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Women health extension workers: Capacities, opportunities and challenges to use eHealth to strengthen equitable health systems in Southern Ethiopia

  • Public Health Intervention Research
  • Published:
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Abstract

OBJECTIVES: This study assesses the feasibility of female health extension workers (HEWs) using eHealth within their core duties, supporting both the design and capacity building for an eHealth system project focussed initially on tuberculosis, maternal child health, and gender equity.

PARTICIPANTS: Health extension workers, Health Centre Heads, District Health Officers, Zonal Health Department and Regional Health Bureau representatives in Southern Ethiopia.

SETTING: The study was undertaken in Southern Ethiopia with three districts in Sidama zone (population of 3.5 million) and one district in Gedeo zone (control zone with similar health service coverage and population density).

METHODS: Mixed method baseline data collection was undertaken, using quantitative questionnaires (n = 57) and purposively sampled qualitative face-to-face semi-structured interviews (n = 10) and focus group discussions (n = 3).

RESULTS: Themes were identified relating to HEW commitment and role, supervision, and performance management. The Health Management Information System (HMIS) was seen as important by all participants, but with challenges of information quality, accuracy, reliability and timeliness. Participants’ perceptions varied by group regarding the purpose and benefits of HMIS as well as the potential of an eHealth system. Mobile phones were used regularly by all participants.

CONCLUSION: eHealth technology presents a new opportunity for the Ethiopian health system to improve data quality and community health. Front-line female HEWs are a critical bridge between communities and health systems. Empowering HEWs, supporting them and responding to the challenges they face will be an important part of ensuring the sustainability and responsiveness of eHealth strategies. Findings have informed the subsequent eHealth technology design and implementation, capacity strengthening approach, supervision, and performance management approach.

Résumé

OBJECTIFS: Cette étude porte sur la faisabilité pour les vulgarisatrices de la santé (VS) d’utiliser la télésanté dans leurs tâches principales, en appuyant à la fois la conception et le renforcement des capacités en vue d’un projet de système de télésanté axé initialement sur la tuberculose, la santé maternelle et infantile et l’égalité des sexes.

PARTICIPANTS: Vulgarisatrices de la santé, chefs de centres sanitaires, responsables sanitaires de district et représentants de services de santé de zone et du bureau régional de la santé dans le Sud de l’Éthiopie.

LIEU: L’étude a été menée dans le Sud de l’’Ethiopie avec trois districts de la zone Sidama (3,5 millions d’habitants) et un district de la zone Gedeo (une zone témoin où la couverture des services de santé et la densité de population sont semblables).

MÉTHODE: Nous avons entrepris une collecte de données de référence à méthodes mixtes à l’aide de questionnaires quantitatifs (n = 57), d’entretiens qualitatifs semi-directifs en personne auprès d’un échantillon délibérément choisi (n = 10) et de groupes de discussion (n = 3).

RÉSULTATS: Les thèmes qui se sont dessinés avaient trait à l’engagement et au rôle des VS, à leur supervision et à la gestion de leur rendement. Le système de gestion des informations de santé (SGIS) a été jugé important par tous les participants, mais la qualité, l’exactitude, la fiabilité et l’actualité de l’information posent des défis. Les perceptions des participants concernant le but et les avantages du SGIS et le potentiel d’un système de télésanté ont varié d’un groupe à l’autre. Tous les participants utilisaient régulièrement des téléphones mobiles.

CONCLUSION: Les techniques de télésanté offrent au système de santé éthiopien une nouvelle possibilité d’améliorer la qualité des données et la santé communautaire. Les vulgarisatrices de la santé travaillant aux premières lignes sont une passerelle indispensable entre les communautés et les systèmes de santé. Il sera important d’habiliter ces VS, de les appuyer et de répondre à leurs besoins pour assurer la durabilité et la réceptivité des stratégies de télésanté. Ces constatations ont éclairé la conception et la mise en œuvre de techniques de télésanté, la démarche de renforcement des capacités, la supervision et la démarche de gestion du rendement adoptées ultérieurement.

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Authors and Affiliations

  1. Liverpool School of Tropical Medicine, Liverpool, UK

    John N. Dusabe-Richards MSc, PhD, Hayley Teshome Tesfaye MPH, MFPH & Sally Theobald MA, PhD

  2. Karolinska Institutet, Stockholm, Sweden

    John N. Dusabe-Richards MSc, PhD

  3. Public Health England Health Education Northwest, Liverpool, UK

    Hayley Teshome Tesfaye MPH, MFPH

  4. REACH Ethiopia, P.O. Box 303, Hawassa, Ethiopia

    Jarso Mekonnen BSc, Aschenaki Kea BSc, MPH & Daniel G. Datiko MD, PhD

  5. Institute of Development Studies, Brighton East Sussex, UK

    Sally Theobald MA, PhD

Authors
  1. John N. Dusabe-Richards MSc, PhD
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  2. Hayley Teshome Tesfaye MPH, MFPH
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  3. Jarso Mekonnen BSc
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  4. Aschenaki Kea BSc, MPH
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  5. Sally Theobald MA, PhD
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  6. Daniel G. Datiko MD, PhD
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Correspondence to Daniel G. Datiko MD, PhD.

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Conflict of Interest: None to declare.

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Dusabe-Richards, J.N., Tesfaye, H.T., Mekonnen, J. et al. Women health extension workers: Capacities, opportunities and challenges to use eHealth to strengthen equitable health systems in Southern Ethiopia. Can J Public Health 107, e355–e361 (2016). https://doi.org/10.17269/CJPH.107.5569

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  • DOI: https://doi.org/10.17269/CJPH.107.5569

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