Ethiopia has been working to achieve universal health coverage through optimizing the Health Extension Programme (HEP). The HEP optimization aspires to increase health service access, quality, and equity through different strategies, including establishing HEP units in health centres and primary hospitals. Therefore, understanding the processes of the HEP unit and its implementation experience is crucial for scale-up and sustainability.

This paper aims to document and share the lessons learned from implementing the HEP unit.

This research collected qualitative data from 14 districts/woredas in 2023. Forty-three in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted. Audio-recorded data were transcribed verbatim and translated. A thematic analysis approach was used to analyze the data, and direct quotations were used to present the findings.

In the Improve Primary Health Care Service Delivery (IPHCSD) project implementation sites, all 64 health centres, and primary hospitals established HEP units. Setting up the unit improved healthcare provision by promoting collaboration and teamwork, enhancing their skills, coordination, technical support to the catchment health post and increased access to healthcare services through outreach delivery. However, challenges such as a shortage of human resources, dedicated offices for the unit coordinators and team members, inadequate stakeholders’ engagement in the establishment processes, and insufficient tools and supplies were identified.

The HEP unit has improved community-level health services, enhanced health professionals’ skills and teamwork, and technical support to catchment health posts. Strengthening community engagement, advocacy, mentorship, training, and ensuring sufficient staffing, infrastructure, and supplies are essential for the programme’s scale-up and sustainability.