Implementation of the Health Extension Program Optimization Roadmap: The Case of Shashemene Wereda, Oromia Region, Ethiopia

Background The Ethiopian government had revised the Health Extension Program (HEP) after 15 years of its application, resulting in the Optimization of the Health Extension Program (OHEP). This optimization developed a roadmap to guide HEP from 2020 to 2035, which has been in operation for nearly five years. Thus, this assessment aims to document progress, obstacles, and lessons learned in the process and provide evidence for consideration in informing subsequent years. Methods An exploratory design was employed in Shashamane Wereda (district) of the Oromia region in Ethiopia from May 22 to June 1, 2025. The study conducted key informant interviews and focused group discussions among 40 participants from various health structures, community leaders, village health leaders, and stakeholders who contribute to the optimization agenda. Data saturation was observed at each level of participant category. Findings were transcribed, coded, and analyzed thematically. Results At policy level, our study revealed that the optimization was ambitious but short-lived, with early political advocacy driving its rollout. In the wereda, 13 Basic and three Comprehensive Health Posts are operational, with multidisciplinary teams in comprehensive posts; however, service delivery is inconsistent due to supply shortages and staff grievances in duty and workload. Although community-level health service delivery could thrive with structured multi-sectoral collaboration, this was grossly missing. Conclusion While the optimization roadmap offers opportunities to extend health services to end users at the community level, its success within the remaining timeline calls for charting mechanisms on how to ensure consistent availability of medical supplies and equipment and motivate the health team at the health post level. Furthermore, the Ministry of Health should define how to ensure support for primary health care and health service delivery at the community level by all sectors, with defined accountability for multisectoral collaboration.