Expectations and satisfaction of urban health extension workers regarding their service delivery environment

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 a household level - is one of the three approaches of the national Health Extension Program (HEP). As health extension workers (HEWs) are the backbone of the program, the present study was designed to assess their expectations and satisfaction regarding their service delivery environment. Methodology: The study for this assessment involved in-depth interviews that included urban health extension professionals (UHE-ps), supervisors of UHE-ps, as well as village health committee members and health service managers and supervising health workers in 76 selected urban health extension facilities within the 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. Findings: Most UHE-ps seem to be less motivated in their jobs and consider it as only temporary. A lack of training opportunities and absence of a clear career structure, non-uniformity of payment and being engaged in administrative routines that are not directly related to health services are among the reasons mentioned for dissatisfaction by UHE-ps. On the other hand, there are also some who are satisfied with their work and who feel that they are making changes to the health status of their communities. Conclusions: The findings of the study show that there are UHE-ps who are satisfied in their professional activities and consider themselves as contributing to changes in the health status of their communities. However, most of the UHE-ps are said to be less motivated in the jobs, and seem to consider their roles as temporary (until they get a better job). Many complain about the lack of training opportunities, absence of a clear career structure, and having to engage in non-professional activities. To address UHE-ps' lack of motivation, it is recommended that the government should propose a clear career structure for them and implement a uniform payment structure across the country.