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The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study

Araya Medhanyie156*, Mark Spigt67, Yohannes Kifle2, Nikki Schaay4, David Sanders4, Roman Blanco5, Dinant GeertJan6 and Yemane Berhane3

Author affiliations

1 Department of Public Health, Mekelle University, Mekelle, Ethiopia

2 Tigray Regional Health Bureau, Mekelle, Ethiopia

3 Addis Continental Institute of Public Health, Addis Ababa, Ethiopia

4 School of Public Health, University of Western Cape, Cape Town, South Africa

5 Department of Medicine, University of Alcala de Henares, Madrid, Spain

6 CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands

7 Department of General Practice, Tromso University, Tromso, Norway

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Citation and License

BMC Health Services Research 2012, 12:352  doi:10.1186/1472-6963-12-352

Published: 8 October 2012



Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services.


A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women’s utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous national survey from 2005. In addition, we investigated the association between several variables and utilization of maternal health services using logistic regression analysis.


HEWs have contributed substantially to the improvement in women’s utilization of family planning, antenatal care and HIV testing. However, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant. Women who were literate (OR, 1.85), listened to the radio (OR, 1.45), had income generating activities (OR, 1.43) and had been working towards graduation or graduated as model family (OR, 2.13) were more likely to demonstrate good utilization of maternal health services. A model family is by definition a family which has fulfilled all the packages of the HEP.


The HEWs seem to have substantial contribution in several aspects of utilization of maternal health services but their insignificant contribution in improving health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards. For example, strengthening HEWs’ support for pregnant women for birth planning and preparedness and referral from HEWs to midwives at health centers should be strengthened. In addition, women’s participation in income generating activities, access to radio and education could be targets for future interventions.

Health extension workers; Community health workers; Utilization; Maternal health services; Income generating activities