Ethiopia is Africa’s second most populous country with an estimated total population of 99.3 million. Although it is a low-income country with a per capita income of $590, it is one of the fastest growing economies in the world. Poverty levels were cut from 55.3% in 2000 to 33.5% in 2011 and the country has made remarkable progress towards achieving the health-related Millennium Development Goals 4, 5 and 6. One of the policies credited with making a substantial contribution to these gains is the government’s flagship Health Extension Program (HEP), which is the subject of this case study.
This case study looks at the role of learning from other countries in the evolution of the HEP. Launched in 2003, it developed a new cadre of paid female community health workers (CHWs), supported by volunteers at community level. It is thought to have significantly contributed to Ethiopia’s achievement of the health Millennium Development Goals. It is also interesting because of the growing interest in the potential contribution of CHWs and task-shifting to improving outcomes within health systems. This case study seeks to: (1) provide insights into the contribution of international evidence to (and learning from) the conceptualisation, internalisation, contextualisation, operationalisation and evaluation of the health extension programme; and (2) gather country-level stakeholder perspectives on how they could better use and contribute to other countries’ experience.