Family Folder System Guides Health Workers in Ethiopia

Family folder systems are helping Health Extension Workers in Ethiopia follow up with patients and keep track of their health.

When Health Extension Worker (HEW) Tigist Adane referred a sick child to the hospital, she was reminded of the child’s illness and the need to follow up with the family because of a simple card in front of her. Each day she looked at the infant’s health card kept at the health post, and when she did not hear any news of the child’s status, Tigist visited the family at home. The child’s mother was so impressed by Tigist’s visit that she told other mothers in the neighborhood.

This mother sharing her story “helped build trust in me,” says Tigist.

These child and other health cards are part of a family folder system being used in Ethiopia, an extension of the country’s Community Health Information System (CHIS). For the family folder program, HEWs conduct individual household numbering and assessments of each household’s health behaviors, such as whether mosquito bed nets are being used to reduce malaria infections, and availability of adequate latrines and safe drinking water. HEWs then take the information they gathered to make a kebele (village) health profile, and assign a set of health cards on individuals in each home as part of a family folder for the home. These health cards are then kept at the health post and HEWs update them when family members come to the post for care. 

To cover family members who may not come to the health posts, HEWs also visit every household in the village about every two months. Even families that visit the health posts for care receive these home visits as part of regular follow-up. There are generally two HEWs per one health post. Both the CHIS and family folder system began in Ethiopia with a 2010 pilot implementation in four villages: two in the Southern Nations, Nationalities, and People’s Region and two in the Amhara region. The family folder system is now being carried out in three regions.

Tariq Azim, a resident advisor for MEASURE Evaluation, says Tigist’s story shows how the family folder system is helping with relationship building between the health worker and the family. “One big benefit is that it is a family-centered or family-oriented approach,” says Azim.

HEWs receive follow-up assistance from MEASURE Evaluation to help them better understand the family folder system, including the system’s “tickler file” for tracking people in need of health services. More about Tigist and other HEWs’ experiences with the family folder system can be accessed at