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Ethiopia is a second populous country in Africa with a total population of 82.8 million, birth rate
of 39 and death rate of 12 per 1000 population. Ethiopia is the least develop country and has
poor health status as dictated by low per capita income and high infant mortality rate 1.
The health policy of the Federal Government of Ethiopia uses decentralization and
democratization as a tool to address the problem of under privileged rural people 2. The Policy
has been realized after formulation of health sector development program. The 1st health sector
development program HSDP-I (1997/8 to 2002) and the 2nd health sector development program
HSDP-II (2003-2005) had been completed with encouraging results and potential experiences
gained which was an in put for the development of HSDP. HSDP- II took a stock of experiences
from HSDP-I and further aimed to the delivery of cost effective preventive and promotive health
care services through an integrated and articulated plan of health extension program (HEP)
which will be implemented almost through HSDP-III (2005/6- 2009/10) 3.
HEP is a new initiative, and defined package of basic and essential promotive, preventive and
selected high impact curative health services targeting households which had been started in
HSDP-II in response to HSDP-I findings. It is an initiative community based health care delivery
system aimed at creating healthy environment as well as healthy living using cadres of health
extension workers 4. It was introduced in recognition of failure of essential services to reach
communities in remote areas. HEP services have been customized to meet the needs, demands
and expectations of the pastoralist, agrarian and urban population. It is considered as the most
important institutional framework for achieving the Millennium Development Goals (MDGs) 5.
HEP is based on the concept and principles of PHC. It is designed to improve the health status of
families, with their full participation, using local technologies and the community's skill and
wisdom. HEP is similar to PHC in concept and principle, except HEP focuses on households at
the community level, and it involves fewer facility-based services. The philosophy of HEP is that
if the right knowledge and skill is transferred to households they can take responsibility for
producing and maintaining their own health. The HEP is the main vehicle for bringing key
maternal, neonatal and child health interventions to the community. It is expected that almost all

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of the activities listed in the National Child Survival Strategies are to be implemented through
the HEP 6.
The main objectives of HEP are shifting health care resources from predominantly urban to rural
areas; improving access and equity of essential health services at the village and household
levels; ensuring ownership and participation among community members; promoting gender
equality; improving the utilization of peripheral health services by bridging the gap between
communities and health facilities through Health Extension Workers (HEWs); reducing maternal
and child mortality and to promote an overall healthy lifestyle

5,7

. HEP is designed to achieve

significant basic health care coverage in Ethiopia through the provision of a staffed health post to
serve every 5000 people. Every health post is being staffed by two female HEWs who had been
under gone one year training and receive salary from the government at the end of the month in
order to provide 16 major packages under four components 6, 8, 9, 10, 11. These are:
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Immunization. Family planning. and First Aid emergency measures)      (Maternal and child health. and Adolescent reproductive health)        . (HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control. Nutrition. Malaria prevention and control.

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and Personal hygiene)     . Healthy home environment. Water supply and safety measures. (Excreta disposal. Food hygiene and safety measures. Control of insects and rodents. Solid and liquid waste disposal.

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And it is a timely issue to assess the motivation of health extension workers who are the most important cadre for the implementation of health services extension program. community health agents. nurses. (Health education and communication). community health volunteers. The word health extension worker is not common in many countries other than Ethiopia. doctors and health workers/health professional are used for reviewing the literature on issues related to health extension workers. in this literature review other terms like community health workers. Therefore. î . community health representatives. the utilization of health extension program and the impact of the program.

î     .

it needs to create an environment conducive to high degrees of motivation. Thus it is often said that motivation is a   . î c    ! Motivation is an internal psychological process that can be defined as an individual¶s degree of willingness to exert and maintain an effort towards organizational goals. some of the determinants of motivation. The results of the internal process of motivation reflect the specific individual¶s situation and environment. Motivation by itself is not an observable phenomenon. People cannot be motivated directly. it is only possible to observe either the results of the motivational process (such as improved performance) or perhaps.

and expectations for consequences of work behavior). as a specialty in the broader field of human motivation. and in particular those processes that influence the individual¶s achievement of workplace goals and tasks. Different studies have been conducted by different researchers on motivation of health workers and factors influencing motivation especially on community health workers. efficiency and equity is directly affected by worker motivation 12. work context or organizational level (organizational structure and processes. Emphasis is placed on a narrower set of person and situational factors than is considered in broader theories of human motivation. Work motivation is often mentioned as a major problem to health systems performance in developing and middle-income countries. and human resource management inputs). and the broader societal context. work motivation refers to the psychological processes that have direct implications for individual behavior in the context of work. societal values). Motivational determinants of health worker motivation at several levels can be seen as 14 : individual level (goals. Generally. and broad sociocultural factors (community expectations. ‘ J . The findings of motivational studies can be seen as incentives versus disincentives. Worker motivation is critical issue in the health sector since health care delivery is highly labor-intensive and service quality. doctors and other health workers.  process: it depends upon the relationship between the individual and the organizational context within which they work. organizational culture. peer pressure. nurses. and also motivating factors versus de-motivating factors. 13. self-concept.

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. These motivating factors can be generally classified in to two: incentives and disincentives.  ‘‘   ‘ Motivation can be influenced by different factors.

For example. professional nurses in South Africa expressed greatest satisfaction in their relationship with patients and the gratification they obtained from patient care. lack of community involvement in CHW selection. personal growth and development. and poor access to training opportunities17. and unclear role and. commitment of managers to improve staff conditions. and clear role. inadequate supervision. lack of promotions. their relationship with their nursing colleagues. poor salaries. ‘   ‘   Unmet expectations. lack of fairness. possibility of future paid employment. inconsistent remuneration financial. 17 . low salary. training. working conditions and inadequate facilities for performing expected duties. financial incentives. lack of respect from health facility staff. lack of concern by  . inappropriate selection of CHWs. acquisition of valued skills. prestige. visible change. CHWs from outside community.‘  ‘ ‘‘   ‘ ‘ Motivation can also be influenced by motivating and demotivating factors. and support. community recognition and respect. professionalism. recognition and appreciation 16. peer support. inadequate refresher training. failure to take community needs into account. job security. A survey done on‘ work satisfaction of professional nurses in South Africa indicated that overall. and inadequate staff and supplies can lead health workers to dissatisfaction 15. lack of incentives. challenged by the demands of clients. inequitable distribution of incentives among different and community workers. ‘    ‘ on the other hand.   ‘ atisfactory remuneration: material incentives. change in tangible incentives.  ‘  Altruism. policies or legislation that support health workers are some incentives that could lead to motivation of health workers 15. accomplishment. and doctors and their sense of belonging in the communities within which they work 16. poor inter-professional relations poor communication system. community involvement in selection.

and even economic status. poor information flow to and from hospital management 18 . giving reason for volunteerism. colleagues of the community (45%). career development in regards to the possibility to specialize or be promoted (85%). support. may not be paid regularly. Non-monetary incentives such as supportive supervision.having the opportunity to take classes and attend seminars (80%). administrative environment (government regulations. peer support. A systematic review of motivation and retention of health workers in developing countries (Africa and Asia) 19 revealed seven major themes regarding motivational factors were identified: financial in terms of salary or allowances (90%). lack of participation in decision making. factors that appear to influence the motivation and work of CORPs include: hopes for better life through continuous development of life skills and opportunities. conditions. personal interests (values. such as an identification badge. characteristics). the workload. laws.The same study in South Africa indicated that professional nurses and doctors were most dissatisfied with their pay. hospital infrastructure (the physical condition of the health facility. and refresher training are critical to the success of any CHWs and are very crucial to motivate CHWs 15. In other study in Kenya.employers for staff welfare. will affect how they are perceived by community members and their ability to work effectively. procedures. But monetary incentives often bring a host of problems because the money may not be enough. hospital management . or may stop altogether. gender. in papers often described as 'work environment' (5%). Monetary incentives can increase retention.refers to having a positive working relationship with the management with whom the health workers work (70%). and personal recognition or appreciation . A study conducted to examine experiences with various incentives for CHWs and their impact on retention and sustainability of CHW programs indicated that the motivation and retention of CHWs is influenced by who they are in the community context. such as their age. resource availability (refers to equipment and medical supplies that are necessary for health workers to perform their job (75%). appropriate training and relatively small things.either from managers. their career development opportunities and the resources available to them 16. continuing education . ethnicity. logistics supplies º . appropriate job aides such as counseling cards and regular replenishment of supplies. The inherent characteristics of CHWs.

and mangers in participatory skills. receiving incentives. Among Kenyan respondents. poor housing and the absence of basic amenities such as water and electricity were considered to negatively affect work performance 22. i. understanding and involvement). receiving financial benefits from user fees. working within a team spirit. A study conducted to assess the role of non-financial incentives and human resource management tools on health worker motivation in Africa showed health workers in Benin strongly referred to vocation and professional conscience. and supportive supervision by a multidisciplinary team of professionals 20. living near the ÿ . healing patients. appreciation. Both dimensions ± values and goals ± indicate a strong professional ethos and commitment and strongly appear to translate into the "will-do" component of the motivation process. supervisors. training of the health workers.e. The motivating factors include: feeling responsible. In addition. including lack of supervision and continuous education. One major demotivating factor mentioned by all cadres of health workers was monetary. These aspects nurture health workers' goals.available for the work leading to motivation). Other demotivating factors mentioned were lack of proper assistance from the Ministry of Health and poor human resource management practices. the wish to help patients and professional satisfaction were frequently mentioned 21. Also. having your partner. A study on the match between motivation and performance management of health sector workers in Mali on 370 health workers identified motivating and demotivating factors. They were specifically motivated to remain in the districts because of the lower cost of living. coupled with a spirit of patriotism. salary increment. political and policy environment (creation of supportive structure). receiving recognition. receiving training. receiving promotion. Likewise. their personal professional values. community factors (acceptance. professional satisfaction and recognition were considered important. holding responsibility. A study on retention of health workers in Malawi indicated that health workers were encouraged to take jobs as health professionals within the districts because of the opportunity and ability to assist mankind. vocation was equally very dominant. the significant impact they made within the communities they served and the fact that they learnt faster on their jobs in the districts compared to their other colleagues in the urban areas. the strength of the governing structures linking the community with the health system.

and pay and benefits are factors that can motivate or demotivate health workers. in the above literature. it can be concluded that incentives and disincentives or motivating and demotivating factors are mostly similar for different categories of health workers though majority of motivational studies are qualitative. Overall. Ecuador and Pakistan identified different factors that influence healthcare utilization. Studies in Uganda. either because they fail to fulfill his or her needs and values or because they do not meet his or her expectations. These factors can be categorized under work-itself. poor management. human and social resources were reported as determinants of health care service use 26. co-workers. acceptability and affordability of services. workload. local illness and treatment perceptions. working conditions. private or public-private facilities 25. The studies indicated that service acceptability depended on the health worker attitudes and practices. management. perceived gender discrimination. Availability. 27. and there is a clear understanding that improving management. organizational structure. living far away from an urban centre and living far away from places where decisions are being made 23. subjective performance appraisal.workplace. and payment and benefits 24. promotion opportunities. organizational structure. Fear and stigma were also identified as barriers in the health seeking process. Other noteworthy points emerged from this literature is that a person can be relatively satisfied with some aspect of his or her job and dissatisfied with others. u . work load. partner living far away. and having good colleagues. difficult living conditions. î î "  !# Health Service Utilization denotes an individual demand and use of health care resources and services and indicates the way‘ customers (patients) interaction with health care providers. poor functioning of the health committee. Factors that de-motivate health workers include: lack of material. 28. Health care‘service utilizations are provided by public. adequacy. lack of recognition. Therefore health service utilization (utilization of‘health care services) is a proxy of health status of a population and use of health care services. working conditions. promotion. lack of a job description. and ownership of material.

A study on Utilisation of Health Care in North Bengal. have a tendency to utilise care more 30. For example. the result indicates that as compared to the people of the rural areas. India indicated that demographic factors like age and family size have been important determinants of utilization of care. However. urban dwellers are likely to avoid utilizing a care from modern source. physical resources and free public health services. However.In Uganda barriers to healthcare utilization were reported for all the wealth categories (poor. social resources were perceived as important in overcoming some of the existing barriers 25. The poorest' wealth category were keen to utilize public health services which are provided free of charge. The demand for public health facilities is tremendously high as compared to that of private health facilities in rural areas of the districts. higher doctor concentration was significantly associated with greater use of measles immunization and higher nurse concentration was associated with greater use of skilled birth attendants. Cost of treatment seems to affect utilisation of care positively. A study conducted focusing on developing countries revealed that utilization of health service can be influenced by the type and mix of health professional working in the health care facilities. Income source. health services delivery. Availability of health facilities is seen to have negative impact towards utilisation of a care. the lack of these was a barrier for the poorest wealth category. and rich) along three different axes (the health seeking process. medium. ownership of means of transport. those households whose heads make frequent trips. The question of financing of × . and health literacy were reported as centrally useful in facilitating use of healthcare utilization for the 'least poor' and 'medium' wealth categories. The regression analyses indicate that children in the 5-14 age groups are by and large neglected. and the ownership of livelihood assets) regardless of wealth category. Probability of utilisation is seen higher in small families. Probability of utilisation is very high in rural areas when the preference for the system of medicine is Homeopathy. As of µnormal out-of-door trips¶. The effect is too strong to hold well in the area as a whole (combined category) also. This study suggests that in addition to income. The underlying assumption was that in the urban areas health facilities are available. Aggregate health worker concentration was positively and significantly associated with use of skilled birth attendants and measles immunization 29.

The overwhelming majority of women interviewed (31 out of 37. after the introduction of cost sharing reduction of service utilization amounts to 21.2%). cost (3. and insurance system also affect utilization of health care 32 services . and language (1. knowledge and attitude of people and demographic factors that are affecting the use of CHC facilities at the THC level and information about the children under 5 years of age. only 19 (61%) of them delivered in health facilities. drawing attention 30.seeking behaviors and perceptions using an analytic induction approach. Nicaragua was conducted to investigate women¶s maternal health care. It was found in the study that higher level of knowledge of the respondents about the CHC service provision of the use of the THC increases the use of THC 34.3%).e. A qualitative study on utilization of maternal health care services in the department of Matagalpa. The study focuses on socio-economic factors. providers' attitudes (17.9%).3% for all cases and 12% for malaria cases 31. or 84%) reported seeking prenatal care at health facilities.6%)) at the Keraniganj. A study on determinants of health care utilization by immigrants in Portugal.2%). The percentage of vaccinated children (97% approximately) among sample population was found close to that of the recorded percentage (98..health care is. length of stay. More than 10 years of school education or being born in Eastern European or South American countries were significantly associated with a lower probability of using health services. In Bangladesh. distance and transportation (2. legal status and economic situation as positively associated with the use of health services. Cost sharing overall reduces utilization of services i. both for males and females33. Family income and mother`s education was found to have positive effect on the rate of child vaccination. in Lisbon indicated that barriers to appropriate and timely access were identified as waiting times (50. The study identified different factors that affect for utilization of maternal health care services 35 : . Though 31 women reported they accessed prenatal care services.4%). The logistic regression analysis allowed the identification of age. therefore. a cross-sectional study was conducted to investigate the pattern of utilization of child health care services provided by the Thana Health Complex (THC) of Keraniganj and to identify the factors that are affecting the use of Child Health care (CHC) services.

  

  
 

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1. 3. 4) were significantly related to utilization of modern health institutions. Over the two weeks period preceding the survey. Secondary education or above (OR =2. The most important reasons were believed that the disease did not need treatment in health institutions (31.'  A study conducted on health service utilization in Amhara Region of Ethiopia in 1998 showed 59% of the people who died in a period of 12 months preceding the survey were taken to health institutions for the disease.3%) did not visit health institutions for their perceived sickness.2) and visited traditional healers (20. 995 (5. From the above literature on service utilization we can conclude that   .7%) while the rest 610 (61. bought drugs from drug vendors (27.7%). which killed them while the rest 41% did not visit health institutions.9%).6%) people claimed that they were sick.2. 95%CI 1. The number of sick people who visited health institutions for treatment was 385 (38.2%).1%) and the deceased would not benefit from the services of modern health institutions (31. The two most frequent reasons for not taking patients who died for the disease was fast course of the disease (34.36.

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training and conduct of workers towards the client). (professional mix.   .

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(  )  such as family characteristics (age, gender, household size, marital
status), social structure (education, employment, ethnicity), assets / affordability (land, livestock,
cash income), and perceptions about modern health care services;   

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 such as
availability of health facilities, accessibility to health care, quality of care, and costs; and   

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They achieve these goals by serving as the bridge between clients in need and needed health care and human services 37.33-36.  $intensity of illness and number of spells ) can affect utilisation of health care services 26-29.  î % &  !# Community health workers (CHWs) improve access to and increase utilization of primary health care. c . 38. and reduce health disparities. improve quality of care. reduce costs of care.31.

These programs could also be tied to national service programs and high school enrichment programs. in of areas as nutrition.In the United States of America. and by making broader social contributions. specialist health roles. improving the health environment. and diagnosis and/or treatment of diseases such as pneumonia and TB. and the reduced role of CHWs in national health care systems. It was believed that universal health coverage could be achieved through implementation of health extension program 41. Evidence suggests that these workers have increased coverage of a range of services over the last 30 years 40 . supporting health programs such as EPI. allowing young people exposure to health careers. not just in the field of health. improving the quality of care. There is generally a clear consensus that in many aspects of health care. CHW programs can also assist health profession schools in better preparing their graduates for the realities of practice 38. and that they are trained. and wider roles as community advocates and change agents. In many Africa countries CHWs have fulfilled generalist health functions. the bridging activities of CHWs may provide opportunities to increase both the effectiveness of curative and preventive services and. perhaps cc . CHW programs can enable low-skilled unemployed workers and welfare recipients to pursue a new occupation and career advancement. the inattention to primary health care. reducing the costs of care. the CHW combines service function and developmental/promotional function that are also ideally. and malaria control. And also the key to successful community-based programs may lie in the effective training and continuing education of its CHWs and their acceptance by the community. that more CHWs are needed. 39. Yet the effectiveness of CHW programs on the continent has often been constrained by a lack of government support. CHWs have a vital role in the achievement of MDGs relating to health. particularly during political transition. The types of tasks where CHWs have been successful include (but are not limited to) communication within communities. community health workers contributed to the delivery of primary and preventive care by increasing access to health care. perhaps the most important developmental or promotional role of the CHW is to act as a bridge between the community and the formal health services in all aspects of health development. reproductive health. Ideally.

05) 44.7% to 29. namely knowledge on the management of child fever (p = < 0.9%) had received a visit the month before the survey (April. Ghana and Niger are some of examples of countries that introduce CHWs as part of health sector reform initiatives aiming to enhance accessibility and affordability of health services to rural and poor communities with in a PHC approach 43. CHWs may be the only feasible and acceptable link between the health sector and the community that can be developed to meet the goal of improved health in the near term 42.6%) had received at least one visit in the last three months prior to the study period and of these 162 (73. 40% mentioned to have treated fever with the correct regimen.3%. When compared on knowledge and practice.001). 219 (54. intervention October 2004 to October 2006 and the post-intervention assessment in November 2006. The proportion of women who were assisted by traditional birth attendants (TBAs) decreased from 35. showed a significant improvement in the utilization of a skilled attendance with variation across the villages. as part of health sector reform processes. Deliveries with skilled attendants significantly increased from 34.9% while those assisted with relatives went down from 30. As available literatures indicate community health worker programs have come about as a result of dramatic political transformation. as the initiative of NGO and faith based organizations. A study done to assess the performance of CHWs in the promotion of basic child heath services in rural Mali indicated that of the 401 households suppose to receive a visit by a CHW. which was implemented in three phases: situational analysis June 2004. A community-based intervention study was conducted using a pre-post comparison of the same group.more importantly.7%). Some of the observed positive effects during the course of the study as expressed by cî .001) of bed net and. Regarding knowledge of the child caregiver on home management of child illness.1% to 51. community management and owner ship of health related program. A high percentage of households had iodized salt (98.2% to 17.05).4% in 2006 (r < 0. a positive influence of CHWs on specific essential family health practices by the households was found. utilization of iodized salt (p = 0. 2006). Seventy-nine percent of the visited households had a bed net. use (p = < 0. Comparison between households with and without CHWs showed no statistically significant difference concerning sociodemographic characteristics.

small and inexpensive changes that motivated changing traditional ways. Computing each of these measures is data intensive and also requires careful effort in documentation and analysis over a period of time. an outcome evaluation was conducted to investigate the long-term impact community intervention activities on maternal and child health and identified reduced incidence of illness and improved physical health in families of those villagers who made behavioral and environment changes to improve their health. Changes in one community have influenced nearby communities because they see the benefits to family health in their neighbours 47. Individuals reported experiencing benefits from simple. In Papua New Guinea.community leaders. SMPs and pregnant women and TBAs. the degree of trust and confidence of the community members that CHWs have gained over a period of time is important in sustaining the motivation of CHWs to function with commitment and effectiveness 46. assessment of the training of the first intake of health extension workers . In the literature review. reduction in the wastage of resources. and working conditions of health extension workers in Ethiopia 50 did not assess the motivation of health workers. increased involvement of religious leaders in community health activities. increase in the utilization of services provided by them. cJ . Often performance is measured in terms of improvement in health status of the population that CHWs serve. health providers. The retention of health extension workers and the outcome of the health extension program are yet to be evaluated 20. Positive benefits from these changes have resulted in people accepting a more hygienic environment and improved sanitation practices as the social norm. and the intervention has built linkages between health providers. continuing education and reference materials 49 48 . the presence and accessibility of CHWs to the community members. utilization and impact of the health extension program. safe motherhood promoters (SMPs) and villagers during monitoring and in the final assessment were the following 45 : improved involvement of community leaders at sub-village level in promoting safe motherhood. However. it was very difficult to get published researches on health extension program and health extension workers and those researches done on health extension program related issues such as health extension workers access to information.

% '() ) (* Health service extension program is an innovative approach which is encompassed under the Health Sector Development Program to meet the millennium Development Goals (MDGs).             c . Therefore the findings of this study will have a substantial contribution in maximizing utilization of health service. While the program is innovative and is supposed to bring better health status of population especially in peripheral areas. improving healthy practice. studies done concerning program are rare. utilization of health extension program (HEP) by the community and outcome of health extension program. It will also give insight for health care planners and policy makers whether the policy change is required or not. This study will be conducted with the aim of assessing motivation of health extension workers (HEWs). and enhancing motivation of HEWs and overall reduction of morbidity and mortality.

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Amhara National Regional State. (   c .   î (/&&-. Ethiopia.&(  l‘ To assess the motivation of Health Extension Workers‘‘.& The general objective of this dissertation is to assess the Implementation of Health Extension Program (HEP) in West Gojjam Zone.-.

 l‘ To assess the utilization of Health Extension Program by the community‘‘.

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 l‘ To assess the outcome of being graduated households/kebeles on maternal and child health. family planning and immunization‘‘.

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                    cº .

(2000): An Indepth Analysis of Individual Determinants and Outcomes of Health Worker Motivation in Two Jordanian Hospitals14. and a conceptual framework used in the research done by Amlan Majumder (2006): Utilisation of Health Care in North Bengal: A Study of Health Seeking Patterns in an Interdisciplinary Framework30. Milburn L.      cÿ . Qarrain Reem. This conceptual framework is the modification of conceptual framework used in the research done by Franco M. Kanfer R... Utilization of HEP by the Community and Outcome of HEP.º   ! )  0 Figure 1: Conceptual Framework for Motivation of HEWs.. and Stubblebine P..

324 females) according to 2007 CSA survey 51.401 rural and 129 urban health extension workers) and there are 782 health extension workers (772 rural and 10 urban health extension workers) in the Wesst Gojjam zone working in all districts and kebeles of the zone. West Gojjam Zone.580. 1 special zone and 1 special district. the Oromia Region in the South and the Benshagul Gumuz Region and Sudan in the West. ÿ î ( # ‘ ‘  ‘  ‘ ‘ . 397 kebeles (364 rural kebeles and 33 urban kebeles) with a total population of 2. In the region. The zone has 18 districts (13 rural districts and 5 urban district administrations).466 kebeles (3.048.396 females) according to 2007 CSA survey 51.610).157 rural kebeles and 309 urban kebeles) with a total population of 17.530 health extension workers (6. on the South by Abay River which separates it from Oromia Region.976 (8.069.106.ÿ  .641. is one of the 10 zones of Amhara National Regional State and is bordered on the North by Lake Tana. The region has 166 districts (128 rural districts and 38 urban district administrations). the Afar Region in the East. on the Northwest by North Gondar Zone.221.*  ÿ c (    Amhara National Regional State (ANRS) is one of the eleven regions of the country and is administratively divided into 10 zones. The coverage of graduate heads of households is 57% (2. on the Northeast by Bahir Dar and Abay River which separates it from South Gondar Zone. on the East by East Gojjam and on the West by Agew Awi Zone. there are 6.596 (1.914) for Amhara Region and West Gojjam zone respectively 52.580 males and 8. 32% (150. 3.‘  The study area. It is borderd by the Tigray Region in the North.058.272 males and 1.

cu .· Across-sectional study design will be employed in which health extension workers will be interviewed using structured questionnaire to assess motivation of Health Extension Workers.

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· A community based cross-sectional study design will be used to collect data for assessment of utilization of HEP services/packages by the community. ‘ .

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and {‘ Outcome of health extension program on maternal and child health. ‘ ÿ % (&!/ ( !/ The source population for assessment of: {‘ Motivation of health extension workers will be all health extension workers who are currently working in West Gojjam Zone. and District Health Offices and HEWs. family planning and immunization will be all households in West Gojjam Zone.· A multi-methods approach to collecting qualitative and quantitative data will be employedto assess outcome of being graduated households on maternal and child health. For quantitative data. family planning and immunization. in which graduated households will be compared with non-graduated households in terms of maternal health. c× . family planning and immunization will be heads of households from randomly selected kebeles. {‘ Assessing health service utilization of Health Service Extension Program by the community will be heads of households from selected kebeles. The study population for: {‘ Measuring motivation of health extension workers will be all health extension workers in each selected kebeles of West Gojjam Zone. Officials of Regional Health Bureau. Qualitative data will be collected through in-depth interviews. retrospective cohort studydesign will be used. Zonal Health Department. {‘ Assessing the outcome of Health Services Extension Program on maternal and child health. family planning and immunization services. {‘ Utilization of health service extension program by the community will be all households in West Gojjam Zone. and focus groups discussion.

50) (0.50) (0. and 50% of HEWs may be satisfied. nf = sample size after correction. p = proportion of community HEP services utilization. and 50% utilization of HEP by the community. p = proportion of HEWs who may be satisfied.50) = 384 (0. the final sample size will be 256 + 26 = î î HEWs. n = sample size. and d = assumed marginal error (5%) n = (1. n = sample size. The assumption in the calculation of the sample size is 95% confidence interval (CI). a design effect of 3 is needed.05)2 Since the total number of HEWs in West Gojjam Zone is less than 10. The assumption in the calculation of the sample size is 95% confidence interval (CI). n = ZĮ 2 p (1-p) d2 Where. the correction formula nf = ______n______ is used. n = ZĮ 2 p (1-p) d2 Where. N = total HEWs nf = ____384_______ = 256 HEWs 1+ 384/772 Ten percent non-response rate = 10% x 256 = 26 HEWs Therefore. ca .000.96)2 (0. 1+ n/N Where.50) = 384 HEWs (0.ÿ  (/(" The number of health extension workers to be included in the study for measuring their motivation will be determined using single population proportion formula. marginal error (d) of 5 %. marginal error (d) of 5 %.05)2 In this case.  !/·The number of heads of households to assess the utilization of HEP services/packages by the community to be included in the study will be determined using single population proportion formula.96)2 (0. n = 3 x 384 = 1152 heads of households. and d = assumed marginal error (5%) n = (1.

Therefore. family planning and immunization. 3 from Zonal Health Department. n = 3 x 407 = 1221 heads of households. For focus group discussions. the final sample size will be 1152 + 116 = cîÿ heads of households. a total of îÿ households/ heads of households. 12 from District Health Offices) and î HEWs will be included in the study. Therefore. aº& &$c2 13 4 = the chance of not detecting the relative risk (Type II error) i. the number of heads of households to be included in the study will be determined using "  ‘ ‘ ‘  ‘  ‘ ‘ ‘  ‘  ‘   ‘  ‘  ‘ ‘   ‘!‘  " ‘ 1 = the level of significance (Type I error) i.20 The software produces an output of sample size  for unexposed (non graduated households) and sample size of  for exposed (graduated households). individuas from the community which will consist of 8-12 individuals will be included. !/ · To assess the outcome of HEP on maternal and child health.e. a design effect of 3 is needed.   î . c health officials and program coordinators (3 from Regional Health Bureau. /5$c243 !c = º of immunization coverage for participants in non-graduated households !î = ÿ of immunization coverage in graduated house hold  = unexposed: exposed = c·c  (RR) = 1. In addition.e.. Ten percent non-response rate = 10% x 1221 = 123 heads of households.Ten percent non-response rate = 10% x 1152 = 116 heads of households. In this case. the final sample size will be 1221 + 123 = c% for unexposed (non graduated households) and sample size of c% for exposed (graduated households) i..e.. for in-depth interviewing.

1344 graduated households and 1344 non-graduated households) will be selected using simple random sampling technique from each selected kebele proportional to the number of the households of each kebele.ÿ º (/#!&  The sampling technique for all the three papers will be multistage sampling with simpe random sampling. In this case. Six districts will be randomly selected among the 13 rural districts of West Gojjam Zone. the sampling procedure again will start with random selection of districts in the zone.. All (282) HEWs in 141 kebeles of those 6 districts will be included in the study. For utilization of HEP by the community and outcome of HEP on the community. îc . The study participants for assessment of utilization (1268 households) and outcome of HEP (2688 households i. The sampling procedure for assessment of motivation of health extension workers will start with random selection of districts in the zone. 6 districts will be randomly selected and from these 6 districts 141 kebeles will be selected.e.

