• Duduzile Nsibande, Marian Loveday, Karen Daniels, David Sanders, Tanya Doherty, and Wanga Zembe.
• Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
• Afr Health Sci. 2018 Mar 1; 18 (1): 188-197.

BackgroundGlobally, preventable and treatable childhood conditions such as pneumonia, diarrhoea, malaria, malnutrition and newborn conditions still account for 75% of under-five mortality. To reduce the mortality rate from these conditions, Ethiopia launched an ambitious Health Extension Programme (HEP) in 2003. Trained Community Health Workers (CHWs), named Health Extension Workers (HEWs) were deployed to deliver a package of care which includes integrated Community Case-Management (iCCM) of common childhood diseases.ObjectivesThis qualitative study aimed to explore approaches and strategies used in the HEW training and supervision as part of an evaluation of the Catalytic Initiative to Save a Million Lives.MethodA qualitative rapid appraisal study using focus group discussions and in-depth interviews was conducted.ResultsTraining of HEWs followed a cascaded training of trainer approach supported by implementing partners under guidance of the Ministry of Health. A comprehensive planning phase enabled good coverage of districts and consistency in training approaches. Training was complemented by on-going supportive supervision. HEW motivation was enhanced through regular review meetings and opportunities for career progression.ConclusionThese findings describe a thorough approach to training and supervision of HEWs delivering iCCM in rural Ethiopia. Ongoing investments by partners will be critical for long-term sustainability.

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