October 13, 2010

Every time I hear or read the term “health extension worker” (HEW) I cringe.  This visceral reaction happened today when I clicked on a link from a Tweet posted on Twitter by the Bill & Melinda Gates Foundation. I landed on a new post by Melinda French Gates “Walking the Walk to Save Children’s Lives”  that included a short video. The story features an Ethiopian community health worker, Mahmunda, and her work caring for the families and children in rural Ethiopia over a one hundred mile radius.  The article refers to her as “… one of those health extension workers who deliver essential health services to families in rural communities.”

What is the history of this term? How did we assign a title to a person in such an important community role an extender? Why can’t we refer to them as community health workers?  Partners in Population and Development (PPD) works in Ethiopia providing resources to train HEWs to provide health care to the people in rural Ethiopia, accounting for more than 84 percent of Ethiopians. Their training program,  Ethiopian Health Extension Programme , aims to dramatically increase the number of these health workers.  “By 2010, 30,000 health extension workers (HEWs), almost all young women from the communities they serve, will be trained and distributed in pairs to live and work at the village-level throughout the country.”

These young women train for one year and learn disease prevention and control, family health, hygiene and environmental sanitation, and health education and communication. They provide immunizations and work in close collaboration with voluntary workers, such as community-based reproductive health agents (CBRHA) to provide reproductive health and family planning services at the household level.

We must ramp up the number of health care workers to meet the world’s health care needs and these health care community workers bring health closer to the homes of the people of Ethiopia most marginalized communities. They cannot work alone. We must train more physicians, nurses, midwives, clinical officers, laboratory technicians and pharmacists to work together to address this need.

Two words that begin with the letter “e” essential and extension are used when referring to these health care workers.  This mostly all women work force of community health workers are often selected by their own communities for the training.  I think they deserve a title that reflects the autonomous function as health care workers that they are supporting the primary health care needs of their communities. When more professionals join their ranks I hope they engage them in collaboration and learn from them on how best to serve their people.