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an interview-administered face-to-face questionnaire consisting mainly of close-ended questions will be applied. and then self-administered. In this cohort. Quantitative data for assessment of the outcome of HEP will be collected through administering structured questionnaire to mothers or heads of households.. Sessions at the five study districts will be run by data collection facilitator. six health extension workers). the HEP outcomes of 1344 graduated households will be compared with 1344 non-graduated households. îJ .ÿ ÿ  &!&  Individual HEWs questionnaire data will be collected during group sessions where health extention workers hold monthly meeting at common place (usually one common site for three kebeles i. in collaboration with district health office manager or district health extension supervisor (if available). It will take approximately half an hour to complete the questionnaire. Participation in the study will be voluntary. family planning (family planning users versus non-users) and maternal and child health (institutional deliveries versus home deliveries. and vitamin A supplementation versus no -supplementation). In this study.e. Amhara National Regional State. Data collectors and supervisors will be diploma and degree holder health professionals respectively and will be trained for two days by the principal investigator. Of these households. a cohort of households who were given health extension program services between 2007 and 2010 will be selected from district health office reports/documents at six districts of West Gojjam Zone. A retrospective cohort design will be used to examine the hypothesis that graduated households have better HEP outcome in terms of immunization (fully immunized versus non-fully immunized).The relationship between Health Extension Program outcomes and being graduated (exposed) and non-graduated households is a critical issue since it has been given emphasis by the Ministry of Health. Completing the Individual HEWs questionnaire will take about 40 minutes. The questionnaire will be introduced by data collection facilitator. For utilization of HEP by the community. Trained interviewers who are trained for this purpose will administer the questionnaire. 2688 households which will meet the selection criteria will be selected for the study.

the data quality will be kept by using a structured questionnaire that has been applied in other areas. double data entry will be used to see whether there is any inconsistency of data and to avoid any problem through the data entry processes. Five percent of questionnaire will be checked every day by the supervisors and finally by principal investigator for its completence and consistency. who are responsible for implementation of HEP. performing a daily check-up of the questionnaires filled by data collectors and by double entry. During data collection. the structured questionnaire will be pre-tested two weeks before the study period in kebeles which will not be included again in the actual study. and by conducting focus group discussions with community. Zonal Health Department. for qualitty purpose. The pre-test will be done on about 5% of the study participants and the questionnaire will be assessed for its completeness. and HEWs.Qualitative date for assessment of HEP outcomes will be collected by in-depth interviewing officials of Regional Health Bureau. There will be strict supervision by the principal investigator and supervisors. After data collection. and District Health Offices.   î . clarity and length. Incomplete or incorrectly filled questionnaires will be given to the data collectors so that they could correct it by revisiting the respondent. ÿ  6 Before data collection.

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and human resources management.personality factors related to work7 personality factors related to emotions. Organizational culture.  Resources. andorganizational/task characteristics.‘ Motivation Age and sex. Community expectations. peer pressure.andindividual differences. and societal values ‘. processes. values/work ethic . of HEWs Expectations.

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and perceptions about modern health care services. quality and preference of health care facilities/health posts ‘. Availability. marital status. of HEP religion. employment. education. household size. Type and severity of illness. gender.‘ Utilization Age. affordability. HEWs` Training and conduct towards the community. accessibility. income.

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Utilization of HEP. religion. household size. The analysis will be divided into two stages: a descriptive analysis of the socio-economic characteristics of study participants. and coded into computer using EPI Info 2002 and will be analyzed using SPSS 17. and perceptions about modern health care services  ÿ a # (&  Quantitative data will be entered. utilization of health extension program by the community and outcome of health extension program in terms of maternal and child health. employment. Age. family planning and immunization. For observational studies like this PhD project. gender. cleaned. income. and multivariate analyses for identifying factors associated to motivation of health extension workers. îº . education. multivariate analysis is advantageous.‘ Outcome of HEP Motivation of HEWs. edited. where total control is never possible. marital status. Multivariate analysis examines interactions and relations between a large number of determinants and the esponse variable simultaneously.

e. and socio-economic factors interact with extraneous influences in causing an outcome. The analysis of qualitative data will be based on an inductive approach geared to identifying patterns in the data by means of thematic codes i. For paper III logistic regression method will be employed to describe how many times more likely the outcome of HEP in graduated households compared to non-graduated households is in terms of maternal and child health. The basic level of analysis i. multiple regression models will be used.. The grounded theory method will be employed in this study. the next step will be coding the data in the transcripts. The regression equation acts as a compact summary of a complex state of affairs. The actual data analysis process will be classified into two levels.For paper I and II.. themes. demonstrates how those themes emerged and generates a theory grounded in the data53. which will involve the comprehension of the themes (or perspectives). The complete transcript should then be compared with the handwritten notes taken by the note-taker to fill in the gaps. In the analysis. Another advantage of multiple regression analysis is that by taking into account simultaneously several explanatory variables it helps to correct for any possible confounding. and secondly. and categories of analysis come from the data.e. and regression modeling of data will help provide an insight into a compex situation with this it is possiple to predict the outcomes. a descriptive account of the data: explanation of what is said and no assumption is made. creates links between the themes. Once the transcribing is done. the language in which the analysis will be taken place. the discussion and interview that are recorded in Amharic will be translated to English. verbatim transcript of the entire focus group discussion and in-depth interview will be produced first. immunization and family planning.  îÿ . The second level of analysis is interpretative. In assessment of motivation of HEWs and utilization of HEP by the community a variety of factors like demograghics. A grounded theory is one that is inductively derived from the study of the phenomenon it represents. Open Code software will be employed for coding data to categories and for analyzing qualitative data. which involves sorting the data and assigning them to categories.

In this manner it is hoped that the community can be educated so that health problems of the community can be alleviated and study participants may benefit personally by being able to given emphasis by higher officials (for HEWs) and by having improved health service strategies (for the community). they will be advised to visit the nearest health institution. explaining why it will be done. information sheets in Amharic about the study will be given out. University of Gondar. If participants and/or their family are in need of any medical care. In the household survey.         îu . The West Gojjam Zone Health Department and the selected Districts Health Offices will be communicated through formal letter obtained from the Regional Health Bureau. During field work. Results of the research will be communicated to government offices and most importantly to the study subjects and members of the community through the primary care assistant technicians at there local level.ÿ c  &   Ethical approval will be obtained from university of Gondar Ethical Review Board of School of Public Health. College of Medicine and Health Sciences. and what it will involve. The right of the respondent to withdraw from the interview or not to participate will be respected. written and verbal consent of all study participants will be sought. Privacy of study participants during data collection time and confidentiality of their information to all study participants will be assured. A written consent will be requested from Amhara National Regional State Health Bureau. by whom.

2009 Confirmation of advisor and supervisor &&5 Research thesis proposal preparation ‘.  0! ) (* *c October. 2009 Enrolment October-November.

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Assessment of Motivation of HEWs ‘.

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‘Assessment of Outcome of HEP on Maternal and Child Health. Family Planning and Immunization Research thesis proposal defence ‘.

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July. 2011 August. University of Gondar Data collection .August. 2010 Submission of research thesis proposal for consideration by School of Public Health. 2012 September . 2012 November. 2012 June . 2011 April . 2011 October . 2010 June. 2010 July .October. 2011 March. University of Gondar Working on research proposal and incorporating comments *î 5& September ± October.‘. 2011 March.May. 2010 February. 2010 June . 2012 December. 2012 December.August.December.December. 2011 July .May . 2010 November . January . 2012  Obtaining ethical clearance from School of Public Health.

‘.‘ Submission of Research Plan for the next 12 months Submission of research progress report.

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Data Collection .‘.

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‘. Submission of research progress report.

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‘ Submission of Research Plan for the next 12 months Manuscript Preparation for publication‘‘‘.

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Submission of research progress report.‘.

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Finalization .‘.

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* Synthesis of the dissertation papers (Paper I. II. and III) Identification of examiners Submission of thesis for examination Final dissertation defence î× .

128 **#.200 1.000 4.400 2.000 100 200 450 200 450 180 360 *+#/-‘ (‘ 12.000 ‘‘‘‘*#‘ (‘ 2.600 9.600 19..‘ š ‘ Paper 25 rims Toner 8 pieces Flash Disk 8 pieces(4 GB) CD-R 25 pieces CD-W 20 pieces Binder/folder 15 pieces Stapler 5 pieces Notebook 15 pieces Pen 45 pieces Binding 36 bindings ‘ )    ‘ š ‘ Refreshments For 6 districts ‘ ) ‘ ' ‘ &   ‘*1‘ 2 ‘' ‘ îa Total Cost & ‘ 100 100 100 80 80 80 80 80 80 00 00 00 00 00 00 00 00 00 (‘ & ‘ 4.920 1.000 7..608 16.000 8.000 4.‘ 00 00 00 00 00 00 00 00 00 00 00 00 00 ‘ & ‘ 00 00 ‘ & ‘ 00 00 00 00 00 00 00 00 00 00 ‘ & ‘ 00 ‘ ‘ .000 6.692 7.‘ *0#-.800 4.-‘ (‘ 00 00 00 00 00 00 00 00 00 ‘ & ‘ Paper I Paper II Paper III Paper I Paper II Paper III Paper I Paper II Paper III 8.600 9.‘ All Papers Paper I Paper II Paper III Paper I Paper II Paper III Paper I Paper II Paper III Paper I Paper II Paper III $%‘ $%‘ All Papers $%‘ All Papers $%‘ All papers . () !'  Cost Category Unit Cost (‘  ‘ & ‘  ‘ š ‘ '  ‘ Principal Investigator 1 PI for 4 days for 6 districts 1 PI for 4 days for 6 district 1 PI for 4 days for 6 districts Supervisors 6 supervisors for 2 days 6 supervisors for 2 days 6 supervisors for 2 days Data Collectors 12 data collectors for 2 days 12 data collectors for 2 days 12 data collectors for 2 days ‘ )   ‘& ‘ ‘ ‘ š ‘ &  ‘ Advisors 2 advisors Principal Investigator 1 PI for 60 days 1 PI for 60 days 1 PI for 70 days Supervisors 6 supervisors for 10 days 6 supervisors for 10 days 6 supervisors for 20 days Data Collectors 12 data collectors for 10 days 12 data collectors for 10 days 12 data collectors for 20 days Data Clerks 282 questionnaires 1268 questionnaires 2688 questionnaires ‘ )  '  ‘ š ‘ Advisors 3 advisors Investigator 1 investigator ‘ ) ‘ "  .400 960 960 960 1.000 6.400 2.000 *#‘ *0-#.‘ */#.800 9.000 500 4 10 30 40 30 4 10 ‘ & ‘ 00 00 00 00 00 00 00 00 00 00 (‘ ‘ ‘ & ‘ ‘ ‘ ‘ ‘ ‘ Unit Cost (‘ Total Cost & ‘ $%‘ 2.000 15.‘ (‘ 6.920 1.‘ .000 100 100 100 80 80 80 80 80 80 6 6 6 00 00 00 00 00 00 00 00 00 00 00 00 00 (‘ & ‘ ‘ (‘ 80 1.920 *+#.

moh. 2005. Ruth Kanfer. Public Sector Health Worker Motivation and Health Sector Reform: A Conceptual Framework.A. July.‘ FMOH (2007). Partnerships for Health Reform.‘ Ruth Kanfer (1999).20 12. Partnerships for Health Reform. Abt Associates Inc.‘ Center for National Health Development in Ethiopia. 2009 6. Partnerships for Health Reform. A. 3.‘ FMOH. 1993.. Health Extension program implementations guide line. September 2000 15.‘ 2009 World Population data Sheet.et/index.‘ Federal Ministry of Health of Ethiopia (2005) Essential Health Services Package for Ethiopia. and Marie Tien. and Patrick Stubblebine (2000).gov. Federal Ministry of Health. January 1999 13.‘ Karabi Bhattacharyya.1371/journal.‘ Teklehaimanot A. June 2007 7. Measuring Health Worker Motivation in Developing Countries. Ethiopia.org 2. Lynne Miller Franco (1999). www.Ethiopia. Abt Associates Inc. Major Applied Research 5. Working Paper 1. (HSDP-III).‘ FMOH: Health policy of the Transitional Government of Ethiopia September. Draft. Health Sector Strategic plan. An In-depth Analysis of Individual Determinants and Outcomes of Health Worker Motivation in Two Jordanian Hospitals.. Addis Ababa. Reem Qarrain. Major Applied Research 5. 2004. Abt Associates Inc. Ministry of Health. 5.May.a  )   ( 1.A. January 1999 14. Ethiopia. Addis Ababa. 11. 4. Health Extension and Education Center. et al: Study of Working Conditions of Health Extension Workers in Ethiopia. Health Extension Program in Ethiopia Profile.2009) November. Lindtjorn B (2009) Health Extension Workers Improve Tuberculosis Case Detectionand Treatment Success in Southern Ethiopia: A community Randomized Trial. doi: 10.2006 9. (2005. Peter Winch.000543.phone. PLoS ONE 4(5): e5443. Population Reference Bureau.‘ Miller Franco Lynne. 8. .Assessment of working condition of the 1st batch of health extension worker .php?option=com_content&view=article&id=166&Itemid=315 accessed on October 7th. Working Paper 8. Working Paper 1. A. Major Applied Research 5. 2005.‘ Federal Ministry of Health.‘ Datiko DG. 10.. Karen LeBan.‘ Federal Democratic Republic of Ethiopia Ministry of Health: Accelerated Expansion of Primary Health care coverage in Ethiopia.‘ Federal Democratic Republic of Ethiopia Ministry of Health http://www. Planning and Programming Department.prb. Lonna Milburn.‘ Sara Bennett. Ethiopian Journal of Health Development.: The Earth Institute of Columbia University . 2006.

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16. Virginia. . Published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency International Development. October 2001.‘ Rubin Pillay (2009) Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors   /. Arlington.      .

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   2009.1186/1478-4491-7-15 17. Lucy Gilson.‘ Patrick Mbindyo. +$  . 7:15 doi: 10. Duane Blaau and Mike English(2009). Contextual influences on health worker motivation in district hospitals in Kenya.

Laura Wyness. East African Journal of Public Health Volume 5 Number 1 April 2008 19. 8:247 doi:10.‘ Melkidezek T.Mbembati (2008).    2009. Motivation and retention of health workers in developing countries: a systematic review0-  /2008.1186/1748-5908-4-43 18. M.Muhondwa1. Motivation of Healthcare Workers in Tanzania: A Case Study of Muhimbili National Hospital. Leshabari.‘ Mischa Willis-Shattuck. Posy Bidwell.Y.A. 4:43 doi:10. Duane Blaauw and Prudence Ditlopo (2008). Eustace P.A.Mwangu. Naboth A.1186/1472-6963-8-247‘ J . Steve Thomas.

