Date of Award

Spring 4-25-2013

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Laura Salazar

Second Advisor

Dr. Ike Okosun



Background: The Health Extension Program (HEP) is one of the most innovative community-based health programs launched by the Ethiopian Federal Ministry of Health (FMOH) to make health services accessible to rural communities by setting out women health extension workers (HEWs) in rural health posts. The program was officially rolled out in 2003 and become operational in 2004. Its approach is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Deployed as pairs, the HEWs are premised to provide basic, largely preventive, primary health services to rural villages and empower families to take charge of their own health. Primarily, the program gives special attention to children and mothers.

Objectives: The primary objective of this study was to evaluate the short and medium-term impact of the HEP on maternal and child health outcomes in Tigray region and analyze if the impact suggests that the region is moving in a direction towards achieving the 4th and 5th Millennium Development Goals (MDGs). Additionally, the study sought to provide some policy relevant insights into the performance of the program in the region.

Methods: Using administrative data, the study estimated the impact of the HEP on child health variables (ex., child vaccines:-DPT3, BCG, OPV3 & measles and full immunization) and on maternal health (ex., tetanus toxoid injection and attended delivery). Two empirical models were estimated. Using these models, the study estimated multiple regression equations for each outcome of interest against the predictor variable (HEW coverage) controlling for confounding factors such as electricity, telephone etc. and year to capture variations over time.

Results: Since it became operational in 2004, the program has had a tangible effect on child health outcomes. Results showed that a 10% increase in the program (HEWs coverage) increased full immunization rates by 1.85%, BCG vaccination by 2.6%, DPT3 by 2.4% and OPV3 by 2.7%, all of which were statistically significant. However, the impact on measles was found statistically insignificant. For maternal health outcomes, results showed that a 10% increase in the program coverage increased TT2 uptake of pregnant women by only 0.5%, TT2 by non-pregnant women 0.08%, and attended delivery by 1.06%--all statistically insignificant.

Conclusion: Result of the estimation indicated that there is significant impact on child health indicators which could be attributable to the presence of the HEP in the districts. Particularly, the program has statistically significant effect on BCG, OPV3, DPT3 and full immunizations. Although the impact on measles was positive, it was not statistically significant. No effect of the program on maternal health indicators was found .Therefore, federal, regional and local governments should put collaborative efforts to increase the utilization of maternal health services as well as support and strengthen the outreach effort of the health extension workers to reach the targeted goal.