Analytical summary - Community ownership and participation
Ethiopia's overall national policy and hence its National Health Policy is founded on commitment to democracy for citizens to fully exercise their rights and powers in a pluralistic society. Community ownership and participation aims to empower communities to manage the particular health problems that are specific to their community. In 2003, a Health Extension Programme was introduced and its priorities were to create community ownership and empowerment in the health sector.
This objective is implemented through deployment of two community-selected health extension workers in each health post in nearly all of the estimated 15 000 kebeles. The Programme emphasizes an integrated approach, including health promotion, preventive health and referral health services through health extension workers, with the support of community volunteers and model family households. Similarly, with the same objective of ensuring community engagement, ownership and social mobilization, the Health Development Army has initiated a new strategy to scale-up best practices by organizing and mobilizing families.
The expected outcome of the Health Development Army is community empowerment for continuity and sustainability of health programmes. The Health Development Army will be a network created between five households and one model family to influence one another in practising healthy lifestyles. This network of families will have technical support and training by health extension workers to aid implementation of the packages of the Health Extension Programme. The Health Development Army will help to expand the successful Health Expansion Programme deeper into communities and will thus improve community ownership.
The Health Development Army will be engaged in promotion and prevention activities at household and community level, including the regular coordination of structured community dialogue sessions, with the guidance of health extension workers. The local government councils, health extension workers and the Health Development Army will have extensive responsibility for social mobilization, increasing a community’s awareness of their health rights, and for creating an enabling environment.
The mechanics and detailed operation of the Health Development Army are well articulated. Efforts are being made to support this initiative with strong leadership by the civil service and political leaders. However, mechanisms and tools need to be in place if the transformation in health-seeking behaviour and development is to be achieved as envisaged by the Government of Ethiopia.
In addition, communities will be represented on governance boards of all public sector health facilities. To further reinforce community ownership, elected community members participate in health facility governing boards that have power to:
- make decisions on health facility plans
- breakdown the block budget, approve use of retained revenue and oversee health finance reforms
- plan service delivery.
Health extension workers also use community-level structures such as kebele and idir, religious organizations, religious leaders and community leaders to involve and mobilize the community.