Attachments
Rationale
Background
Ethiopia, the second most populous country in Africa with 123 million people is affected by a multitude of complex issues. Ongoing conflicts, crisis-level food insecurity, flooding, drought, and disease outbreaks are some of the multiple and often overlapping crises that continue to strain the lives of communities, refugees, internally displaced people, and returnees in Ethiopia.
The Tigray region, located in northern Ethiopia, has experienced devastating conflict that has severely impacted the living standards of its communities. Essential service facilities, including those in the health sector, have suffered immense damage, resulting in significant losses of human resources, infrastructure, and funding. The Tigray region continues to experience the long-term effect of the past conflict, which is still affecting people's ability to access health facilities. Asgede Wereda, situated in the Northwestern Zone of Tigray, was at the epicentre of the conflict. With an estimated population of 107,125 and an undetermined number of internally displaced persons residing there informally, reports from the Tigray Regional Health Bureau indicate a surge in cases of cholera and malaria, with the highest rates compared to other weredas. Additionally, recent increases in gold mining activities and subsequent population movements have exacerbated the transmission of these diseases and have contributed to other public health challenges, such as sexually transmitted infections, infestations like scabis, and environmental health issues including contamination of WASH facilities and harmful hygiene practices like open defecation. These compounded factors have created added pressure on the already strained health system. Taking all the above factors into account, and discussions with Regional Health bureau of Tigray and the Tigray Health Cluster, Asgede wereda was selected for this RNA.
The HEP was started in 2003 as a nationwide community-based health program involving the training of two female health extension workers (HEWs) per community, recruited from the communities they were intended to serve, and the construction of one community health post (HP) The Health Extension Program has served as a platform for delivering primary healthcare (PHC) services, especially to rural communities with limited access to healthcare. Each PHC unit is designed to serve up to 25,000 users, while each health post (HP) serves up to 5,000 users in rural areas of Ethiopia. Each PHC unit consists of one health center and five satellite health posts, with typically one health post per kebele. The Health Extension Program provides a comprehensive package of promotive, preventive, curative, and rehabilitative services organized under four major categories: Family Health, Disease Prevention and Control, Hygiene and Environmental Health, and Health Education and Promotion. These services encompass a range of interventions delivered at health posts and through outreach and mobile units, to reach a wider community.