20. submitted to the Ministry of Health by Tropical Institute of Community Health and Development (TICH) in Africa. Strengthening Community Based Kenya Essential care package for Health (CBKEPH) at the Community level.  /. March 2006 21.‘ TICH (2006). Health worker motivation in Africa: the role of nonfinancial incentives and human resource management tools.‘ Inke Mathauer and Ingo Imhoff (2006).

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1186/1478-4491-4-24 22. /.‘ Ogenna Manafa. 4:24 doi:10. Retention of health workers in Malawi: perspectives of health workers and district management. Fresier Maseko. Cameron Bowie. Malcolm MacLachlan and Charles Normand (2009). 2006. Eilish McAuliffe.

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Hamadassalia Touré and Tim Martineau3(2006). Jurrien Toonen. The match between motivation and performance management of health sector workers in Mali. 2009. :65 doi:10.   /.1186/1478 4491-7-65 23.‘ Marjolein Dieleman.

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1186/1478-4491-4-2 24. No. 5.. Moteghedi 1(2009. Eastern Mediterranean Health Journal. 15.. Kebriaei 1 and M. Sarah P. (2009): Community perceptions and factors influencing utilization of health services in Uganda.Job satisfaction among community health workers in Zahedan District. Vol. Sandro G. 3(3): 3008-3024. 2006. Inflation. Islamic Republic of Iran. Bourne (2009).. Australian Journal of Basic and Applied Sciences.‘ Solome K. and George W. 4:2 doi:10.‘ Paul A. 2009 25. 2009 26. Stefan P. Andrew S.. Public Health Care and Utilization in Jamaica.‘ A. +   .S.

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2   2009.  /. 49±54 29. No. Understanding the context of health care utilization in Ecuador: A multilevel analysis (Unpublished).‘ Daniel F López-Cevallos. Department of Public Health. Are doctors and nurses associated with coverage of essential health services in developing countries? A crosssectional study. +1 541 737 4001. 254 Waldo Hall. 1. Journal of Public Health Advance Access Publication 8 December 2004. Corvallis. 27.orst.1186/1475-9276-8-25 27. 8:25 doi:10.Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. +1 541 908 0267. Oregon State University. VoI. Fax. Tel. E-mail: lopezced@onid. OR 97331. pp.‘ Margaret E Kruk. Marta R Prescott.edu 28.‘ Babar T. Shaikh and Juanita Hatcher(2004. Helen de Pinho and Sandro Galea (2009).

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Social Science & Medicine 64 (2007) 199±212 33. Eddy Van Doorslaer. health staff incentives. ISSN 1992-1462 35..  . Gilbert Burnham. 79 (11) 32.M. Health Service Utilization in Amhara Region of Ethiopia. Tin. 2008. and service utilization in Kabarole District. (2008): Determinants of health care utilization by immigrants in Portugal. Stephenson RB (2008). 2001. 36. Utilization of maternal health care services in the department of Matagalpa. Soonman Kwon.Bulletin of the World Health Organization.‘ Walter Kipp.. Lu. 8:207 34. Soc. 1186/1478-4491-7-27 30.‘ Farazi Binti ferdous and A. Asian Journal of Epidemiology. Uganda.K. and Getu Degu (2003). Rev Panam Salud Publica. 13(1): 43-51 (2006) 31. Zafrul Azam (2009).‘ Amlan Majumder(2006): Utilisation of Health Care in North Bengal: A Study of Health Seeking Patterns in an Interdisciplinary Framework. User fees. :27 doi: 10.. Gabriel M. Keith Y.0-  /2008. 2009. Jimmy Kamugisha. Phil Jacobs.‘ Mesganaw Fantahun. Nicaragua. Owen O¶Donnell (2007).‘ Sónia F. Leung. Horizontal equity in health care utilization evidence from three high-income Asian economies. A Study of Keranigani.‘ Jui-fen R. and Henrique B. Sci.T. Tom Rubaale (2001). J. Milton S.‘ Lubbock LA. Utilization of Child Health Care Services in Thana Health Complex of Bangladesh.24(2):75±84.

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Health and Health Related indicators. Atlanta. Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. Mushi et al. Trinity collage. BMC Pregnancy and Childbirth 2010.‘ Federal Ministry of Health.‘ A Joint Learning Initiative.1186/1472-698X-9-28 41. Human Resources for development: Review of the Utilization and Effectiveness Community-Based health Worker in Africa.       / 2009. February. 2004. Rose Mpembeni. 9:28 doi:10.‘ Asedu Yeshewalul: Evaluation of health service extension program in Ethiopia. 45. July 2006. Ireland. National Center for Primary Health Care. 42.‘ Prasad BM and VR Muraleedharan (2007). 2009. Health Care for the Underserved. / /. Community Health Workers: a review of concepts. practice and policy concerns 47. 2005/2006. The case of Mtwara Rural District in Tanzania. 44. Research presented to center for global health. L Barclay. Dublin University. 43.‘ Declare Mushi. 10:14 46. Outcome evaluation of community health promotion intervention within a donor funded project climate in Papua New Guinea. Albrecht Jahn (2010). Morehouse School of Medicine. Planning and Programming Department.‘ Community Voices.‘ HE Ashwell.

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Please note that there is no right or wrong answers. satisfaction. Please answer EVERY question in the booklet. This survey is part of a PhD dissertation aimed at better understanding the beliefs. and we will aggregate responses from all interviews so that no one individual will be identifiable. and work conditions that contribute to employee motivation and job satisfaction. By gathering information from many HEWs. and job performance among HEWs in West Gojjam Zone and in particular and Amhara National Regional State in general. attitudes. satisfaction. we hope to learn what factors are most important in affecting worker motivation. All the information that you provide in this session will be held in confidentiality.: ____________ Kebele: ____________ JJ . The aggregated information we collect from these interviews will be used to: (1) identify strengths and weaknesses in the current administrative system with respect to enhancing worker motivation. This booklet contains a series of brief questionnaires that take about 40 minutes to complete.No. and job performance. focusing on West Gojjam Zone and Bahir Dar Special Zone of Amhara National Regional State.c   8 ( c c   9 6 The Principal Investigator and University of Gondar and Addis Continental Institute of Public Health are jointly conducting this study on health extension worker motivation. Instructions for how to respond to the different questionnaires in the booklet are provided at the top of each page. just what YOU think and how YOU perceive your work situation. Subject Number: ____________ ID. Your responses will be kept by the researchers. (2) assist us in developing recommendations to enhance motivation.

Are you ____ Male or ____ Female? 3. either write in your answer or put an ³X´ beside the best response option. What is your age? _________ Years old 6. 1. How many years of experience do you have working in this profession? _____ yrs 2.(&· 9 6$ 3 District: ____________ Zone: _____________  +&#  For each question below. approximately how many workers do you supervise? ______   . Do you supervise any other workers? ______ Yes _____ No 7. How long have you been working for this health post? ____ Years and ____ months 4. How long have you been in your current job? ______ Years and ______ months 5. If the answer to question 6 is yes.

3 = neither agree nor disagree. If employees are unhappy with a decision make by their boss. Questions Scale No. only what is TRUE of you. A job is what you make of it. you can find a job that gives it to you.   use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. 1 2 3 4 5 3 Work should be done with sufficient effort 1 2 3 4 5 4 One should strive to achieve better results. Remember there are no right or wrong answers. 5 = strongly agree Ser. J 1 1 2 2 3 4 3 4 5 5 1 2 3 4 5 1 2 3 4 5 . 1 2 3 4 5 2 Cooperation is a virtue in work. they should do something about it. 1 2 3 4 5 7 Work is not an end in itself but a means to foster personal growth. 4 = sgree. 1 2 3 4 5 8 Devotion to quality work is a virtue. 1 2 3 4 5 6 Consultation allows one to overcome obstacles and avoid mistakes. If you know what you want out of a job. Scale: 1 = strongly disagree. On most jobs. 2 = disagree. 1 2 3 4 5 5 Work is a source of self-respect. 1 2 3 4 5 11 A person can overcome difficulties in life and better him/herself by doing 1 2 3 4 5 12 13 14 15 his/her job well. 1 2 3 4 5 9 Progress on the job can be obtained through self-reliance. 1 Dedication to work is a virtue. 1 2 3 4 5 10 A successful person is one who meets deadlines at work. people can pretty much accomplish whatever they set out to accomplish.

Questions Scale No. 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 1 1 2 2 3 4 3 4 5 5 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 1 2 3 4 5 1 1 2 2 3 4 3 4 5 5 1 1 1 2 2 2 3 4 3 4 3 4 5 5 5 1 1 2 2 3 4 3 4 5 5  #"  Directions: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. I feel bad. this would bring shame to my family. My co-workers in this health post regard their work as boring. 35 I feel comfortable saying what I really think to health posts/ district health 1 2 3 4 5 36 37 38 39 40 41 42 management about how things are going at the health post. Making money is primarily a matter of good fortune. If I do not put in a full day¶s work. only what is TRUE of you.16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Getting a job you want is mostly a matter of luck. In order to get a really good job you need to have family members or friends in high places. 5 = strongly agree Ser. 2 = disagree. It would be difficult for me to say something that my supervisor might disagree with. If there were a goal I did not achieve at work. Scale: 1 = strongly disagree. The main difference between people who make a lot of money and people who make a little money is luck If I were known as a difficult worker. The majority of my co-workers in this health post are proud to work here. This health post has a good reputation in the community. Promotions are given to employees who perform well on the job. Remember there are no right or wrong answers. it would bring shame to my family. People who perform their jobs well generally get rewarded for it. Most employees have more influence on their supervisors than they think they do. my family would feel shame. To make a lot of money you have to know the right people. Promotions are usually a matter of good fortune. If my supervisor told me I did a poor job. I would feel bad even if no one else notices. 3 = neither agree nor disagree. 4 = agree. If I do not do well. It takes a lot of luck to be an outstanding employee on most jobs. If everyone were to know that I was not reliable. My co-workers help others if they fall behind in their work My co-workers willingly [' . Co-workers at this health post pride themselves in providing good services to patients. even if no one else notices. I would feel ashamed. If co-workers had to redo my work. I would feel ashamed. Most people are capable of doing their jobs well if they make the effort. When it comes to getting a really good job. who you know is more important than what you know.

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$ . Jº 1 2 3 4 5 1 1 1 2 2 2 3 4 3 4 3 4 5 5 5 1 1 1 2 2 2 3 4 3 4 3 4 5 5 5 . share expertise and skills with other members of the unit.

My co-workers talk to co-workers before taking action that might affect them. My co-workers attend and actively participate in (team) meetings [   . My co-workers provide constructive suggestions about how the unit can improve its effectiveness. My co-workers are willing to risk disapproval in order to express beliefs about what is best for the unit.43 44 45 46 47 48 49 50 51 52 53 My co-workers try to act like peacemakers when co-workers have disagreements. My co-workers take steps to prevent problems with other co-workers. My co-workers willingly give time to co-workers who have work-related problems.

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My co-workers find fault [ 3. My co-workers discourage co-workers from complaining about trivial matters... rather than the positive side. My co-workers focus on what is wrong with the situation. I feel comfortable saying what I really think [  . with what other co-workers are doing.

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. 1 2 3 4 5 1 1 2 2 3 4 3 4 5 5 1 1 2 2 3 4 3 4 5 5 1 2 3 4 5 1 2 3 4 5 1 1 2 2 3 4 3 4 5 5 1 2 3 4 5 1 2 3 4 5 . to my supervisors about how things are happening in my work unit.

. My managers and co-workers provide me with feedback about the effectiveness (e.g. My job offers adequate pay compared with the job requirements and with pay in similar jobs. quality and quantity) of my performance. tasks. 4 = agree. My job gives me a feeling of achievement and accomplishment. My job offers job security as long as I do a good job. Jÿ 1 2 3 4 5 1 2 3 4 5 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 1 1 2 2 3 4 3 4 5 5 . Questions Scale No. My job requires a high level of knowledge and skills. My job duties. My job provides opportunities for advancement to higher level jobs. My job gives me the opportunity to participate in decisions that affect my job. only what is TRUE of you Scale: 1 = strongly disagree. Remember there are no right or wrong answers. and goals are clear and specific. My job requires a variety of knowledge and skills. My job provides the opportunity for social interaction such as teamwork or co-worker assistance..g. and activities in my job. 2 = disagree. 54 The work I do provides me with direct feedback about the effectiveness (e. There is much variety in my job. 5 = strongly agree Ser. 1 2 3 4 5 55 56 57 58 59 60 61 62 63 64 65 66 67 quality and quantity) of my performance.  /&     use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. My job permits me to get information and talk to people about things that affect my work. 3 = neither agree nor disagree. requirements. I have a variety of duties.

I am left on my own to do my own work. [+  .68 69 70 71 72 73 74 75 76 77 78 My duties are very repetitious.

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e. the chance to do a whole job) I have a lot of opportunity for independent thought and action. It is easy for me to find out how well I am doing on the job as I am working. [?$$.  ! . 5 = very important Ser. 2 = unimportant. 1 1 2 2 3 4 3 4 5 5 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 1 2 3 4 5   use the scale below to indicate how much the following items are important or not important for you in your work. 79 80 81 82 83 Being able to do a complete piece of work. I have control over the pace of my work. I usually have the opportunity to complete work I start. I receive frequent feedback from individuals other than my supervisor. Place the number that best corresponds to your response in the space next to the question number. Questions Scale No. Scale: 1 = very unimportant to me. I am able to do my job independently of others. I have freedom to do pretty much what I want on my job. 3 = neither unimportant nor important 4 = important. I usually have the opportunity to do a job from the beginning to end (i. I often see projects or jobs through to completion..

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right away. when actually doing the job. Have considerable freedom to adopt my own approach to the job. Being able to achieve something that I really value. 1 2 3 4 5 1 1 2 2 3 4 3 4 5 5 1 1 2 2 3 4 3 4 5 5  . . Have a job that gives me a feeling of doing something really worthwhile. Being able to judge my work performance.

!   ‘use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Even when my work is boring. 4 = agree. 5 = strongly agree Ser. I feel that I have control of things concerning my work. Remember there are no right or wrong answers. Ju 1 2 3 4 5 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 . I effectively cope with any important changes that occur in my work life I feel that at work things are going the way I would like them to. Questions Scale No. 2 = disagree. Scale: 1 = strongly disagree. 84 85 86 87 88 I am confident about my ability to handle work problems. only what is TRUE of you. 3 = neither agree nor disagree. I can keep focused on my tasks.

I make a game of it. I do not like to quit a task until it¶s done.89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 I consider myself to have self-control. I check my progress frequently. I find satisfaction in working as well as I can. I am easily distracted in my job. I do not let my emotions interfere with my work. I can not do my work. I like to work hard. I find satisfaction in exceeding my previous performance even if I don't outperform others. It is important for me to do my work as well as I can even doing it well isn¶t popular with my coworkers. When I have a boring task to do. On difficult tasks. It is easy for me to keep myself from being distracted. I have a difficult time concentrating when I am upset (bothered by something). I prefer to put off more difficult tasks to the end. I like to set specific work goals for myself. When I am worried about something. Part of my enjoyment in doing things [ '. There is satisfaction in a job well done.

