The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia

Abstract

BACKGROUND: Women’s preference to give birth at home is deeply embedded in Ethiopian culture.Many women only go to health facilities if they have complications during birth. Health ExtensionWorkers (HEWs) have been deployed to improve the utilization of maternal health services by bridgingthe gap between communities and health facilities. This study examined the barriers and facilitators forHEWs as they refer women to mid-level health facilities for birth.METHODS: A qualitative study was conducted in three regions: Afar Region, Southern NationsNationalities and People’s Region and Tigray Region between March to December 2014. Interviews andfocus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by AfarPastoralist Development Association, Afar Region) and 11 other health workers from health centers,hospitals or health offices. Data analysis was done based on collating the data and identifying keythemes.RESULTS: Barriers to health facilities included distance, lack of transportation, sociocultural factorsand disrespectful care. Facilitators for facility-based deliveries included liaising with HealthDevelopment Army (HDA) leaders to refer women before their expected due date or if labour starts athome; the introduction of ambulance services; and, provision of health services that are culturally moreacceptable for women.CONCLUSION: HEWs can effectively refer more women to give birth in health facilities when the HDAis well established, when health staff provide respectful care, and when ambulance is available at anytime.