Ethiopia has implemented an innovative community-based health program, called the health extension program, to enhance access to basic health promotion, disease prevention, and selected curative services by establishing health posts in every village, also called kebeles, with average of 5,000 people, staffed with two health extension workers (HEWs).
This time and motion study was conducted to estimate the amount of time that HEWs spend on various work duties and to explore differences in urban compared with rural settings and among regions. 44 HEWs were observed for 21 consecutive days, and time and motion data were collected using tablet computers. On average, HEWs were on duty for 15.5 days out of the 21 days and worked about 6 hours per work day. Out of the total observed work time, the percentage of time spent on various activities was: 12.8% providing health education or services, 9.3% meetings and giving trainings, 0.8% conducting community mapping and mobilization, 13.2% reporting, managing family folders, 1.3% managing commodities and supplies, 3.2% receiving supervision, 1.6% receiving training, 15.5% travel between work activities, 24.9% waiting for clients in the health post/health center, 13.3% building relationships in the community, and 4% not meaningfully categorized.
The proportion of time spent on different activities and the total time worked varied significantly between the rural and urban areas and among the regions. Findings of this study indicate that only a minority of HEW time is spent on providing health education and services, and substantial time is spent waiting for clients. The efficiency of the HEW model may be improved by creating more demand for services or by redesigning service delivery modalities. Authors: Hibret Tilahun, Binyam Fekadu, Habtamu Abdisa, Maureen Canavan, Erika Linnander, Elizabeth H Bradley. and Peter Berman.