. 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 1 1 1 2 2 2 3 4 3 4 3 4 5 5 5 1 1 1 2 2 2 3 4 3 4 3 4 5 5 5 1 1 2 2 3 4 3 4 5 5  . is improving my past performance.

My work is rarely disrupted due to bureaucratic processes. A fundamental reason I do not do my job properly is that I do not have the equipment. #" :-&   use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. 5 = strongly agree Ser. 3 = neither agree nor disagree.       J× 1 2 3 4 5 1 2 3 4 5 1 1 1 1 2 2 2 2 3 3 3 3 5 5 5 5 4 4 4 4 . supplies and equipment to do a good job. Questions Scale No. I am often prevented from getting my work done effectively and efficiently by bureaucracy and unneeded processes. I have the necessary materials. 106 107 108 109 110 111 This health post provides everything I need to do my job effectively. Remember there are no right or wrong answers. 2 = disagree. 4 = agree. There are few instructions that obstruct and delay work. supplies and/or materials I need. only what is TRUE of you. Scale: 1 = strongly disagree.

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1 2 3 4 127 I am rarely absent from work. Scale: 1 = very true of me. 1 2 3 4 114 I always finish my work on time. 1 2 3 4 120 I get upset at work. 1 2 3 4 113 I am reliable and dependable at work. 1 2 3 4 129 I spend my time at work on work-related activities. 1 2 3 4 115 My work is of high quality. 1 2 3 4 121 I am careful not to make errors. 1 2 3 4 116 I am a hard worker. 1 2 3 4 118 I am very knowledgeable about my job. 1 2 3 4 117 I do things that need doing without being asked or told. 112 I am punctual about coming to work. 1 2 3 4 122 I keep updated on new equipment and procedures. Place the number that best corresponds to your answer to the left of the statement. 1 2 3 4 124 I get along well with my supervisor. indicate how YOU have performed your job. 1 2 3 4 123 I get along well with my co-workers. 1 2 3 4 128 I am a fast worker. 1 2 3 4 119 I do not get defensive or upset when criticized. 2 = usually true of me 3 = sometimes true of me 4 = rarely true of me 5 = not at all true of me Ser. Questions Scale No. 1 2 3 4 125 I maintain a positive attitude toward my work. !& . 1 2 3 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5  .& Think about your job activities over the past six months. 1 2 3 4 126 My work attendance record is very good. For each statement below.

2 = moderately satisfied. lighting. how satisfied are you with your co-workers in your work unit? 1 2 3 4 5 131 All in all. Scale: 1 = very satisfied. how satisfied are you with your job? 1 2 3 4 5 133 Considering your skills and the effort you put into your work. by placing the number which best indicates your response in the space beside the question number. how satisfied are you 1 2 3 4 5 with your pay? 134 How satisfied are you with the management in your work unit? 1 2 3 4 5 135 How satisfied are you with your opportunity to use your abilities in your job? 1 2 3 4 5 136 How satisfied are you with the chances you have to learn new things? 1 2 3 4 5 137 How satisfied are you with the chances you have to accomplish something 1 2 3 4 5 worthwhile? 138 How satisfied are you with the chances you have to do something that makes you feel 1 2 3 4 5 good about yourself as a person? 139 How satisfied are you with the fringe benefits you receive? 1 2 3 4 5 140 How satisfied are you with the educational/training opportunities you get? 1 2 3 4 5 141 How satisfied are you with the physical working conditions (space. 3 = neither satisfied nor dissatisfied 4 = moderately satisfied. and 1 2 3 4 5 ventilation)? ‘ Ja . how satisfied are you with your supervisor? 1 2 3 4 5 132 All in all. 5 = very satisfied Ser.  & . Questions Scale No.& Directions: Use the scale below to indicate how satisfied you are with the following aspects of your job. 130 All in all.

144 I feel very little commitment to this health post. 149 It would take very little change in my present personal circumstances to cause me to leave this health post. 146 I am proud to tell others that I am part of this health post. how satisfied are you with your present job when you consider the expectations you had when you started working here? 159 How satisfied are you with your present job in light of (career) [! $. 152 For me. 142 I am willing to put in a great deal of effort beyond that normally expected in order to ensure that our work at this health posts is successful. 147 This health post really inspires me to do my very best on the job. only what is TRUE of you. 148 I am extremely glad I work for this health post. Remember there are no right or wrong answers.. 151 Often.&   Use the scale below to indicate how satisfied you are with the following aspects of your job by placing the number which best indicates your response in the space beside the question number. 150 There is not too much to be gained professionally by working for this health post (indefinitely) [$  . 154 How satisfied are you that you have been given enough authority by your superiors to do your job well? 155 How satisfied are you with your present job when you compare it to similar positions in Ethiopia? 156 How satisfied are you with the progress you are making toward the goals which you set for yourself in your present situation? 157 On the whole. Scale: 1 = very satisfied 2 = moderately satisfied 3 = neither satisfied nor dissatisfied 4 = moderately satisfied 5 = very satisfied Ser. training and experience? 158 On the whole. Questions No. as opposed to other health posts I might have worked for. 143 I often tell my friends that this health post is a great organization to work for. Scale 1 2 3 4 5 1 1 1 1 1 1 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 5 5 5 5 5 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 8  # . Questions No. I find it difficult to agree with this health post¶s policies on important matters relating to its employees. how satisfied are you that your superior accepts you as a professional expert to the degree which you are entitled by reason of your position. this is the best of all possible health posts to work for.   use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. 145 I find that my values and this health post¶s values are very similar. 153 Accepting to work for this health posts was a definite mistake on my part. Scale: 1 = strongly disagree 2 = disagree 3 = neither agree nor disagree 4 = agree 5 = strongly agree Ser.

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expectations?   Scale 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 . .

Place the number that best corresponds to your answer to the left of the statement. indicate how each one has performed his/her job. 2 = usually true of this person 3 = sometimes true of this person. Scale: 1 = always true of this person. For each statement below. Questions (Performance Component) Scale No. 1 punctual about coming to work 1 2 2 reliable and dependable at work 1 2 3 always finish his/her work on time 1 2 4 work is of high quality 1 2 5 a hard worker 1 2 6 does things that need doing without being asked or told 1 2 7 very knowledgeable about his/her job 1 2 8 does not get defensive or upset when criticized 1 2 9 gets upset at work 1 2 10 Is careful not to make errors 1 2 11 keeps updated on new equipment and procedures 1 2 12 gets along well with co-workers 1 2 13 gets along well with supervisor 1 2 14 maintains a positive attitude toward his/her work 1 2 15 work attendance record is very good 1 2 16 rarely absent from work 1 2 17 a fast worker 1 2 18 Spends his/her time at work on work-related activities 1 2         c 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 .(& 5·  9   $(/    !&3 Think about the performance of Health Extension workers in your district over the past six months. 4 = rarely true of this person 5 = not at all true of this person Ser.

We are doing a survey that is part of a PhD research by the University of Gondar/Addis Continental Institute of Public Health in West Gojjam.. .« Respondent agrees to be interviewed . Do you have any questions? May I begin the interview now? Signature of interviewer: ««««««««««««. just let me know and I will go on to the next question or you can stop the interview at any time. The information we collect will help the government to plan health services.«««««««««««««««««« Name District««««««««««««««««««««««««««««««««« Zone««««««««««««. Date: «««««««««. 1 respondent does not agree to be interviewed . . ««Region«««««««««««««««««««  (&·/ <+&#   &  Hello. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team.House No. In case you need more information about the survey. We study the Implementation of Health Extension Program (Utilization of Health extension Program by the Community) which has been implemented by the Government of Ethiopia.c î 6" 9!#$!&#3-  General Information Name of Household Head «««««««««««««««««««««««««««« Name of Kebele «««««««««.. You don't have to be in the survey. you may contact the person listed on the card that has already been given to your household. 2 end î . The questions usually take about %minutes. My name is _______________________________________. . I am working with University of Gondar/Addis Continental Institute of Public Health. Amhara National Regional State. Your household was selected for the survey. but we hope you will agree to answer the questions since your views are important.. . If I ask you any question you don't want to answer.

..10 Self-employed....«««...99 Male«««««««««««««..1 I do not know««««««««««.«.4 Divorced«««««««««««««««..3 Grade 7-8 (junior secondary education)««««..2 Catholic««««««««««««««««....1 Married««««««««««««««««.5 Other (specify)____________________________6 Illiterate««««««««««««««««.... Other (specify)__________________________7 Unemployed««««««««««««««.. Grade 9-12 (senior secondary education). business with employees«««.3 Disabled/ sick««««««««««««««...««««.4 House wife«««««««««««««««.3 Widowed«««««««««««««««.4 Other (specify)«««««««««««««...1 Retired«««««««««««««««««2 Pupil/ student««««««««««««««..«««..5 Amhara«««««««««««.«.1 J ...«««....7 Employed by government«««««««««....«99 Ethiopian Orthodox Tewahdo««««««««.__ __ Refused to tell««««««««««««.«. university«««««««««««..2 Separated«««««««««««««««.....2 Single (never been married)««««««««... business no employees««««12 Self-employed........5 Merchant««««««««««««««««6 Daily laborer««««««««««««««....2 Grade 1-6 (primary education)...««..«««««.1 Female«««««««««««««....11 Self-employed......1 Muslim««««««««««««««««.««««. College........(&·(&2 && #/& &&" !(&-   No 101 QUESTIONS AND FILTERS How old are you? 102 What is your sex? 103 What is your marital status? 104 What is your educational status? 105 What is your main occupation (Past twelve months)? 106 What is the monthly income of your family? 107 108 Number of people living in your family? What is your religion? 109 What is your ethnicity? CODING CATEGORIES SKIP Years««««««««««««««...__ __ I don¶t know««««««««««««««98 Refused to tell««««««««««««..«.1 Read and write only«««««««««««..6 7.13 Other (specify___________________________ 14 _______ Birr«««««««««««..99 Number««««««««««. farmer/ fishing«««««««....98 Refuse to tell«««««««««««««....3 Protestant««««««««««««««..5 6..8 Employed private for profit sector««««««9 Employed by NGO«««««««««««.4 5.

98 HEP have? Refuse to tell«««««««««««««««99 205 Which HEP you are familiar HIV/AIDS and other sexually transmitted infections with? (STIs) and TB prevention and control«««««.....«««...««««..3 It is bad«««««««««««««««««4 It is very bad«««««««««««««...4 Other (specify)____________________________98 203 Have you had an understanding Yes«««««««««««««««««««.... . . . Yes No Watch 1 2 Bicycle 1 2 Motorcycle/scooter 1 2 Animal-drawn cart 1 2 Car/truck 1 2 Boat with motor 1 2 112 It is very good««««««««««««......4 It is very bad««««««««««««««........5 Rooms .......2 201 From where did you get the Health extension workers««««««««««.2 their client (you)? Neither good nor bad«««««««««.«..1 how many components do the I do not know««««««««««««««.«....2 Tigrie««««««««««««.5 113 How do you see the conduct of It is very good««««««««««..2 Community««««««««««««««««3 Radio««««««««««««««««««..............«.....««.1 extension program? No««««««««««««««««««.... ........ ..2 204 If you already know about HEP...««.5 (&5·! /#)&" !(&-  No QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Have ever heard about health Yes«««««««««««««««««««...«««««..... ..10 Water supply and safety measures««««....«. ..«..1 information about HEP? Other health workers««««««««««««..«.......2 Neither good nor bad««««««««««....«.5 Immunization««««««««««..«.4 Family planning««««««««... ________ components«««««««««««. .1 Malaria prevention and control««««..1 health extension workers towards It is good««««««««««««...1 about HEP components? No««««««««««««««««««.. .1 It is good««««««««««««««««. .... ...««««««......3 It is bad««««««««««.3 Oromo««««««««««««««««. ....«««««9 Solid and liquid waste disposal««««.... .... .. .. ....2 First Aid emergency measures«««««.«...8 Excreta disposal«««««««««.7 Adolescent reproductive health«««««.«..«... ......110 111 How many rooms in this household are used for sleeping? Does any member of your household own: A watch? A bicycle? A motorcycle or motor scooter? An animal-drawn cart? A car or truck? A boat with a motor? How do you see the health services given at the health post? Agaw««««««««««««..4 Other (specify)««««««««««««..11  .3 Maternal and child health«««««««..«.«.6 Nutrition««««««««««««««..

..16 HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control«««««........9 Other(specify _____________________________ ________________________________________ ________________________________________98 º ...13 Control of insects and rodents«««««.......................... what are the major reasons for not using HEP components? Food hygiene and safety measures««««.......5 Immunization««««««««««.........«.10 Water supply and safety measures««««..2 First Aid emergency measures«««««......206 Which HEP component(s) have you used (implemented)? 207 Which HEP component(s) have not you used (implemented)? 208 For above question......12 Healthy home environment««««««..«...13 Control of insects and rodents«««««.....................3 Maternal and child health«««««««.7 Community perception is not good«««««««8 Previous experiences««««««««««««..............«3 We are occupied by other business«««««««4 The health post is very far««««««««««..6 Nutrition««««««««««««««......«««...15 Health education and communication«««««.13 Control of insects and rodents«««««.«..............«...3 Maternal and child health«««««««......1 Malaria prevention and control««««............«««««9 Solid and liquid waste disposal««««........«......«..........16 We did not understand the benefit«««««««..................«««««............8 Excreta disposal«««««««««.15 Health education and communication«««««..8 Excreta disposal«««««««««..5 Immunization««««««««««......7 Adolescent reproductive health«««««.«.....10 Water supply and safety measures««««...11 Food hygiene and safety measures««««...............5 Very long waiting time in the health post««««..............4 Family planning««««««««.6 Nutrition««««««««««««««......«««««9 Solid and liquid waste disposal««««.4 Family planning««««««««.12 Healthy home environment««««««...«...6 HEWs are not approachable«««««««««....«««..14 Personal hygiene«««««««««««..14 Personal hygiene«««««««««««..16 HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control«««««.2 First Aid emergency measures«««««...««««2 Economic problem««««««««««««..7 Adolescent reproductive health«««««........«««««.....«.....11 Food hygiene and safety measures««««..............1 Malaria prevention and control««««....15 Health education and communication«««««...«.......1 The HEWs did not teach us«««««...14 Personal hygiene«««««««««««...........12 Healthy home environment««««««...

