​Health extension workers (HEWs) in Ethiopia have a unique position: connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance.

Conducting a qualitative study in six districts in the Sidama zone, this paper finds that HEWs’ relationships with the community and health sector can be constrained as a result of inadequate support systems, lack of trust, communication and dialogue and differing expectations. Clearly defined roles at all levels and standardised support, monitoring and accountability, referral, supervision and training, which are executed regularly with clear communication lines, could improve dialogue and trust between HEWs and actors from the community and health sector. This is important to increase HEW performance and maximise the value of HEWs’ unique position.

Maryse C. Kok, Aschenaki Z. Kea, Daniel G. Datiko, Jacqueline E.W. Broerse, Marjolein Dieleman, Miriam Taegtmeyer and Olivia Tulloch