Access to health and agricultural extension services

1. Access to health and agricultural
extension services
Tirsit Genye
IFPRI - NIPN
Diets, Affordability and Policy in Ethiopia:
From Evidence to Action
Addis Ababa | December 12, 2019

2. Introduction
 Ethiopia’s Food and Nutrition Policy:
“Improve availability and accessibility of adequate food to all
Ethiopians at all times”
“Access to quality and equitable nutrition and nutrition smart health
services to all Ethiopians at all times in all settings”
 To achieve objectives, extension agents envisioned to have major role to
deliver these different services
 If done well, they can have major impact

3. Extension in Ethiopia
 One of the most-dense extension services in the world
- 72,000 Development Agents (DAs) – 43 DAs per 10,000 farm households
- 42,000 Health Extension Workers (HEW) – 2 HEW per 5,000 individuals
 Research question:
- Food and Nutrition Policy stresses importance of reaching all Ethiopians
- Not clear how most remote rural households are served by these extension
services

4. Remoteness matters for nutritional outcomes
Remoteness negatively affects household diet diversity and food
consumption
Source: Headey et al, 2018; DHS data
0123456
0 20 40 60 80
Transport Cost (Birr/kg)
All Household Members Chldren under age 5
Average Number of Food Groups in Household Diet
0
20406080
100
Percent
Least Remote Quintile 2 Quintile 3 Quintile 4 Most Remote
Percent of Households Consuming Particular Food Items
Oil Milk
Meat Fruit

5. Remoteness and DAs
Remote farmers within kebeles and remote kebeles less exposed to DA services
0 2 4 6 8 10 12
Plot visited by DA
DA advice on type fertilizer
DA advice on type seed
DA advice on type of crop
%
Less likelihood of extension exposure
Remotest households (tercile) in kebele Remotest kebele (tercile) in woreda

6. Remoteness and DAs
Less DAs and lower effort by DAs in remote kebeles
 Number of DAs per kebele  Number of hours worked per week

7. Remoteness and DAs
DAs in remote kebeles: less experience and worse test scores
 Test scores Experience

8. Remoteness and HEWs
HEW exposure don’t vary by remoteness of kebele. However, within the kebeles,
households most remote from health posts are less exposed to HEW services
0 2 4 6 8 10 12
Knows HEW
Has met with HEW
HEW visited during pregnancy
Received antenatal care
%
Less likelihood of extension exposure
Remotest households (tercile) in kebele

9. Remoteness and HEWs
No difference in number of HEWs and effort by remoteness
 Number of HEW per kebele  Number of hours worked per week

10. Conclusions
 Remoteness matters, for nutritional outcomes and for service delivery
 Most remote households in each kebele less exposed to extension
services, health as well as agriculture
 While extension delivery worse in most remote kebeles for DAs, this is not
the case for HEWs
Implications:
1. Additional justification in further investments in rural roads
2. Better incentives and services required for those extension agents willing
to locate in more remote areas

11. Reference
Abate, Gashaw T.; Dereje, Mekdim; Hirvonen, Kalle; and Minten, Bart. 2019.
Geography of public service delivery in rural Ethiopia. ESSP Working Paper
133. Washington, DC and Addis Ababa, Ethiopia: International Food Policy
Research Institute (IFPRI) and Federal Democratic Republic of Ethiopia
Policy Studies Institute.
https://doi.org/10.2499/p15738coll2.133338