2 First Aid emergency measures«««««.....4 Traditional Healers««««.1 «302 required to seek health services....4 Family planning««««««««.... STIs and TB ««««««««««..........«4 Once every six weeks««««««««««««...«««««...«......1 No««««««««««««««««««..11 Food hygiene and safety measures««««..6 Nutrition««««««««««««««..... what did they teach and/or demonstrate you about? 306 Have you ever visited a health post? How often do you have to travel to Health Post for health services/medical treatment? 307 More than once per week«««««««««........12 Healthy home environment««««««..........2 what would be your preferred Hospital«««««««««««««««««..«.«........«.......2 More than once per week«««««««««.....1 your home? No««««««««««««««««««.. Health Center«««««««««««««««.3 location? Private Health facilities«««««««««««.....5 Immunization««««««««««.....................«««««9 Solid and liquid waste disposal««««..3 Maternal and child health«««««««.5 Others ___________________________________98 (Specify) 302 Have HEWs ever visited you or Yes«««««««««««««««««««...13 Control of insects and rodents«««««........«4 Once every six weeks««««««««««««......«.....5 Other ____________________________________6 (Please specify) Teach health extension packages«««««««.14 Personal hygiene«««««««««««..15 Other (specify______________________________ _________________________________________98 Yes«««««««««««««««««««..«.......«.1 Once per week««««««««««««««....5 Other ____________________________________6 (Please specify) ÿ .2 303 How often do HEWs visit you or your home? 304 What do HEWs do when they come to your home? 305 If HEWs visited you..........«3 Once per month«««««««««««««.. (&· -#&$ &&&3" !&-  No QUESTIONS AND FILTERS CODING CATEGORIES SKIP 301 If you or a family member were Health Post««««««««««««««««..7 Adolescent reproductive health«««««......2 Once per fortnight««««««««««««..«...........................«««...2 Once per fortnight««««««««««««..1 Malaria ««««.«3 Once per month«««««««««««««.8 Excreta disposal«««««««««.........1 Demonstrate health extension packages«««««2 Other (specify) ____________________________ _________________________________________98 HIV/AIDS.10 Water supply and safety measures««««............................«...1 Once per week««««««««««««««.......

98   u .«.5 Diagnosis and treatment«««««««««««.5 Family illness«««««««... you usually visit health Child illness««««««««1 post or consult health extension workers? Family planning««««««..««1 Family planning««««««««««««««.3 Other (specify)««««««.2 If the sick person unable to drink and eat««««««««««..««««««.2 Very expensive««««««««««««««.....5 (&)· )&$ &&  3" !-  No QUESTIONS AND FILTERS CODING CATEGORIES SKIP 401 For what type of illnesses.3 Cheap««««««««««««««««««.308 How do you travel? 309 How far do you travel (return trip)? What services did you get at the health post provided by the HEWs? 310 311 312 313 314 Do you think that the quality of care/services provided in the health post is good enough? If the answer to question X is No.6 Other (specify)««««««....««««««..98 Immunization«««««««««««««. Have you ever paid for health services you got from the health post? How do you see the cost you paid for the health services you got? Private vehicle«««««««««««««««1 Community Transport«««««..2 Public Transport««««««...1 No««««««««««««««««««.4 Very cheap««««««««««««««««...98 402 At what stage of the illness do you usually visit the Soon after the illness stats««.««««««. what are the problems? Probe..2 Yes«««««««««««««««««««..6 Other (specify) _____________________________ ___________________________________________ _________________________________________98 Yes«««««««««««««««««««..__ __ I do not know««««««««««««««.5 Other ____________________________________6 (Please specify) Kilometers«««««««.3 On mule/horse back««««««.«««««««.2 Pregnancy«««««««««3 Delivery«««««««««...1 health post when you or your family gets sick? If there is no improvement««..««««««.«.3 Delivery«««««««««««««««««.4 On foot««««««««««.4 Postnatal care«««««««««««««««..2 Antenatal care««««««.«.4 Postnatal«««««««««.««««««««..2 Neither expensive nor cheap«««««««««..1 No««««««««««««««««««.1 Expensive««««««««««««««««..

We study the Implementation of Health Extension Program which has been implemented by the Government of Ethiopia...« Respondent agrees to be interviewed . Do you have any questions? May I begin the interview now? Signature of interviewer: ««««««««««««. just let me know and I will go on to the next question or you can stop the interview at any time. If I ask you any question you don't want to answer. . 2 end       × . 1 respondent does not agree to be interviewed . The questions usually take about % minutes. We are doing a survey that is part of a PhD research by the University of Gondar/Addis Continental Institute of Public Health in West Gojjam. Amhara National Regional State.«««««««««««««««««« Name District««««««««««««««««««««««««««««««««« Zone««««««««««««. you may contact the person listed on the card that has already been given to your household. ««Region«««««««««««««««««««  (&·/ <+&#   &  Hello. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team.House No. ..c % 6 & 9!# )!#7    General Information Name of Household Head «««««««««««««««««««««««««««« Name of Kebele «««««««««. but we hope you will agree to answer the questions since your views are important. I am working with (University of Gondar/Addis Continental Institute of Public Health)). Your household was selected for the survey. In case you need more information about the survey. The information we collect will help the government to plan health services. . Date: «««««««««. You don't have to be in the survey. . My name is _______________________________________.

.««««__ __ family? Refused to tell««««««««««««.... business no employees««««12 Self-employed...........«99 107 What is your religion? Ethiopian Orthodox Tewahdo««««««««.....6 7.«««......3 Widowed««««««««««««...4 Other (specify)«««««««««.__ __ birthday? I don¶t know«««««««««.. Grade 9-12 (senior secondary education)..__ __ I don¶t know««««««««««.«««..13 Other (specify__________________________ 14 106 Number of people living in your Number««««««««««....(&2 && #/& &&$  # cº2a3 No QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 How old are you? Years«««««««««««««.5 Other (specify)____________________________6 104 What is your educational status? Illiterate««««««««««««««««.4 Divorced«««««««««««««.10 Self-employed...«««.1 twelve months)? Retired«««««««««««««««««2 Pupil/ student««««««««««««««......«««...«««««««3 Grade 7-8 (junior secondary education)««««.«. university«««««««««««........«««««98 Refused to tell«««««««««...2 Separated««««««««««««.4 5..5 108 What is your ethnicity? Amhara«««««««««««««««««1 Agaw«««««««««««««««««..1 Married«««««««««««««. Other (specify)__________________________7 105 What is your main occupation (Past Unemployed««««««««««««««.. farmer/ fishing«««««««. business with employees«««....1 Muslim«««««««««««.2 Tigrie«««««««««««««««««..2 Grade 1-6 (primary education).««.. College.2 Catholic««««««««««««««««...99 103 What is your marital status? Single (never been married)«««««...««.4 House wife«««««««««««««««.........««...11 Self-employed........4 Other (specify)««««««««..3 Disabled/ sick««««««««««««««..««..3 Protestant«««««««««««««««..7 Employed by government«««««««««....8 Employed private for profit sector««««««9 Employed by NGO«««««««««««....5 a .....99 102 How old were you at your last Years««««««««««««....«««.5 6..5 Merchant««««««««««««««««6 Daily laborer««««««««««««««....««««98 Refused to tell««««««««««..3 Oromo«««««««««««««««««........1 Read and write only«««««««««««..

106 Have you ever given birth to a boy or girl who was born alive but later died? IF NO..2 108 Boys dead . «««««. 108 Sum answers to 103. . . . 1 No «««««««««««..«. . . .. «««««««. and 107..... . .109 110 How many rooms in this household are used for sleeping? Does any member of your household own: A watch? A bicycle? A motorcycle or motor scooter? An animal-drawn cart? A car or truck? A boat with a motor? Rooms . . . . record '00'.. .. . . . . . . .. .. ..... Total births .. No correct 101-108 as necessary CODING CATEGORIES SKIP Yes «««««««««««««««1 No «««««««««««. . Is that correct? Yes«. .. Daughters elsewhere««««««. . . .. 105. RECORD '00'. . ...«« Yes «««««««««««««««1 No «««««««««««.. ««««««. Daughters at home . . ..... ... . . 2 104 Sons at home .. ...... . ... . .. .. . .. .. . «««««. . . and enter total... . .... . 2 106 Yes «««««««««««. RECORD '00'. Have you ever given birth? 102 Do you have any sons or daughters to whom you have given birth who are now living with you? 103 How many sons live with you? And how many daughters live with you? IF NONE. 104 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? 105 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE. Watch Bicycle Motorcycle/scooter Animal-drawn cart Car/truck Boat with motor Yes 1 1 1 1 1 1 No 2 2 2 2 2 2 )!#$  # cº2a3 (&·/ & No QUESTIONS AND FILTERS 101 Now I would like to ask about all the births you have had during your life... «««««««... ... . Girls dead . . . .2 106 Sons elsewhere .. .. . ««««««..«««.. . . __ __ No«. RECORD '00'. 109 Check 108: Just to make sure that i have this right: you have had in total _____ births during your life... . . . º . Yes «««««««««««««««1 No «««««««««««. PROBE: Any baby who cried or showed signs of life but did not survive? 107 How many boys have died? And how many girls have died? IF NONE. .. ... If none. .. .... .... ... ..

..«« 113 Is (NAME) a boy or a girl? Last birth««««««««««««.... 2 Next to last birth«««««««««....««««««««.«.. Yes ««««.... Men can have an Yes«. No.....__ __ Year.........2 Second to last birth««««««««..............«««««.......2 116 Are you pregnant now? Yes «««««««««««««««1 No ««««««««««««...1 No«........«««. 2 No«.....1 No«..1 Yes««.«««««««««.2 02 (".««««««««. 2 operation to avoid having any more children Yes««..«.. whether still alive or not..«««««........2 114 In what month and year was (NAME) born? Probe: When is his/her birthday? Last birth««««««««««««.««.............. Now I would like to record the names of all your births........ Month ««««... Record names of all the births in 212. 2 avoid having any more children Yes««.«««««.«««««««.«««««««......... baby? Next to last birth««««««««««...........2 ºc .«««««.__ __ Year....«««««... Boy ««««..««««««««...............1 avoid becoming pregnant.........«««««..«««««..2 Second to last birth««««««««.......«««««...... Yes ««««.1 Girl «««««.... __ __ No births«« 116 111.............1 No.1 No. (if there are more than 12 births. Boy ««««.......2 Unsure ««««...........««««««««««................... use an additional questionnaire..««««««««««.....«..«««««.........1 No............................2 03 !: Women can take a pill every day to Yes«.«««...««««««««««. __ __ __ __ Next to last birth«««««««««..«««««.......«........ No..........1 Have you had a partner who had an operation to avoid having any more children... 2 Next to last birth«««««««««............... Women can have an Yes«.........................««««««««««.....the 202. starting with the first one you had... Boy ««««..... Yes ««««.1 Girl «««««...1 Have you ever had an operation to operation to avoid having any more children...«««««««..«««««... Month ««««............. Have you ever heard of (method)? 01 )(". 112 What name was given to your (first/next) Last birth«««««««««««««...1 Girl «««««.. starting with the second row)........ Record twins and triplets on separate rows..110 Check 108: One or more births«....... __ __ __ __ Second to last birth««««««««. No..... Have you ever used (Method)? various ways or methods that a couple can use to delay or avoid a pregnancy......8  (&5· &/ 201 Now I would like to talk about family planning ..««««««««..«««««. Second to last birth«««««««...__ __ Year...... __ __ __ __ 115 Is (NAME) still alive? Last birth««««««««««««. Month ««««.

............................... 2 Yes««.2 Yes«...1 method to delay or avoid getting pregnant? No «««««««.«.......1 No........««««««««.....1 No.....«....................1 No«... As an emergency measure....1 No....2 Check 202 Not a single µµyes¶¶ (never used) « go to 304 At least one used µµyes¶¶ (ever used)«««««««««..1 No«......«.. 2 Yes«.1 No«..2 Yes««...............E ºî .........2 Yes««.. 2 Yes««.. 2 Yes«...... 2 Yes««......«...2 Yes«............. #& &/..209A Check 116: Not pregnant or unsure«««««...............«...2 Yes«...1 No«...............................2 Yes««..1 No«. 2 Yes««.........................................1 No«....... 2 Yes««..2 «211 What have you used or done? Correct 202 and 203 (and 201 if necessary) Check 202(01) Woman not sterilized««««««« Women sterilized«««««««.«......1 No........................................... ««««««««««««...................«...........2 «211 Which method are you using? Female sterilization«««««««A Circle all mentioned Male sterilization««««««««B If more than one method mentioned...1 way to delay or avoid getting pregnant? No ««««...2 Yes___1 specify No____2 specify Yes««...««««««««....................««««««««..« Pregnant«..1 No«.....04 05 06 07 08 09 10 11 12 13 203 No 204 205 206 207 208 209 : Women can have a loop or coil placed inside them by a doctor or a nurse..........«..««««««««.....«....C instruction for highest method on list......1 No.............««««««««..............«««..................... )  : Women can place a sheath in their vagina before sexual intercourse......««««««««..........  5: Men can be careful and pull out before climax................  : Men can put a rubber sheath on their penis before sexual intercourse...................................2 Yes««.................. 2 Yes«...2 Yes««. «211 Are you currently doing something or using any Yes «««««.«««««««....... &  (LAM)   : Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.&-: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months..1 No................««««««««...................1 No..................2 Yes«...........««««««.......D Injectables««««««««««..«««««...........1 No«........«.1 No«...... /: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years....1 No............... women can take special pills to prevent pregnancy.................1 No«... Have you heard of any other ways or methods that women or men can use to avoid pregnancy? Yes«.««««««««.««««««««....... within three days after they have unprotected sexual intercourse........ follow skip Pill.............. IUD«««««««««««..«««««««......................1 No«. ....««........ .........1 No..«.....206 QUESTIONS AND FILTERS CODING CATEGORIES SKIP Have you ever used anything or tried in any Yes «««««.... 2 Yes«.««««««««..««««««««...............................

.K Other (specify)««««.J Withdrawal««««««««««..H Lactational Amenorrhea Method««.....33 Other ________________________96 (specify) Yes «««««....210 Where did you obtain (current method) the last time? If more than one method circled in 209..I Mobile clinic«««««««««.21 Pharmacy««««««««««.N Friend/relative««««««««..O Other ________________________ X (specify) «301 «301 «301 «301 .....«.F Condom«««««««««««........1 No ««««.D Fieldworker««««««««.. fieldworker.«««««..J Fieldworker«««««««««..G Female condom««««««««. If unable to determine if public or private sector.G Pharmacy««««««««««.««. Name of Place ºJ Implants«««««««««««..13 Public or private mobile clinic««..2 Public sector Government Hospital««««... do not circle code for pharmacy.31 Church«««««««««««... Name of Place If method is sterilization......25 Other private medical____________26 (specify) Other source Shop«««««««««««..«..I Rhythm method««««««««. write the name of the place...M Church«««««««««««. shop.E Other public ___________________ F (specify) Private medical sector Private hospital/clinic«««««... Ask about method If unable to determine if public or private sector.11 Government Health center«««.««.X Public sector Government Hospital«««««........32 Friend/relative«««««««...... friend /relative 211 Do you know of a place where you can obtain a method of family planning? 212 Where is that? Any other place? Probe to identify each type of source and circle the appropriate codes.C Public or private mobile clinic««..«..H Private doctor«««««««««.......«..12 Family planning clinic«««««..«««««««..24 Fieldworker«««««««««..B Family planning clinic«««««.......15 Other public ___________________16 (specify) Private medical sector Private hospital/clinic«««««..14 Fieldworker«««««««««.22 Private doctor««««««««.K Other private medical ____________L (specify) Other source Shop««««««««««««....... write the name of the place.A Government Health center«...23 Mobile clinic«««««««««.«.

