Promoting and institutionalizing community health cadres in Ethiopia to enable progress towards the SDGs: a historical perspective

Ethiopia has experimented with various approaches to establish and sustain cadres of community health workers to provide basic services to a large, diverse and mostly rural population. This chapter examines the factors underpinning the evolution of village-based health systems, and elements retained over different political periods which led to the creation of the contemporary health extension workers (HEWs) and Women’s Development Army (WDA) cadres that are central to the country’s primary healthcare (PHC) strategy. Ethiopia’s experience underscores that strong and consistent political and social commitment and support are critical for establishing and sustaining effective PHC. However, while political backing is essential for program initiation and expansion, perceptions of political affiliation of health workers can also lead to them facing suspicion and losing public trust. Strong local ownership is key to ensuring the sustainability and effectiveness of Ethiopia’s approach to achieving universal health coverage, a key element of SDG 3.