Equipping Health Extension Workers with Digital Health Tools Sparks Hope in Ethiopia’s Post-Conflict Tigray Region
By Mihret Aschalew
Community health workers provide vital health services, particularly in remote communities. Civil conflict in Tigray left much of the region without health care infrastructure, medical equipment, and vital health records. A 2023 WHO report revealed that 86 percent of the 853 health service delivery units in Tigray have endured varying degrees of structural damage, while 71 percent of medical equipment remains nonfunctional. It also emphasizes the complete destruction of 28 health facilities in Tigray, leaving the equipment in an additional 232 facilities unusable. Tigray’s health extension workers, Ethiopia’s community health worker cadre, were left with soaring demand and little resources.
Tesfa Gebre has been a health extension worker (HEW) for four years. After a year and half of unrest, she returned to Adishishay, her health post, following the signing of a peace deal between Ethiopia’s central government and Tigray. She describes conditions upon return, “Medical records, along with household and related data were completely destroyed. Health posts, health centers, and woreda health bureaus were starting from scratch.”
The conflict completely hindered routine activities of HEWs like Tesfa, preventing the care they often provide including child immunization, antenatal, and postnatal care. However, digital health interventions such as those implemented through JSI’s Children’s Investment Fund Foundation-funded Electronic Community Health Information System (eCHIS) Scale-up For Health Extension Program Improvement project gave quick access to the resources HEWs struggled to find in a post-conflict Tigray. The eCHIS system digitizes existing community family folders, health manuals, registers, tools, and service workflows, along with all reporting forms. It allows HEWs to easily pull household member health data and ensure continuity of service. It gives each HEW access to counseling guides and aids their delivery of the highest quality care, while reducing paper-based reporting burdens.
With the advent of eCHIS, HEWs have abandoned paper-based registration and started over in Tigray, digitally. JSI and the Ministry of Health began eCHIS implementation before the conflict, but as tensions in the region mounted, activities such as training and mentorship as well as health extension worker counseling sessions were halted to ensure staff safety. Upon completion of a peace deal, JSI organized a series of consultative workshops with relevant officials in the regional government structure to create a common understanding and get leadership buy-in. The Ministry of Health distributed tablets to HEWs serving the region. Each tablet included modules on common health care counseling topics from neglected tropical diseases and infectious diseases to antenatal and postnatal care. JSI trained all HEWs and followed the trainings with routine mentorship and supportive supervision. The next big step was then underway: HEWs went door-to-door and served in health posts to register each household and community member, rebuilding the health data lost in the war.
Currently most woredas in Tigray have finalized registration and started eCHIS based service delivery. Netsanet Elias, a HEW from Debrebirhan health post in Tigray explains how she is feeling about the progress, “We have our records in our hand in the event of manmade or natural risks. The data can be retrieved now and forever. Nothing will be lost again as it had been and I am happy and hopeful that eCHIS will enable our community to have better continued access to services.”
Tserehawomberta, a woreda health bureau in Tigray, resumed service following complete damage during the war. The woreda started implementing eCHIS eight months ago. According to Birhane Atsebeha, woreda health bureau head, eight kebeles (lower tier of health administrations) in the woreda have finalized household and member registration while four are in process. “I have no doubt that we will benefit from the system. It’s the direction the sector and the world is heading toward and we’re taking that first step by ensuring every client is registered and has a health record on file.” Birhane asserts.
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