Lessons Nigeria Can Learn from Ethiopia’s Experience Infusing Digital Tech and Community Workers
Sonia Biose (Lead Writer)
“Before I became a Community Health Worker, women in my village often gave birth at home without any medical help. Today, they call me first and I refer them to the health centres.” — Atsede (not real name), a Health Extension Worker (HEW).
Across Ethiopia’s rural landscape, thousands of community health workers like Atsede are transforming lives by bringing critical healthcare services to the doorsteps of those who need them most. These unsung heroes, often women from the very communities they serve, have become the lifeline of healthcare delivery in Ethiopia’s most remote corners.
Locally referred to as HEWs, they are often the only accessible link to formal healthcare in remote communities. They play a crucial role in reducing maternal and child mortality, combating preventable diseases, and promoting healthier lifestyles.
Recognising their vital contribution and the evolving demands of modern healthcare, Ethiopia is now equipping its community health workforce with the digital tools and knowledge they need to do even more.
A bit of a back story
Ethiopia’s journey towards community-based healthcare began in 1997 when the Federal Ministry of Health launched the National Health Sector Development Programme (HSDP), a blueprint for addressing the healthcare needs of its predominantly rural population, which accounts for 83% of all Ethiopians.
By 2003, after five years of implementation, the HSDP underwent significant reforms marked by the introduction of key initiatives, including the Health Extension Programme (HEP). Formally launched in 2004, the HEP marked a transformative shift in Ethiopia’s healthcare delivery, aiming to reach the last mile.
Its core strategy focused on expanding access to health services in underserved rural areas by mobilising local human resources. By 2023, the programme had trained and deployed 40,000 HEWs across the country’s rural landscape.
However, as health knowledge rapidly evolved in the digital age, these dedicated workers were increasingly constrained by outdated information and traditional training methods that were time-consuming, resource-intensive, and lacked mechanisms to measure improvements in knowledge and skills.
Abraham Serihun, Country Director of Last Mile Health Ethiopia, noted, “training community health workers was very expensive, and there was no technology in place to effectively track learner engagement or measure changes in knowledge and skills.”
Strengthening health worker capacity — A blended approach
To address these challenges, Last Mile Health, an organisation with nearly two decades of experience supporting government-led community health systems, partnered with Ethiopia’s Ministry of Health to revolutionise health worker capacity building. This collaboration introduced an innovative blended approach that integrates structured face-to-face mentorship with advanced digital learning tools.
This partnership led to the development of the Extension Essentials app, a learning management system (LMS) designed explicitly for HEWs in Ethiopia. Mr Zerihun explained that this LMS enhances health education by compiling effective multimedia resources, including instructional videos, educational animations, and interactive content that improve knowledge retention and practical application.
Another crucial feature of the Extension Essentials app is its offline functionality, enabling continuous learning in areas with limited internet connectivity, which is typical in rural Ethiopia and most parts of Africa. Mr Zerihun added that what made this tool stand out was the incorporation of practical and skill-based modules as opposed to modules solely focused on improving knowledge.
Within four years of implementation, the Ministry of Health and Last Mile Health have successfully reached and trained 12,400 HEWs, approximately 30% of Ethiopia’s community health workforce. This digital transformation has demonstrated considerable advantages over traditional training methods, proving 40% more cost-effective while enhancing learning outcomes.
The programme has also successfully expanded beyond its initial maternal and child health (MNCH) focus to include comprehensive training for non-communicable diseases (NCDs), enabling health workers to provide early detection and referral services for conditions that are increasingly prevalent throughout the region.
Overcoming implementation challenges
The implementation of technology-based learning in rural settings wasn’t without its challenges. As Abraham of Last Mile Health noted, initial concerns centred on the feasibility of digital-based training for rural health workers with potential gaps in digital literacy.
However, these concerns were addressed through strategic user experience design, creating an intuitive and accessible interface that met the unique needs of the HEWs. The results convincingly demonstrated the capacity of rural health workers to effectively engage with digital learning platforms because while the training design called for health workers to spend two hours daily on self-directed learning, data showed they averaged more than 2.5 hours, demonstrating the high level of engagement achieved when appropriate digital tools are provided.
Another critical element of the programme’s success was the prioritisation of government ownership. Last Mile Health ensured the Ministry of Health maintained central authority throughout the implementation as training facilitators were sourced from within the Ministry, and sessions were conducted in government-owned continuous professional development centres.
A model for regional implementation
The partnership between the Ethiopian Ministry of Health and Last Mile Health offers a structured model that can be replicated for strengthening community health workers’ capacities throughout Africa.
In Nigeria, where a shortage of skilled human resources at community healthcare centres remains a huge concern, leveraging this model could be game-changing.
In June 2024, the Nigerian government, through the National Primary Healthcare Development Agency (NPHCDA), boldly committed to training 120,000 frontline health workers and strengthening capacity across 37,000 primary healthcare facilities. This presents a timely opportunity to apply these insights. However, maximising success at scale would require tailoring these lessons to fit into the country’s unique context, especially in rural communities where access to power and internet connectivity remains an issue.
Therefore, adaptation should also consider:
· Adapting training content to reflect Nigeria’s language diversity and varied cultural contexts.
· Creating effective coordination mechanisms between federal and state healthcare authorities to ensure consistent implementation and ownership.
