Health Extension and Primary Health Service

1.    Introduction

The Health Extension and Primary Health Care Directorate of Ministry of Health is essentially established in order to enhance the grass root level public health services by realizing Comprehensive promotive, preventive, basic curative and rehabilitative care to the households and the community, mainly through PHCU (Health centre and Health Post. Basically, the Directorate divided in to three sub- structures which are known as; 

(a) The Health Extension and Primary Health Care (PHC) team, 
(b) The Health Education and Promotion team and
(c) The Health Centres   reform team (see Figure 2). 

Each team comprises variety of health experts with different educational backgrounds and experiences. Collectively, the directorate is headed by the Director and Assistant Director, while each team has its own team leader under the leadership of the Director. 

To this end hence, it is important to highlight the key tasks of the Health Extension and Primary Health Care Directorate. Essentially, the directorate has been mandated to lead and guide Community Based health care services/ programs that are being provided at the Primary Care Level, notably, at the Health centres and the Health Posts in rural and urban settings of the country.

The primary level of care includes primary hospitals, health centers (HCs) and health posts (HPs). The primary health care unit (PHCU) comprises five satellite HPs (the lowest-level health system facility, at village level) and a referral HC (Figure 1). A further network (WDA networks) links community members with the PHC system at community level

Ethiopian Health Tire System
 Figure 1: Ethiopian Health Tire System 


2. Strategic portfolio

2.1 Vision

የጤና  ዘርፍ፡ ጤናማ፣ ምርታማና የበለፀገ ኀብረተሰብ ተፈጥሮ ማየት ነው፡፡
Health Extension and Primary Health Care Directorate
ጤናማ ባህርይ እና ድርጊቶች የሕዝቡ ልማዳዊ ዕሴት በሚሆኑበት ደረጃ ደርሶ ጤናማ፣ ምርታማና የበለፀገ ኀብረተሰብ ተፈጥሮ ማየት ነው፡፡

2.2 Why the Directorate Exists

Being part of the broader health system of the country, HEP and PHC directorate strives to contribute to the mission of the health sector; which is: To promote health and wellbeing of Ethiopians through providing and regulating a comprehensive package of promotive, preventive, curative and rehabilitative health services of the highest possible quality in an equitable manner."


Organogram of Health Extension and Primary Health Care Directorate
Figure 2: Organogram of Health Extension and Primary Health Care Directorate 


2.3 Strategic Objectives 

The major Strategic Objectives of the Directorate are as follow. They are:

  • Improve Community Ownership
  • Improve Community Participation
  • Improve equitable access to health care services
  • Improve Good Governance practice
  • Improve Evidence-Based Decision Making
  • Increase the use of new innovations and technologies
  • Improve the effective and efficient  utilization of resources


3. Role and Responsibilities

3.1 General Role and Responsibilities of the Directorate: 


The Health Extension and Primary Health Care Directorate with its team members is expected to execute the following major roles and responsibilities which include the existing and additional anticipated ones.  These are:

3.1.1 Major Roles and Responsibilities (existing)


  1. ስትራተጂክና ዓመታዊ ዕቅድ መነሻ በማድረግ ዓመታዊ ዝርዝር ዕቅድ ማዘጋጀት
  2. አጋርነትን (ፓርትነርሽፕን) ለመፍጠር የሞብላይዜሽን ስራዎች ማከናወን
  3. ቴክኒካዊ መመሪያዎችን/ማንዋሎችን ማዘጋጀት
  4. የስራ ላይ ስልጠና መስጠት
  5. የጤና ትምህርት መርጃ መሳሪያዎችን ማዘጋጀት
  6. የአድቮኬሲ ስራዎችን ማካሄድ
  7. ድጋፋዊ ክትትል ማድረግ
  8. የተገልጋይ እርካታ ክትትልና ምላሽ
  9. የዕቅድ ክንውን ክትትልና ግምገማ ማድረግ
  10. ምርጥ ተሞክሮ መቀመርና ማስፋፋት
  11. ግብአት ፍላጎት ሟሟላት

3.1.2    Major Roles and Responsibilities (additional antecipated )

The above mentioned Roles and Responsibilities and the following anticipated ones: 

  • Contribute to the development of national  Health Policy and the subsequent HSTPs
  • Utilize the recommendations of national HEP assessment by including them in long term envisioning roadmap for the optimization of

HEP.  Derive strategic implementation plans in alignment with the subsequent HSTPs. These will cover a wide range of HEP activities such as:

  • Designing, testing and implementing sustainable community engagement approaches in context of Woreda Transformation Agendas and support continuous capacity development and accreditation initiatives
  • Continue the implementation of Woreda Transformation activities in an improved and sustained manner
  • Support the application of new Essential Health Service Package
  • Implementing the second-generation health extension program
  • Designing and implementing more advanced HEP to respond to the ever growing client needs and changing epidemiologic and demographic patterns of health (application of FHT approach with imbedded quality improvement initiatives)
  • Optimizing the designing, production and utilization of IEC and BCC materials
  • Designing separate urban HEP implementation strategy based on the type of urban settings (use of FHT for major cities) 
  • Revising existing manuals, guidelines, SOPs , Protocols, etc
  • In collaboration with Ethiopian Health Insurance Agency, evaluating  process and outcome of current CBHI scheme and strengthening it accordingly 
  • Supporting the strengthening pre- service training of health care provider for community health service ( opening of level 5  training programs for mixed professions in generic and up-grading enrolment of the professionals)
  • Assessing and developing capacity of training institutions to ensure the quality of pre-service training
  • Ensuring continuous capacity development of community health professionals through regular need-based competency based in-service training  in class-room settings and virtually
  • Support the Improvement of  retention, motivation and Legal protection of HEWs
  • Supporting  the preparation and implementation of health post renovation and new upgrading Standard: 
  • Developing and implementing functional supply chain and logistics management system for health posts : 
  • Enhancing Institutional and individual capacity and motivation to generate, synthesize and translate evidence
  • Maximizing multi sectoral collaboration and actions towards optimizing HEP 
  • Ensuring leadership management and governance support and commitment 
  • Ensuring proper implementation of the HEP Optimization
  • Strengthening linkages between the Health Centre and Health Post 
  • Designing and implementing health post (performance) management standards
  • Support the generation and utilization data on the overall implementation of HEP and HC reform activities using different mechanisms (assessments, evaluative researches, routine service data (DHIS), etc.)
  • Provide the required technical support to the HCs in terms of assuring the fulfilment of minimum requirements to practices, permises, professionals and products/ materials
  • Support technically and financially for the effective implementations of the Primary Health Care reforms (PHCG); EHCRIG; EPAQ; and CASH-IPPS).
  • Produce and implement the Primary Health care strategy
  • Strengthen the school health and nutrition programs
  • Establish and strengthen national Health Education and Promotion Media Forum
  • Design health education and promotion strategy for  factory and prison facilities



  • Develop internal capacity of the directorate (managerial and technical)
  • Monitor and evaluate the performance of an individual performer, team and the directorate on regular basis including proper allocation and utilization of budgets using inputs from program Review meetings,  SSVs, Inspections, assessments, process evaluations, other studies( EDHS, SPA, SARA), analysis of service data (DHIS), etc.
  • Organize and facilitate various taskforce meetings, forums, panel discussions and town hall meetings with different stakeholders, including implementing and development partners, universities, CBOs, CSOs and the community
  • Advocate national best experiences on different forums and support the scale up implementation of those experiences
  • represent FMOH on different international conferences/ summits and advocate HEP to other societies of the world