Implementation, Experience, and Challenges of Urban Health Extension Program in Addis Ababa: A Case study from Ethiopia

Background: Ethiopia started implementing the Urban Health Extension Program in urban areas since 2009 to provide health care services to the community members of the urban health extension professionals. But, limited evidence is there to the extent of this program implementation, acceptance, and utilization. Therefore, this study was aimed at exploring the implementation, experience, and challenges of the urban health extension program. Methods: : A qualitative case study was conducted in Addis Ababa from November 15 – December 29, 2017. The study participants were recruited purposively that includes health extension professionals, health post supervisors, health development army leaders, Addis Ababa city health extension program administrators, and women of the community. A total of 4 focus group discussions and 31 in-depth and key informant interviews were conducted. The data were transcribed verbatim, translated into the English language, and analyzed by an inductive thematic analysis approach using Atlas ti7.1 software package. Result: This study found that there were 15 health service packages of the urban health extension program provided to the communities by the Urban Health Extension Professionals in Addis Ababa. The strategies used for the program implementation were a provision of training for UHEPs, conducting home to home visit, creation of model households, strengthening of health developmental army, conducting of regular supervision or monitoring, referral and feedback, and community mobilization. Lack of coordination between the health extension program and other sectors, poor supply management system, having no clearly defined career and education path and lack of motivation and incentives were some of the challenges posed in the program implementation. Conclusions: : Although the urban health extension program has made a significant contribution to the health of the community through increasing access to public health services in urban settings, its implementation is affected by many challenges. Therefore, all stakeholders, governmental and non-governmental organizations should have support the system to increase the acceptability and utilization of the urban health extension services.