....2 Separated««««««««««.5 you like to have another child. would And not pregnant or unsure«««.3 Check for presence of others. ««««««««....2 No.00 How old were you when you had sexual intercourse for the very first time? Age in Years«««««««.. lived with a man «...2__ __ How long would you like to wait from now Soon/now««««««««««993 before the birth of (a/another) child? Says she can't get pregnant«««. formally married «««.1 Yes...995 After the birth of the child you are expecting Other _______________________ 996 now.«.2 children? Says she cannot get pregnant«««.3 Pregnant ______ Undecided/do not know: Now I have some questions about the future: And pregnant«««««««««4 After the child you are expecting now..«. answer must be recorded in years  (&)·)!& No QUESTIONS AND FILTERS CODING CATEGORIES 401 Check 104: Neither sterilized ««««««««««««««««««««««««.««««.__ __ intercourse? Weeks ago«««««««.998 º SKIP «304 «304 «401 SKIP «409 «404 «409 «405 «404 «409 ..__ __ If 12 months (one year) or more.«. __ __ When was the last time you had sexual Days ago««««««««..994 Pregnant__________ After marriage««««««««...... not in union ««««««««.__ __ in days... make every effort to ensure privacy Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues Never had sexual intercourse ««. Years ago««««««....««««.3 Have ever married or lived together with a man Yes.. currently married «««««.. Go to 402 He or she sterilized «««««««««««««««««««««««««««« 402 Check 116: Not pregnant or unsure ______ Now I have some questions about the future: Would you like to have (a/another) child.... weeks or months.«««««..... how long would you like to wait before (specify) the birth of another child? Don't know«««««««««.. answer must be recorded Months ago«««««««.2 No.1 would you prefer not to have any (more) No more/none«««««««««......1 as if married? Yes.... ««««.«1__ __ Not pregnant or unsure ______ Years««««. (&·# (9 & No QUESTIONS AND FILTERS 301 Are you currently married or living together with a man as if married? 302 303 304 305 306 CODING CATEGORIES Yes.««... Before Continuing.3 What is your marital status now: are you Widowed«««««««««««1 married? Divorced? Separated? Divorced««««..... living with a man «««««. or would you prefer not to have any more children? 403 Check 116: Months«««.«...__ __ If less than 12 months... or Have (a/another) child««««««..

««««««go to 405 No......51 Fear of side-effects««««««...8 Female sterilization«««««....«..««00 Number«««««««««.53 Costs too much«««««««..05 Implants««««««.«22 Subfecund/infecund««««..07 Female condom««««««««.......««««««...«««««..... Yes «««««.404 405 406 407 Check 203: using a contraceptive method? Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future? Which contraceptive method would you prefer to use? What is the main reason that you think you will not use a contraceptive method at any time in the future? 408 Would you ever use a contraceptive method if you were married? 409 Check 103 and 105: Have living children __________ If you could go back to the time you did not Not asked«..03 IUD««««««««««««.............«...34 Lack of knowledge Knows no method««««««.. 2 Do not know«««««««..24 Opposition to use Respondent opposed«««««.....21 Menopausal/hysterectomy««....... 1 No ««««.. currently using«««««««.10 Withdrawal«««««««««.04 Injectables««««««««..8 None ««««««««««..... 2 Do not know«««««««.02 Pill.««...««««««....52 Lack of access/to far«««««........98 Not Married««««««««..08 Lactational Amenorrhea Method«......11 Other (specify)________________ 96 Unsure«««««««««««.....06 Condom«««««««««... not currently««««......«.........«11 Fertility related reasons: Infrequent sex/no sex«««««......go to 405 Yes. 1 No ««««....56 Other (specify)________________ 96 Unsure«««««««««««.««......41 Knows no source«««««««42 Method related reasons: Health concerns«««««««....««««..........01 Male sterilization«««««««.....31 Husband/partner opposed«««. __ __ ºº «409 «407 «407 «409 «409 «409 «409 «409 «409 «409 «409 «409 «409 «409 «409 «409 «409 «End ..54 Inconvenient to use««««««55 Interferes with body`s normal process ««««««««««...98 Yes «««««.«23 Wants as many children as possible««««««««««....«««««.09 Rhythm method««««««««.32 Other opposed««««««««33 Religious prohibition«««««.

. Ask the questions about all of these births.......B ‘ pregnancy? Aux.. (We will talk about each separately....... Hospital/Clinic.....C ‘ ‘ 6 ‘ ‘ If Yes: Whom did you TBAs««««««.D ‘ ‘ Probe to identify each Other Public type(s) of source and Sector ____________E ‘ ‘ circle the appropriate (specify) code(s)...96 «End No living children ______________ If you could choose exactly the number of children to have in your whole life.. Heal......... go to 102 No births in 2005 ______________.««00 Number«««««««««. Health Post«..... Now I would like to ask some questions about your children born in the last five years.....201 102 Check 114: Enter in the table the name of each birth in 2005or later.) 103 From 212 (Reproduction Last Birth Next to Last Birth Second to Last Birth Part) Name___________ Name___________ Name___________ 104  ‘‘) ‘ ‘  ‘ ‘ ‘ Did you see anyone for Doctor««««««A ‘ antenatal are for this Nurse/Midwife««...F ‘ ‘ If unable to determine if Other Private Medical public or private sector. Midwife««..«..... Begin with the last birth.B ‘ Anywhere else? Govt. __ __ Other(specify)«««««««..........««Y‘ ‘ all mentioned.. to be girls and for how many would be the sex not matter? None ««««««««««... ««««««««. Worker......«....96 $  # cº2a3 (&·    | !‘ š ‘ ‘‘ 3‘( ‘ |5‘ ‘3‘( ‘  ‘ ‘3‘( ‘ |44444444444‘ |44444444444‘ |44444444444‘ 101 Check 114: One or more births in 2005 ______.. Health Center....... Hospital«.... how many would that be? Other(specify)«««««««.....E ‘ Anyone else? 6  ___________ X ‘ Probe to identify each (specify) ‘ type of person and record | ‘ «««.. how many would that be?  )‘ ‘‘ ‘ ‘ How many of these children would you like to be boys........96 «End «End Boys Girls Either Number««.«........D ‘ see?  Com.....C ‘ Govt... ‘ 105 Where did you receive  777777  ‘ ‘ antenatal care for this 2   ‘‘ pregnancy? Govt. _ _ __ __ Other(specify)«««««««.......... ‘ ‘ ‘ ‘ Pvt. Sector ___________ G ‘ ºÿ .......410 have any children and could choose exactly the number of children to have in your whole life........

write the name of the place. Name of Place 106 How many months pregnant were you when you first received antenatal care for this pregnancy? 107 How many times did you receive antenatal care during this pregnancy? |.

 4 .

   108 As part of your antenatal care during this pregnancy.. probe to determine whether any adults were present at the delivery..__ __ ‘ Don't know«««..98 ‘ ‘ ‘ ‘  0  |%  ..__ __ ‘ Don't know«««.. were any of the following done at least once: Were you weighed? Was your blood pressure measured? Did you give a urine sample? Did you give a blood sample? 109 During (any of) your antenatal care visit(s). were you told about the signs of pregnancy complications? 110 Were you told where to go if you had any of these complications? 111 Who assisted with the delivery of (NAME)? Anyone else? Probe for the type(s) of person(s) and record all mentioned.. 112 Where did you give birth to (NAME)? Probe to identify each (specify) ‘ Other ____________ X ‘ (specify) ‘ ‘ Months«««.. If respondent says no one assisted...98 ‘ ‘ ‘ ‘ ‘ Number of times««««.

. 0  |55555555555 |55555555555 Yes No ‘ Weight««1 2 BP«««...1 2 Blood«.«1 2 .1 2 Urine« «..

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.....««1 No ««««««.Y  777777cc ===/%c 2   ‘‘ ºu  ‘ ‘ Doctor«««««A Nurse/Midwife«.E 6  __________ X (specify) | ‘ ‘«...D Relative/friend«. 0  |55555555555 Yes ««««.E 6  __________ X (specify) | ‘ ‘«..... Midwife««..D Relative/friend«. Midwife««..2 Do not know««.C 6 ‘ ‘ TBAs«««««.......D Relative/friend«..B Aux..Y  777777cc ===/%c 2   ‘‘ .««1 No ««««««.B Aux.E 6  __________ X (specify) | ‘ ‘«..2 Do not know««.B Aux.8  ‘ ‘ Doctor«««««A Nurse/Midwife«. Midwife««..C 6 ‘ ‘ TBAs«««««..8 Yes ««««..Y  777777cc ===/%c 2   ‘‘  ‘ ‘ Doctor«««««A Nurse/Midwife«..C 6 ‘ ‘ TBAs«««««..

Health Post«. Health Center..1 No «««««««««««.. Hospital«.««1 No ««««««..«.«««««««. (&5·+ # Was (Name of Child) ever breastfed? 202 Is (Name) still being breastfed? CODING CATEGORIES SKIP Biological Mother«««««««.07 Sister/brother««««««««««......««««««««««.01 Biological Father.04 Grandmother««««««««««..««««««««««.21 Govt.21 Govt.....«. Health Post«.. Hospital/Clinic.. Health Post«....31 Other Private Medical Sector ___________36 (specify) Other ___________ 96 (specify) Yes ««««..«. If unable to determine if public or private sector.98 Year««««««««««««. Hospital«..««1 No ««««««.8 Govt.....05 Grandfather«««««««««««....«09 Not Related..08 Other Relative«««««««««...31 Other Private Medical Sector ___________36 (specify) Other ___________ 96 (specify) Yes ««««...__ __ Don't know year««««««««... write the name of the place..22 Govt.....2 º× «203 .««1 No ««««««...2  $: #   º3 (&·  <+&#  No QUESTIONS AND FILTERS 101 I would like to ask you some questions about (Name of child from cover page).22 Govt...«. Hospital/Clinic....9998 Age in completed years««««__ __ Yes ««««...2 Do not know««.22 Govt. Hospital«...... did you receive a vitamin A dose like (this/any of these)? Show vitamin A capsule  Govt..23 Other Public Sector ___________26 (specify) ‘ ‘ ‘ Pvt..98 Month«««««««««««...31 Other Private Medical Sector ___________36 (specify) Other ___________ 96 (specify) Yes ««««.«02 Stepmother««««««««««... Health Center. Hospital/Clinic.__ __ Don't know month«««««««.2 Yes ««««...type(s) of source and circle the appropriate code(s)....10 Day«««««««««««««__ __ Don't know month«««««««.. Health Center.23 Other Public Sector ___________26 (specify) ‘ ‘ ‘ Pvt... Name of Place 113 Was (NAME) delivered by Caesarean? 114 In the first two months after delivery.06 Adoptive Parent«««««««««....2 Govt.««1 No ««««««.....23 Other Public Sector ___________26 (specify) ‘ ‘ ‘ Pvt..2 Yes «««««««««««««««1 No «««««««««««.03 Stepfather«««««««««««...21 Govt.. What is your relation ship to (Name of Child) 102 What is (Name)`s date of birth? 103 201 How old is (Name)? Compare and correct 102 and/or 103 if necessary....

.203 Did (Name) drink anything from a bottle with a nipple yesterday or last night? Yes «««««««««««««««1 No «««««««««««..2 given in a national immunization day Do not know..... ..1 2 8 Juice..««««««...1 recorded on this card.....307 .. Polio 0-3.... did (Name) eat or drink Yes No DK Plain water? Water««««««1 2 8 Baby formula or other milk? Milk««««««.8 campaign? Record µyes¶ only if the respondent mentioned BCG.....««««««««... Go to 304 BCG to Measles all recorded««««««««««««««««««««.2 Do not know. but no date is recorded. DPT 1-3. record dates for most recent and second most recent doses. soda........ ºa .«««««...307 . tea or rice water? Juice/soda/tea««....2 No Card...... Has (NAME) had any vaccinations that are not Yes «««««««««««««. Not seen ««««......... DAY MONTH YEAR BCG POLIO 0 (POLIO GIVEN AT BIRTH) POLIO 1 POLIO 2 POLIO 3 DPT 1 DPT 2 DPT 3 MEASLES VITAMIN A (MOST RECENT) VITAMIN A (2nd MOST RECENT 303 304 Check 302 Not all from BCG to Measles recorded«««««««.307 . ««««««««««. including vaccinations No ««««...... SKIP ? «305 (2) Write µ66' in µday' column if card shows that a dose was given... and/or measles vaccines..«««««««««1 If yes: May I see it please? Yes..««3 302 (1) Copy dates from the card..8 204 Yesterday or last night..307 ... (3) If more than two vitamin ³a¶ doses.........«... written down? Seen«..1 2 8 Any solid or mushy foods? Any food««««.....1 2 8 (&·   No QUESTIONS AND FILTERS CODING CATEGORIES 301 Do you have a card where (NAME)'s vaccinations are Yes...

.... 2 Do not know...... that is........... 1 No ««««...307 «? 306E «? 306G Yes «««««««««««««....2 Do not know..............««««««««......4 ..............««««««««.....1 No ««««..««««««««..310 «? ....... ......2 Do not know.8 Yes «««««««««««««........... a shot in the arm at the age of 9 months or older ± to prevent him/her from getting measles? Check 302.. Go to 308 Date for most recent vitamin A dose«««««««««.....1 No ««««............ Has (Name) ever received vitamin A dose? Show capsule Number of times«_ _ 306F 306G 307 308 309 Did (Name) receive vitamin A dose with in the last 6 months? 310 Has (Name) had diarrhea in the last two weeks? 311 Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk).........310 «? ..««««««««............ date for most recent vitamin A dose recorded No date for most recent vitamin A dose........8 306C Did (Name) receive the first polio vaccine during the first two weeks after birth or later? First two weeks«««««««««1 Later«««««««««««««2 306D How many times was the polio vaccine given? Number of times«_ _ 306E A DPT vaccination..1 Somewhat less«««««««««........... including vaccinations received in a national immunization day campaign? Please tell me if (NAME) had any of the following vaccinations: A BCG vaccination against tuberculosis..1 No ««««........2 Do not know.8 «««««««««««««««... drops in the mouth? Yes «««««««««««««..2 Do not know.......... .305 306 06A 306B If yes write µ66¶ in question 302 in the day column for the corresponding vaccine.............that is..............8 How many times did (Name) receive the DPT vaccine? A measles injection or an MMR injection ... Did (NAME) ever have any vaccinations to prevent him/her from getting diseases......... . an injection given in the thigh or buttocks............ ÿ «? .....................««««««««...............1 No ««««.. that is.. an injection in the arm or shoulder that usually causes a scar?  Polio vaccine.............. which is..2 About the same««........ .....2 Do not know...............«««......... «««««««««8 Yes «««««««««««««.......... sometimes at the same time as polio drops? Yes «««««««««««««.............1 No ««««........... «««««««««8 Yes «««««««««««««....316 ....3 More««««««...... Was he/she given less than usual to drink.............1 No ««««. 2 Do not know.............................. .... Yes «««««««««««««........1 No ««««.2 Do not know..............8 Yes «««««««««««««..... «««««««««8 Much less«««««««««««.

