Ethiopia's community case management

Since 2003, Ethiopia has been implementing the health extension programme (HEP) in communities. The programme focuses on health promotion, disease prevention, and a limited curative service of 16 packages.  

Changes in demography, disease epidemiology, socioeconomic factors, community demand, and global and national priorities have led to the revision of the HEP and development of a Road Map for Optimising the Health Extension Program, 2020–2035. The goal of the Road Map is to accelerate the realisation of universal health coverage through which all Ethiopians will have access to health services. HEP is the primary mechanism to achieve universal health coverage. 

There are 39,878 Health extension workers (HEWs) in more than 17,000 health posts, which achieved a target of having one health post for every 3,000–5,000 people. HEWs are trained in Technical and Vocational Education and Training institutes for 10 months and are provided with a comprehensive integrated refresher training by the Government of Ethiopia. They receive frequent supervision from the district health office and nearby health centers.  

The HEWs focus on preventive services; however, they also provide curative healthcare services for malaria for all ages, and pneumonia and diarrhoea in children under five years of age using the integrated Community Case Management (iCCM) approach of evidence-based diagnostic and treatment algorithms.  

For malaria, HEWs have been trained to confirm and report malaria diagnoses among clinically evaluated acutely ill patients using malaria multi-species rapid diagnostic test (RDTs). Severe malaria cases are referred to the next appropriate health facility, with initial pre-referral management using rectal artesunate. The HEWs are encouraged to consider other diagnostic possibilities for patients who test negative by malaria RDT, and to avoid empiric treatment with antimalarials.