Health extension program factors, frequency of household visits and being model households, improved utilization of basic health services in Ethiopia

BACKGROUND: Ethiopia has implemented a nationwide primary health program (the Health Extension Program) at the grassroots level since 2003. The aim of the program is to increase public access to basic health services, mainly by producing model households. These are households which attend at least 75% of the training given by health extension workers and implement at least 75% of the Health Extension Program packages. This study was conducted to assess the extent of the Health Extension Program utilization by the community, and to identify factors associated with it. METHODS: A community-based cross-sectional study was conducted to assess the utilization of the health extension program. Data were collected from 1320 mothers using a structured questionnaire. Multilevel logistic regression was used to identify factors associated with the utilization of the program. RESULT: Health extension workers conducted frequent visits to 52.7% (95% CI = 50.0 to 55.4%) of the households, and 78.5% (95% CI = 76.2 to 80.7%) mothers visited health posts. Mothers who had frequent household visits by health extension workers were 1.289 more likely to visit the health posts (AOR = 1.289, 95% CI = 1.028 to1.826) than mothers who did not get frequent visits. Mothers from model households (3 years after graduation) were 2.410 times more likely to visit health post (AOR = 2.150, 95% CI = 1.058 to 4.365) compared to mothers from non-model households. Mothers who felt that they understood the Health Extension Program packages were 1.573 times more likely to visit the health posts (AOR = 1.573, 95% CI = 1.056 to 2.343) than mothers who did not feel they understood the program packages. Mothers from higher income families were 2.867 times more likely to visit health posts (AOR = 2.867, 95% CI = 1.630 to 5.040) compared to mothers from lower income families. CONCLUSIONS: Conducting continuous home visits of non-model households and following up the existing model households, producing more model households by giving model-family training to non-model households, and strengthening the information, education, and communication package are crucial in the implementation of the HEP to increase basic health services utilization.