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Health Education and Training (HEAT) latest news


With the launch of the HEAT programme in 2010/2011, rural Health Extension Workers (HEW) in Ethiopia received brief training in mental health and childhood developmental problems such as autism and intellectual disability for the first time. Up to 1 in 100 children and adults in Ethiopia may be affected by autism, but the country’s only diagnostic and educational centres are in Addis Ababa and therefore inaccessible to the majority of the country’s population living in rural villages. In 2012, the charity Autism Speaks funded a team from the OU’s Life, Health and Chemical Sciences Department and the Department of Psychiatry at Addis Ababa University (AAU) to research the knowledge, attitudes and current practice of rural HEWs on a range of adult and childhood mental health and childhood developmental problems. This HEAT+ project revealed a need for more training in early detection, particularly in children, and specific support in tackling the stigma that often leads individuals affected by conditions such as autism to be concealed by their families. 

In response to these research findings, the HEAT+ team, with the Ethiopian Federal Ministry of Health built on the HEAT mental health training, producing a ‘Mental Health Pocket Guide’ aimed at reinforcing and extending training in adult and childhood mental health and developmental problems.  The OU/AAU team also filmed five short scenarios modelling an HEW interviewing mothers of children with autism or intellectual disability to demonstrate skills in early detection, supportive counselling and problem solving. In an evaluation, the research team found that these materials had a beneficial effect in counteracting HEWs’ negative beliefs about, and desire for social distance from autistic children (1)  

Currently the training materials are included in PRIME (Programme for Improving Mental health carE), a large scale programme aimed at addressing the mental health treatment gap in five African and Asian countries including Ethiopia, by the implementation of evidence-based Mental Health Care Plans trialled at district level.  It is hoped that the training materials will in due course be more widely distributed to Ethiopia’s 39,000 rural HEWs, to support and extend the mental health services they provide for the 65 million Ethiopian’s living in rural communities.

The HEAT+ team was led by Dr Rosa Hoekstra, now at Kings College London. A version of the Mental Health Guide adapted for international use by OU project collaborator, Dr Ilona Roth, together with the five training videos, are available as mental health training resources for free download via:


Tilahun D, Fekadu A, Tekola B, Araya M, Roth I, Davey B, Hanlon C, Hoekstra RA (2017) 'Ethiopian community health workers’ beliefs and attitudes towards children with autism: impact of a brief training intervention.' AUTISM (first published September 25 2017) DOI:; Open Access: