Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study

Abstract

Purpose

Ethiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia.

Patients and Methods

A community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services.

Results

The utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8–63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21–0.63), housewives (AOR=0.36, 95% Cl=0.20–0.64), merchants (AOR=0.08, 95% Cl=0.03–0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73–6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02–2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22–3.18) were factors significantly associated with the utilization of urban health extension services.

Conclusion

The overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants’ perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.

Keywords:

• urban health extension program
• health service utilization
• Gondar
• Ethiopia

Acknowledgment

The authors would like to thank all the respondents for their willingness to participate in the study and giving valuable information. We are also grateful to Gondar city administrative health office for giving us a supportive letter and the University of Gondar, Institute of Public Health staff for their technical support. Finally, our appreciation goes to data collectors and supervisors for their unreserved contribution in the data collection process.

Data Sharing Statements

All the data supporting the findings are within the manuscript. Additional detailed information and raw data are available from the corresponding author on reasonable request.

Author Contributions

All authors substantially contributed to the design, acquisition, analysis, and interpretation of data, drafting, revising, and final approval. Besides, all authors agreed to be accountable for all aspects of the work.

Disclosure

The authors confirmed that they had no conflicts of interest for this work and that no funding for this research was secured.