As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia s Health Extension Program (HEP) has contributed to the country s move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia s experiences of HEP when designing their own path to UHC. HEP is one of the government s UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of health development army ? to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country s move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

This book reviews Ethiopia's experiences in designing and implementing its Health Extension Program, assesses its contribution to the country;s progress towards Universal Health Coverage (UHC), and summarizes lessons that are relevant to other countries when they design their own path to UHC.

Although Ethiopia has made steady progress in health outcomes over the past 10 years, some health challenges remain, particularly those related to maternal health. In part this may be linked to the insufficient number of health professionals providing maternal care services, particularly in the rural parts of the country.

In programs like Health Extension Program (HEP), where various stakeholders are involved, it is important to seriously consider what form of interaction is embedded in the overall functioning of the program. Of the stakeholders, Health Extension Workers (HEWs) and nurses are professionals directly or indirectly involved in the provision of health services while supervisors, woreda (district) coordinators and kebele (lowest administrative unit) officials are the most important ones in the administrative arena. Community Health Workers (CHWs), Trained Traditional Birth Attendants (TTBAs) and other voluntary community health agents are the major stakeholders in the informal health system. More than all, the community is the most important stakeholder in HEP. Access, utilization of health services and functioning of the overall program are significantly influenced by the interaction between stakeholders found either in the formal and/or traditional health systems... The book provides a brief analysis on the aforementioned issues and others related to HEP.

How did seven low- and middle-income countries, inspired by the landmark Alma-Ata Declaration, dramatically improve citizen health by focusing on primary health care? The Alma-Ata Declaration of 1978 marked a potential turning point in global health, signaling a commitment to primary health care that could have improved the safety of air, food, water, roads, homes, and workplaces in all 180 countries that signed it. Unfortunately, progress in many countries stalled in the 1980s. The declaration was, however, embraced by a number of countries, where its implementation led to substantial improvement in citizen health. Achieving Health for All reveals how, inspired by Alma-Ata, the governments of seven countries executed comprehensive primary health care systems, deploying new cadres of community-based health workers to bring relevant services to ordinary households. Drawing on a set of narrative case studies from Bangladesh, Indonesia, Ethiopia, Nepal, Ghana, Sri Lanka, and Vietnam,the book explains how a primary health care focus succeeded in improving population health. The book also conclusively demonstrates that comprehensive, multisector, community-controlled, and population-level primary health care is a viable strategy that, against the odds, has led to sustainable, scalable good health at lower cost. Bringing together a group of experts to analyze the forty-year legacy of the Alma-Ata Declaration, Achieving Health for All is a fascinating look at the work needed to transform nations from places that make people sick to places where they stay healthy. An inspiring array of lessons learned along the way shows how readers can make policies that support the health of all people. Contributors: Onaopemipo Abiodun, Vinya Ariyaratne, John Koku Awoonor-Williams, Kedar Prasad Baral, Ayaga A. Bawah, Pedro Más Bermejo, Fred N. Binka, David Bishai, Carolina Cardona, Dennis Carlson, Chala Tesfaye Chekagn, Hoang Khanh Chi, Svea Closser, Luc Barrière Constantin, Zufan Abera Damtew, Marlou de Rouw, Nadia Diamond-Smith, Philip Forth, Mignote Solomon Haile, Nguyen Thanh Huong, Taufique Joarder, Alice Kuan, Seblewengel Lemma, Sasmira Matta, Ahmed Moen, Rituu B. Nanda, Frank K. Nyonator, Ferdous Arfina Osman, Claudia Pereira, Henry B. Perry, James F. Phillips, Meike Schleiff, Melissa Sherry, Rita Thapa, Kebede Worku