Eleven years ago, when Medihenit Angasu went into labor at home and eventually needed an emergency cesarean section, Aberu Birbirsa never left her side.
“She went (to the hospital) with us that night, and when I entered the theater room, she said she would come inside with me. I was so thankful,” says Medihenit.
Aberu is a health extension worker attached to Medihenit’s local clinic in Koka, Ethiopia. Today, Medihenit is expecting her third child, and Aberu remains by her side — providing prenatal care, ensuring she attends her appointments, and informing health workers about her previous emergency C-section so they can take every precaution for a safe delivery.
Two decades ago, Ethiopia’s health system was under significant pressure. The country grappled with high burdens of HIV, tuberculosis (TB) and malaria, as well as elevated maternal and child mortality rates.
Around 100 km away in the Debre Abay neighborhood in Addis Ababa, another health extension worker, Tizta Shibru, visits Marden Tesfaye and her 3-year-old daughter Nuhmai.
Marden says Tizta and her colleagues are essential in protecting her family’s health:
“They teach us how to prevent diseases and how to recognize signs of sickness. Having this support during my pregnancy was very important.”
In 2003, the government launched the Health Extension Program, which trains and supports community-based health workers like Aberu and Tizta.
Today, approximately 40,000 salaried health extension workers have been deployed across the country, delivering lifesaving services that prevent disease, improve maternal and child health, and treat common illnesses – often right in people’s homes.
Most of the health extension workers are women, which helps build trust – particularly for women during pregnancy, childbirth, postpartum and when their children are young. Health extension workers are fully embedded within the Ministry of Health, ensuring consistent training, supervision and salaries.
Melaku Hilma helps manage the program for the Ministry of Health in Koka and has seen the impact firsthand as communities are empowered to advocate for themselves.
“Community health literacy has improved, and the community is now demanding these services from the government,” he says.
Despite challenges posed by conflict, displacement and extreme weather, Ethiopia’s health systems have made remarkable progress over the past two decades.
A child born in the country today is nearly three times more likely to survive to their fifth birthday than a child born in 2000. A major contributor to this success has been a 71% drop in under-5 deaths from HIV, TB and malaria.
Ethiopia has made remarkable progress in saving mothers' lives, cutting maternal deaths by 73% over the past two decades. In 2000, about 1 in every 100 women died during childbirth. By 2023, that number had dropped to about 1 in 500.
The work of health extension workers like Aberu and Tizta has been vital to making this happen.
Domestic financing has covered core costs for the Health Extension Program, including salaries and training. This funding has been bolstered by investments from partners, including the Global Fund.
The Global Fund has supported Ethiopia’s Health Extension Program for decades, assisting in its national scale-up and the provision of essential tools: HIV and malaria tests, medicines, insecticide-treated nets and other vital health supplies.
The Global Fund’s Catalytic Investments—such as Africa Frontline First have supported the long-term financing and professionalization of community health workers while the Digital Health Impact Accelerator has helped strengthen digital tools and data systems.
Through its catalytic funds, private sector contributions to the Global Fund have been used to reach over 16,000 rural health extension workers with a new training program. The training combines self-guided learning on tablets with in-person instruction.
Health extension workers have been trained in a broad set of interconnected skills – covering maternal and child health, disease prevention and treatment, adolescent health, nutrition, and other essential services – so they can provide comprehensive, coordinated care to communities.
The learning modules are loaded on the tablets and can be used to pass on important health information or advice to women during home visits.
Not only has the blended training program – developed by the Ministry of Health and other partners – saved time and improved learning outcomes; it has also cut costs by approximately 40% compared to conventional in-person learning.
Tablets are used to record and share community health data with officials in real-time, as well as to track visits and health information.
“It has simplified many tasks for us,” says Aberu. “There are also many modules, applications and trainings on the tablet that help us stay updated.”
The Health Extension Program has transformed community health care, but challenges remain.
Aberu’s and Tizta’s workloads are immense.
Both women are responsible for 500 households. It’s a huge workload, and transportation can be particularly challenging in rural areas. Aberu often walks 20 km a day while doing home visits.
But, the impact of Aberu, Tizta and their colleagues is undeniable – a powerful example of how Global Fund support for government-led efforts can strengthen community-based care.
Governments lead, while the Global Fund works in partnership, including through private sector-supported catalytic funds, to help accelerate and scale new approaches and innovations – a proven model for fighting disease and transforming health care for women, children and entire communities.
© 2026 The Global Fund
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