...«.............«.04 Buried««««««««««.....6 Don't know««««««««««..K Other Private Medical Sector _________________L (specify) 6 ‘ ‘ Shop««««««««««««..E Other Public Sector ________________________F (specify) ‘ ‘ ‘ Pvt.5 Never gave food««««««««.«........ A fluid made from a special packet called (local name for ORS packet)? b).......5 Don't know««««««««««..2 About the same«««««««........05 Left in the open... about the same amount.. Health Post««««««... PROBE: Was he/she given much less than usual to eat or somewhat less? 313 Did you seek advice or treatment for the diarrhea from any source? 314 Where did you seek advice or treatment? Anywhere else? If unable to determine If public or private sector... Health Center«««««««B Govt......8 Much less«««««««.««««««.. A pre-packaged ORS liquid? c)..«06 Other ________________________96 (specify) ..C Mobile Clinic««««««««.. was he/she given less than usual to eat........1 2 8 Homemade Fluid«««.«.. A government-recommended homemade fluid? The lat time (Name) passed stools..««...«....01 Put/rinsed into toilet or latrine««..........1 2 8 ORS Liquid««««.1 Somewhat less««««««.8 Yes «««««««««««««...I Mobile Clinic«««««««..««...3 More««««««««««««.....4 Stopped food«««««««««.312 about the same amount.....««..315 )‘ ‘ Govt..««««... Hospital«....«... or more than usual to drink? If less. what was done to dispose of the stools? 316 ÿc Nothing to drink««««««««....«««.J Field Worker««««««.......D Field Worker«««««««......2 ... write the name of the place.... Was he/she given much less than usual to drink or somewhat less? When (NAME) had diarrhea.N Other ________________________ X (specify) Yes No DK Fluid from ORS Packet«««««.«.02 Put/rinsed into drain or ditch«««03 Thrown into garbage.M Traditional Practitioner«««««.. Hospital/Clinic«««««.G Pharmacy««««««««...H Private Doctor«««««««««.....A Govt.....1 2 8 Child used toilet or latrine. or nothing to eat? If less. more than usual.. ___________________________ Name of Place 315 Was he/she given any of the following to drink at any time since he/she started having the diarrhea: a)....«.««...1 No ««««....

/&.c  )&.  ‘ .

I will let you know when we are near the end of our time. Ethiopia. I will start the conversation out with a question. (Have each participant introduce him or herself by name. Feel free to disagree with what others have said or give another opinion: the more different ideas we hear. You are the experts on this topic: the information you give us will help us develop/improve health extension programs to help you and others. I will be moderating this discussion. but after that I will just jump in to get us back on track if we have gotten off the topic. the more information we will have to work with. ___________ will be recording the discussion and taking notes.) ‘  ‘ ‘  ‘ Thank you for agreeing to help us with this PhD project. Immunization and Family Planning) in West Gojjam Zone. If you have to go to the bathroom. If you have any questions about this interview or the project after we leave. What you say here is confidential. just slip out quietly and come back as quickly as you can. Again. how you remember them.‘ +999. or you can talk to !‘ )‘:‘  ‘(the principal investigator). you can call us at 8+*‘ /*. We are interested in hearing your experiences: your name will not be included in any reports. who can get in touch with us. We appreciate your willingness to share your time and expertise. We are with the University of Gondar/Addis Continental Institute of Public Health and are working on a project entitled Implementation of Health Extension Program (Outcome of Health Extension Program on Maternal and Child Health.    ‘ I am __________.‘ 6$‘ 8+*‘ /‘ +09*. I want you to talk to each other rather than to me. Are there any questions before we begin? ÿî . we are interested in hearing your experiences. or to bring up something we are interested in that you have not covered. Amhara National Regional State.

‘ Could you tell me more about the health extension program benefits? Are there any misconceptions about the program in the community?    ÿJ ./&.‘ Do graduated households continue to be a model for non.)&.‘ When is a household said to graduated? 6. 8. 6· 1.‘ If graduated households fail to be a model for non-graduated households.graduated households for a long period of time? [sustainability.‘ What were the key health problems in your community before the implementation of health extension program? (PROBE: What were the main reasons that you had this health problem?) 3. what are the major reasons? 9. immunization.‘ What changes are occurring regarding the health of the community? (Probes: what are the changes on maternal and child health? What are the changes on immunization? And what are the changes on family planning?) 5. in your view.‘ Are there differences between graduated households and non-graduated households? (Probes: in terms of maternal and child health.‘ What is health extension program to you? (PROBES: How do you see the program? What does it look like in your village/community?) 2.‘ What are the key health problems in your community currently (after the implementation of health extension program)? (PROBE: What are the main reasons that you have this health problem?) 4. and family planning?) 7.

Although I will be taking some notes during the session. We are with the University of Gondar/Addis Continental Institute of Public Health and are working on a project entitled Implementation of Health Extension Program (Outcome of Health Extension Program on Maternal and Child Health. Remember. This means that your interview responses will only be shared with research team members and we will ensure that any information we include in our report does not identify you as the respondent.  I want to thank you for taking the time to meet with me today. Are there any questions about what I have just explained? Are you willing to participate in this interview? _____________________________ _______________________________ ________________ Interviewee Witness Date          ÿ . All responses will be kept confidential. immunization and family planning in order to capture lessons that can be used in future interventions. Because we¶re on tape. I will be taping the session because I don¶t want to miss any of your comments. Specifically. I can¶t possibly write fast enough to get it all down. I am __________. Immunization and Family Planning) in West Gojjam Zone. please be sure to speak up so that we don¶t miss your comments.c º 2 /5. I will be indepth interviewing you. I would like to talk to you about your experiences of health extension program (outcome of health extension program). ‘  ‘ ‘  ‘ Thank you for agreeing to help us with this project. as one of the objectives of our PhD project we are assessing the program outcome on maternal and child health. The interview should take less than an hour. recording the interview and taking notes. Amhara National Regional State. you don¶t have to talk about anything you don¶t want to and you may end the interview at any time. We appreciate your willingness to share your time and expertise. Ethiopia.

  2/5. · & $#7>7 &3   9 3  Interviewer code: _______________________________________________________________ Respondent Code: ______________________________________________________________ Region: ____________ Zone: _____________ District: _____________ Kebele: ___________ Name(s) and role(s) of respondent(s):??????????????????????????????????????????????? ?????????????????????????????????????????????????????????????????????????????? ?????????????????????????????????????????????????????????????????????????????? ?????????????????????????????????????????????????????????????????????????????? Interviewer Comments: __________________________________________________________ Date: ____________________Time: from: ____________________to_____________________  2 /56·  c ‘   ‘‘ ‘‘ ‘ ‘"‘ .(.

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 !/· The purpose of this research is to assess the implementation of health extension program in relation to motivation of health extension workers (HEWs). While the program is innovative and is supposed to bring better health status of population especially in peripheral areas. we invite you to take part in our project. you need to understand and sign the consent form. you will be asked to give your response by the data collectors. If you are willing to participate in our project. improving healthy practice. immunization and Maternal and child health in West Gojjam. Therefore the findings of this study will contribute a substantial share in maximizing utilization of health service. All the responses given by the participants and the results obtained will be kept anonymous and confidential using coding system where by no one will have access to your responses.   :&·By participating in this research project you may feel that it has some discomfort specially on wasting your time (-%2) but this may not be too much as you are going to health institutions for you and your family health care and comparing its c× .  For this questionnaire based study.. utilization of health extension program (HEP) services by the community and outcome of HEP on the community in terms of family planning. and enhancing motivation of HEWs and overall reduction of morbidity and mortality... Ethiopia.. Health service extension program is an innovative approach which is encompassed under the Health Sector Development Program to meet the millennium Development Goals (MDGs). The investigator is PhD student from University of Gondar /Addis Continental Institute of Public Health. Then. >7  #(7 /. >7   # (7 /..This information sheet and consent form is prepared by the investigator whose main aim is to study /   9 /#   . participants are health extension workers and all mothers (women aged 15-49) during the study period. Amhara national Regional State. studies done concerning program are rare. !& · In order to assess the /   9 !#   .

utilization of health extension program and outcome of the health extension program and in identifying factors affecting these issues in West Gojjam Zone. and it will not be revealed to anyone except the principal investigator. Information about you that will be collected from the study will be stored in a file. without losing any of your rights as a resident of this site. Finally it will give an insight whether policy change is required or not based on the findings of the study for improving the health status of the community. Which number belongs to which name will be kept under lock and key. You have also the full right to withdraw from this study at any time you wish to. There is no risk in participating in this research project.com ca .com OR mezgebuy@gmail.potential benefits it contributes to the overall improvement of the health status of the community. 1.    ·The information that we will collect from this research project will be kept confidential. Amhara National Regional State. but a code number assigned to it.   &·You will not be provided any incentives to take part in this project. you may not get direct benefit but your participation is likely to help us in assessing the motivation of health extension workers.  #     5: You have the full right to refuse from participating in this research (you can choose not to respond some or all of the questions) if you do not wish to participate. which will not have your name on it.  +· If you participate in this research project. and this will not affect your health services you get at from any health facilities. !&&·If you have any question you can contact any of the following individuals and you may ask at any time you want.‘ )‘:‘   University of Gondar/Addis Continental Institute of Public Health Tel: +251 581 116221/ +251 920 252761 OR +251 918 056668 E-mail: mezgebuy@yahoo. Ethiopia.

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  · Mezgebu Yitayal Mengistu (9· Male !&+· Addet.Health 2004-2006 Master of Public 3. Ethiopia +· 10/07/1975 c ## - Language Amharic English Speak :‘ :‘ Read :‘ :‘ Write :‘ :‘ î  &+&#  #: ) (  !     5  .!  Addis Ababa MPH.47 Gondar* * University of Gondar was formerly known as Gondar College of Medical Sciences and it was under Addis Ababa University % #$((3 {‘ Modular training on !7 7    . West Gojjam.39 Health Science University of Sanitary Science 1992-1994 Diploma 3.52 University Management Health Jimma University Environmental 1998-2001 Bachelor of Science 3.

 .organized and conducted by EPHTI.organized and conducted by Health Education Center. Ethiopia from 2c::î% ccJ . ) &#2# /.organized and given by Gedeo Zone Health Department at Dilla. Federal Ministry of Health of Ethiopia in collaboration with Johns Hopkins University Center for Communication Programs and United Nations Population Fund at Nazareth.organized and given by Gedeo Zone Health Department at Dilla. Ethiopia from î::caaÿ2c:º:caaÿ {‘ Training on  #. Ethiopia from c%2c :º:caaÿ {‘ Training on  #  (. Carter Center-Ethiopia at Nazareth. Ethiopia from %2ÿ::îî {‘ Training on &   &   &&.organized and conducted by South Nations Nationalities and People` s Region Health Bureau in collaboration with Gedeo Health Department and ESHE/JSI at Dilla. Ethiopia from c2îÿ:î:î% {‘ Ethiopian Public Health Training Initiative (EPHTI) Curriculum Development and Staff Strengthening.

health economics and public health courses for under graduate and graduate students and participating in extracurricular activities of the university. and receiving assignments from the Head of the Public Health Faculty {‘ îc2îî· District Environmental Health Expert at Yirgacheffe District Health office.{‘ Training on   &. {‘ îî2î· Instructor and Department Head for Environmental Health department. School of Public Health. Hawassa University /-· teaching environmental health and health sciences students. Health Sciences College. Department.organized and conducted by the Carter Center/EPHTI in collaboration with the LINKAGES Project at Dilla College of Teacher Education and Health Sciences from cÿ2ca:c:î {‘ Training on & #. South Nations Nationalities and People` s Region Health Bureau. Gedeo Zone Health. Ethiopia /-· planning. Department. and health care facilities of the district. Gondar. {‘ cc:a:î2 :î:î · Dean and Instructor at Abay Health College. and receiving assignments from the Head of the District Health Office {‘ caa2caa · District Sanitarian at Bulle and Yirgacheffe District Health offices. College of Medicine and Health sciences. {‘ cc:a:îÿ2c:a:î· Academic Vice Dean and Instructor at Abay Health College. Gedeo Zone Health. Debre Markos. Ethiopia /-· teaching health management.organized and conducted by the LINKAGES Project in Ethiopia in collaboration with the Carter Center/EPHTI. implementing and evaluating environmental health department activities. at Debub University from îÿ2î::î     9/& {‘ a:î:î  · Lecturer and Head at Department of Health Management and Health Economics. implementing and evaluating environmental health activities of the district: carrying out supervision of food and drinking establishments. Ethiopia /-· planning. implementing and evaluating curricular activities of the college and teaching health science students. South Nations Nationalities and People` s Region Health Bureau. implementing and evaluating curricular activities of the college and teaching health science students. Ethiopia /-. Ethiopia Working for each districts for two years cc . Debre Markos. University of Gondar.planning. planning. Faculty of Public Health.

2006(unpublished) {‘ Review of literature on environmental and health to help the environmental economics policy forum to identify possible research ideas for future contracted by Environmental Economics Policy Forum for Ethiopia. 2007(unpublished) {‘ Economic Burden of Tuberculosis to Patients and Their Families: a Cross-sectional Study at Felege Hiwot Referral Hospital. E-mail: shewit91@yahoo. Microsoft power point and Microsoft excel     Mezgebu Yitayal P.planning.com ccº . Addis Ababa University Tel: + 251 911 406790. E-mail: bewassie@yahoo. Yilmana Densa District. Amhara National Regional State. and receiving assignments from the Head of the District Health Office º & {‘ Economic Burden of Tuberculosis to Patients and Their Families: a Cross-sectional Study at Addet Health Center. +251 111 558386(Home): E-mail: mezgebuy@yahoo. carter center/USAID. Belaynew Wassie. Faculty of Medicine.com II. Bahir Dar . Amhara National Regional State. Armauer Hansen Research Institute (AHRI) Tel: + 251 911 247525. Mesfin Addisse. implementing and evaluating environmental health activities of the districts: carrying out supervision of food and drinking establishments. Ethiopia Tel: 0920 252761 OR 0918 056668 (mobile). Community Health Department.com  a & I.‘ Dr. Ethiopia  -- ( {‘ Browsing internet and communicating with peoples and organizations.‘ Dr. School of Public Health College of Medicine and Health Sciences University of Gondar. E-mail: aseffaa@yahoo. and working ability of Microsoft word.com OR mezgebuy@gmail. and health care facilities of the districts. School of Public Health. Gondar.com III. (2004): Food Hygiene for Environmental Health Students.O./-. and W/Cherkos A. watching TV especially soccer match and athletics championship.‘ Dr Abraham Aseffa. Box 628. 2004 ÿ !-& {‘ Yitayal M. University of Gondar Tel: + 251 911 385423/+251 918 778268.

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