Patterns of utilization, expectations, and satisfaction of the community to urban health extension services

Background: The Urban Health Extension Program (UHEP) - an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at the household level - is one of the three approaches of the national Health Extension Program (HEP). There are very few studies on the quality of health care provided by the UHEP in Ethiopia. This study is part of a comprehensive survey designed to assess the quality of health service delivered by the UHEP, and looks at the pattern of utilization, expectations, and satisfaction of the community in relation to services provided within the UHEP. Methodology: The study covered sampled households for a community-based cross-sectional survey using structured questionnaires among 589 households within five major regions (Amhara; Harari; Oromia; Southern Nations, Nationalities, and Peoples' (SNNP); and Tigray), as well as the two city administrations of Addis Ababa and Dire Dawa. Results: According to the findings, about 88% of the respondents have heard about urban health extension services in general, and the majority (51.6%) of them have heard about the services from the urban health extension workers (UHEWs), while 28.4%, 10.6%, and 9.3% heard about it from mass media, health centers and neighbors, respectively. Service packages reported to have been used most include: environmental health (75.7%), health education (56.5%), and immunization of children (39.2%). On the other hand, services such as first aid (2.2%), referral (3.1%), HIV/AIDS care and support (3.7%), postnatal care (7.8%) and nutritional screening of children (9.7%) seem to have very low rates of utilization. With regard to overall satisfaction of respondents on their visits to UHE facilities, more than 40% of the survey households responded as being satisfied or very satisfied with most of the items, except for the availability of UHEPs for home visits, availability of medical supplies, and referrals for consultations. Conclusions: Beneficiary communities seem to have an overall positive impression of the services provided by the UHEP, even though knowledge about and utilization of some of the services seem to be minimal. There are tendencies among many community members of associating the program with kebele political activities. There are also instances where communities expect too much from the urban health extension professionals (UHE-ps), while some others tend to undermine the knowledge and skills of UHE-ps and to not consider them as health professionals.