLOS global public health · 2023Article
- The role of community health workers in influencing social connectedness using the household model: a qualitative case study from Malawi.Global health action · 2022Article
36 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors.
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Abstract
backgroundHealth extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services.
methodsWe conducted a qualitative study in six districts in the Sidama zone, which included focus group discussions (FGDs) with HEWs, women and men from the community and semi-structured interviews with HEWs; key informants working in programme management, health service delivery and supervision of HEWs; mothers; and traditional birth attendants. Respondents were asked about facilitators and barriers regarding HEWs' relationships with the community and health sector. Interviews and FGDs were recorded, transcribed, translated, coded and thematically analysed.
resultsHEWs were selected by their communities, which enhanced trust and engagement between them. Relationships were facilitated by programme design elements related to support, referral, supervision, training, monitoring and accountability. Trust, communication and dialogue and expectations influenced the strength of relationships. From the community side, the health development army supported HEWs in liaising with community members. From the health sector side, top-down supervision and inadequate training possibilities hampered relationships and demotivated HEWs. Health professionals, administrators, HEWs and communities occasionally met to monitor HEW and programme performance. Expectations from the community and health sector regarding HEWs' tasks sometimes differed, negatively affecting motivation and satisfaction of HEWs.
conclusionHEWs' relationships with the community and health sector can be constrained as a result of inadequate support systems, lack of trust, communication and dialogue and differing expectations. Clearly defined roles at all levels and standardized support, monitoring and accountability, referral, supervision and training, which are executed regularly with clear communication lines, could improve dialogue and trust between HEWs and actors from the community and health sector. This is important to increase HEW performance and maximize the value of HEWs' unique position.
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