Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America.
University Research Co. Chevy Chase, Chevy Chase, MD, United States of America.
PLoS One. 2023 Nov 27;18(11):e0291958. doi: 10.1371/journal.pone.0291958. eCollection 2023.
Since 2003, the government of Ethiopia has trained and deployed more than 42,000 Health Extension Workers across the country to provide primary healthcare services. However, no research has assessed the return on investments into human resources for health in this setting. This study aims to fill this gap by analyzing the return on investment within the context of the Ethiopian Health Extension Program.
We collected data on associated costs and benefits attributed to the Health Extension Program from primary and secondary sources. Primary sources included patient exit interviews, surveys with Health Extension Workers and other health professionals, key informant interviews, and focus groups conducted in the following regions: Amhara, Oromia, Tigray, and the Southern Nations Nationalities and Peoples' Region. Secondary sources consisted of financial and administrative reports gathered from the Ministry of Health and its subsidiaries, as well as data accessed through the Lives Saved Tool. A long-run return on investment analysis was conducted considering program costs (personnel, recurrent, and capital investments) in comparison to benefits gained through improved productivity, equity, empowerment, and employment.
Between 2008-2017, Health Extension Workers saved 50,700 maternal and child lives. Much of the benefits were accrued by low income, less educated, and rural women who had limited access to services at higher level health centers and hospitals. Regional return ranged from $1.27 to $6.64, with an overall return on investment in the range of $1.59 to $3.71.
While evidence of return on investments are limited, results from the Health Extension Program in Ethiopia show promise for similar large, sustainable system redesigns. However, this evidence needs to be contextualized and adapted in different settings to inform policy and practice. The Ethiopian Health Extension Program can serve as a model for other nations of a large-scale human resources for health program containing strong economic benefits and long-term sustainability through successful government integration.
自 2003 年以来，埃塞俄比亚政府在全国范围内培训并部署了超过 42000 名卫生推广员，以提供初级医疗保健服务。然而，在这方面，没有研究评估对卫生人力资源的投资回报。本研究旨在通过分析埃塞俄比亚卫生推广计划的投资回报来填补这一空白。
我们从初级和二级来源收集了与卫生推广计划相关的成本和收益数据。初级来源包括患者退出访谈、对卫生推广员和其他卫生专业人员的调查、关键知情人访谈以及在以下地区进行的焦点小组讨论：阿姆哈拉、奥罗莫、提格雷和南方各族人民地区。二级来源包括从卫生部及其附属机构收集的财务和行政报告，以及通过 Lives Saved Tool 获得的数据。考虑到通过提高生产力、公平性、赋权和就业获得的收益，对投资进行了长期投资回报率分析，其中包括方案成本（人员、经常性和资本投资）。
在 2008-2017 年期间，卫生推广员挽救了 50700 名母婴生命。大部分收益由低收入、教育程度较低的农村妇女获得，她们在较高水平的卫生中心和医院获得服务的机会有限。区域回报率在 1.27 美元至 6.64 美元之间，总体投资回报率在 1.59 美元至 3.71 美元之间。
虽然投资回报的证据有限，但埃塞俄比亚卫生推广计划的结果显示出类似的大规模、可持续系统重新设计的前景。然而，需要在不同的环境中对这一证据进行背景化和调整，以为政策和实践提供信息。埃塞俄比亚卫生推广计划可以作为其他国家大规模人力资源投资的一个模型，通过成功的政府整合，实现强大的经济效益和长期可持续性。
