Thirty years after Alma Ata: Communities team up to close gap on reaching MDG 4 in Ethiopia

Background: Ethiopia ranks sixth globally in under-five deaths and suffers from too few trained human resources for health. Approximately 50% of the population resides over ten kilometers from a health center. To address this challenge, the government invested in an ambitious national Health Extension Worker (HEW) program, creating a cadre of 30,000 women workers. To complement two HEWs in each village, 20-30 volunteer community health workers were trained to be role models and assist HEWs to promote healthy actions. This USAID/JSI supported initiative was scaled-up in the three largest regions, training over 54,000 volunteers. In addition, UNICEF and Global Fund, among others, supported HEW and other health initiatives in these regions, with important assistance to supply and distribution of bednets and vitamin A.

Designs/methods: Pre and post household surveys were conducted in 2003 and 2008, respectively. Population proportional to size cluster survey sampling methodology was employed. A total of 180 clusters representative of a total population of 55 million were sampled across the three regions. The post survey included 4293 households, yielding robust coverage estimates of key evidence-based health interventions.

Results: Results demonstrate significant increases across many key evidence-based child health interventions that were cited in the 2003 Lancet Child Survival series. High coverage of these cost-effective interventions is needed if countries are to reach their MDG 4 of reducing child mortality by two-thirds in 2015 compared to 1990 levels. Significant region-wide results documented in the post household in the three regions combined include: exclusive breastfeeding- 57% to 77%, complementary feeding- 49% to 68%, modern contraceptive prevalence rate- 15% to 29%, insecticide-treated bednets- 2% to 52%, Vitamin A supplementation- 35% to 65%, DPT3- 46% to 57%, ORS- 24% to 31%, and care-seeking for sick children- 48% to 56%.

Conclusion: Teaming paid CHWs with a large number of community volunteers proved a successful strategy to rapidly bring significant change in key health behaviors in Ethiopia. Actively engaging the community to be full participants in health can help address the human health resource crisis in many developing countries. Other resource-constrained countries should examine the Ethiopia experience to glean lessons for closing their gap on reaching MDG 4.