Urban health extension service utilization and associated factors in the community of Gullele sub-city administration, Addis Ababa, Ethiopia

Aderajew Mekonnen Girmay, Martin R. Evans, Sirak Robele Gari, Azage Gebreyohannes Gebremariam, Mulumebet Tadesse Reta


Background: In Addis Ababa, the capital of Ethiopia, the urban health extension program was started in 2009. Its approach is based on the assumption that access to and quality of primary health care in urban communities can be improved through transfer of health knowledge and skills to households. The study was conducted to assess the status of urban health extension service utilization and associated factors.

Methods: A community based cross–sectional study was conducted to collect data from 628 participants. Sample size was determined by using a single population proportion formula. Binary logistic regression was used for data analysis.

Results: The proportion of community utilization of the urban health extension program was found to be 86%. Respondents’ odds of utilizing urban health extension services among those who participated in the planning of urban health extension program activities were 2.8 (AOR=2.8; 95% CI: 1.43-3.70) times the odds of those who did not participate. The household respondents who utilized toilet with hand washing facilities had odds of utilizing urban health extension services that are higher by 2.62 (AOR=2.62 with 95% CI: 1.70-9.77) compared to those not utilizing toilet with hand washing facilities.

Conclusions: The study provided important information regarding to the status of community utilization of urban health extension services. Respondents who utilized toilet with hand washing facilities were higher among the respondents who utilized and implemented the urban health extension packages. Respondents who participated in the planning of urban health extension program activities were those who significantly utilized and implemented the urban health extension program.


Urban health extension program, Gullele sub-city, Knowledge, Logistic regression, Addis Ababa

Full Text:



Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low-and middle-income countries? A systematic review. Health Policy Planning. 2014;30(9):1207-27.

Admasu K, Balcha T, Getahun H. Model villages: a platform for community-based primary health care. Lancet Global Health. 2016;4(2):78-9.

Donnelly J. Ethiopia gears up for more major health reforms. The Lancet. 2011;377(9781):1907-8.

Fetene N, Linnander E, Fekadu B, Alemu H, Omer H, Canavan M, et al. The Ethiopian health extension program and variation in health systems performance: what matters? PloS One. 2016;11(5):e0156438.

Workie NW, Ramana GN. The health extension program in Ethiopia. 2013.

Edhs M. Ethiopia Mini Demographic and Health Survey. Ethiopia: Central Statistical Agency Addis Ababa. 2014.

Admassie A, Seid N, May JF, Megquier S, Moreland S. The demographic dividend: An opportunity for Ethiopia‘s transformation. Washington, DC: Population Reference Bureau and Ethiopian Economics Association. 2015.

Jackson R, Tesfay FH, Godefay H, Gebrehiwot TG. Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia. PLoS One. 2016;11(3):e0150747.

Gebrehiwot TG, San Sebastian M, Edin K, Goicolea I. The health extension program and its association with change in utilization of selected maternal health services in Tigray Region, Ethiopia: a segmented linear regression analysis. PloS one. 2015;10(7):e0131195.

Kelbessa Z, Baraki N, Egata G. Level of health extension service utilization and associated factors among community in Abuna Gindeberet District, West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Services Res. 2014;14(1):324.

Teklehaimanot HD, Teklehaimanot A, Tedella AA, Abdella M. Use of balanced scorecard methodology for performance measurement of the Health Extension Program in Ethiopia. Am J Tropical Med Hygiene. 2016;94(5):1157-69.

Yitayal M, Berhane Y, Worku A, Kebede Y. The community-based Health extension Program significantly improved contraceptive utilization in West gojjam Zone, ethiopia. J Multidisciplinary Healthcare. 2014;7:201.

Koblinsky M, Tain F, Gaym A, Karim A, Carnell M, Tesfaye S. Responding to the maternal health care challenge: The Ethiopian Health Extension Program. Ethiopian J Health Develop. 2010;24(1).

Jackson R, Hailemariam A. The role of health extension workers in linking pregnant women with health facilities for delivery in rural and pastoralist areas of Ethiopia. Ethiopian J Health Sci. 2016;26(5):471-8.

Lemma S, Nahusenay MH, Egata G, Yitayal M, Tewahido MD, Berhane Y, et al. Strengthening Ethiopia’s Urb. 2015.

Sibamo EL, Berheto TM. Community satisfaction with the urban health extension service in South Ethiopia and associated factors. BMC Health Services Res. 2015;15(1):160.

Banteyerga H. Ethiopia’s health extension program: improving health through community involvement. MEDICC Rev. 2011;13(3):46-9.

Amare SA. The impact of Ethiopian Health Services Extension Program on maternal and child health outcomes: the case of Tigray Region. 2013.

Tesfa B, Jibat N. Health Extension Program as innovative health care service: the socio-cultural factors affecting its implementation in Jimma Zone, South Western Oromia. Int J Sociol Anthropol. 2014;6(8):235-45.

Gebreegziabher EA, Astawesegn FH, Anjulo AA, Kerie MW. Urban Health Extension Services Utilization in Bishoftu Town, Oromia Regional State, Central Ethiopia. BMC Health Services Res. 2017;17(1):195.

Kok MC, Kea AZ, Datiko DG, Broerse JE, Dieleman M, Taegtmeyer M, et al. A qualitative assessment of health extension workers’ relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance. Human Resources Health. 2015;13(1):80.

Medhanyie A, Spigt M, Kifle Y, Schaay N, Sanders D, Blanco R, et al. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Services Res. 2012;12(1):352.

San Sebastian M, Lemma H. Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis. BMC International Health Human Rights. 2010;10(1):16.

Teklehaimanot HD, Teklehaimanot A. Human resource development for a community-based health extension program: a case study from Ethiopia. Human Resources Health. 2013;11(1):39.

Bekele A, Kefale M, Tadesse M. Preliminary assessment of the implementation of the health services extension program: the case of southern Ethiopia. Ethiopian J Health Develop (EJHD). 2016;22(3):302-5.