Adding value to Ethiopia's Health Extension Program: Impact evaluation of the USAID/ESHE project

Introduction: Ethiopia ranks sixth globally in under-five deaths. The government created the national Health Extension Worker (HEW) program of 30,000 women. To complement two HEWs in each village, 20-30 volunteer community health promoters were trained by USAID/Essential Services for Health in Ethiopia(ESHE) project as role models to extend the reach of HEWs. This initiative was scaled-up in the three largest regions, training over 54,000 volunteers. ESHE also implemented interventions to strenghten health systems and health worker skills. Methodology: Quasi-experimental pre and post household surveys were conducted in 2003 and 2008. 180 clusters representative of 55 million populations were sampled across three regions including 4293 households. ESHE program effect was isolated on four indicators: exclusive breastfeeding, CPR, DPT3, and household latrines. Efforts ensured the control group resembles the intervention group along socio-demographic characteristics. Difference-in-Differences logistic regression model tested the impact of the ESHE program on the four outcomes. Results: Significant region-wide results documented changes between the pre and post household surveys include: exclusive breastfeeding- 57% to 77% with 13% differenced improvement compared to controls, DPT3- 46% to 71% with 11% differenced improvement compared to controls, and latrines- 35% to 89% with 11% differenced improvement compared to controls. Although CPR increased from 18% to 36%, the differenced improvement of 3% was not significant. Conclusion: Engaging volunteers to extend the reach of community based HEW significantly boosted already impressive achievements of the Health Extension Program in Ethiopia in several key child health indicators. USAID/ESHE contributed to decreased child mortality documented in 2010 DHS.