Village Health Leaders Build Trust in Primary Health Care Delivery

3 min readFeb 28, 2024
Health extension worker Hiko Baneta (right) and village health leader Gudetu Loliso (middle) visit a young pregnant woman, Gemene Shumbura (left), in her home.

Ethiopia’s health sector is on a mission to ensure universal coverage for all. However, recent studies have underscored that some communities are less trustful of health facilities, their practitioners, and their services, leading to gaps in service utilization and greater risk of increased morbidity and mortality in certain populations. To understand these beliefs and to offer respectful person-centered primary health care, JSI’s Bill & Melinda Gates Foundation-funded Improve Primary Health Care Service Delivery (IPHCSD) project introduced the village health leadership approach. The approach brings communities and health structures into closer contact.

“I began work as a village health leader because I was worried about the health status of my community.” Belesti Meleket is one of 16 village health leaders in Debre Elias woreda in the conflict-affected area of Ethiopia’s Amhara Region. He elaborates: “I am now responsible for 80 households. I raise awareness on disease prevention, household sanitation, antenatal care, and vaccination and, generally, the benefits of visiting health facilities whenever there is need. I think the most important thing that I bring is just a listening ear.”

Elias Arosa, a village health leader, at a household visit in Bensa Ware Kebele

Village health leaders are community volunteers who connect families and communities to the primary health care system. Through the IPHCSD project, they are educated and skilled in leading group discussions and community mobilization efforts. The project facilitates recruitment of village health leaders and offers each a six-day intensive training on their expected roles and functions.

Each village health leader works with three or four community health organizations and supports 80–90 households, providing information about health and available services, and gathering information about household sanitation, vaccination, antenatal care, and child wellness service use. The IPHCSD project has prioritized reconfiguration of community health engagement strategies to reach frequently excluded people (e.g., youth, men, individuals of low literacy levels, and those with health service trust issues) with services.

Village health leader, Gudetu (right) and Hiko (left), a health extension worker, on their way to visit a pregnant woman

Gudetu Loliso is among 27 recruited village health leaders in Arsi Negele Zone in Oromia Region. Similar to Belesti, Gudetu has served her community for five years. She strongly believes in her work to improve community health. “The community trusts and listens to us and translates the advice we give them to action” she says.

According to Feyiso Dube, a woreda primary health care coordinator, “Of 497 village health leads in my woreda, 302 are women. They bridge gaps in primary health care, which Ethiopia widely recognizes as the most critical point to ensure equity in the health system and ultimately reach universal health coverage.”

As Dessalew Emaway, IPHCSD project director, sees it, “This [village health leader] mechanism is…improving service uptake. In designing this role, we listened to the voices, needs, and aspirations of communities and frontline health workers…to create a role and strategy that would best serve them.”

For more about the Improve Primary Health Care Service Delivery Project, click here.




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