Competency of Level-4 Health Extension Workers to provide Long Acting Reversible Contraceptives: A task shifting initiative in Ethiopia

Background: The Ethiopian health system has been facing challenge to meet the growing desire for family planning service. Shortage of trained service providers at a primary care setting is one of the reasons for unmet need to access Long-Acting Reversible Contraceptives (LARCs). To investigate feasibility of task shifting of providing LARCs, community health extension workers (CHEWs) were trained in four Regions of Ethiopia on how to insert and remove contraceptive of implant and Intrauterine Contraceptive Device (IUCD). Therefore, this study is aimed at assessing the knowledge, attitude and skill of the trained health extension workers to provide LARC. Methods : A cross sectional study was employed from April to May 2017 in four feasibility study regions of Ethiopia, namely; Amhara, Oromia, Tigray, and Southern Nation, Nationalities and Peoples Region (SNNPR). Data were collected from 66 health extensions who give the service of 402 IUCD and 793 implants. The collected quantitative data were analyzed using statistical package for social science (SPSS) version 25.0 for window. Results : Nearly two-third (62.7%) of L4HEWs had good level of knowledge of counseling for LARC. Using anatomical model L4HEWs completely performed all steps for around 58.5% Implanon, 30.6% Jadelle and 22% IUCD insertions. Conclusions : With adequate training and supportive supervision, L4HEWs can provide high-quality implant insertions. The IUCD insertion and removal needs careful consideration. Despite the possibility of improving uptake of LARC services by training more L4HEWs, there is a need to improve the skill of IUCD insertion and removal before scale up the intended task sharing.