263735 Adding value to Ethiopia's Health Extension Program: Impact evaluation of the USAID/ESHE project

Monday, October 29, 2012 : 9:15 AM - 9:30 AM

Mary A. Carnell, MD MPH , Center for Maternal, Newborn & Child Health, John Snow Inc., Arlington, VA
Amanda Pomeroy , Lead Monitoring and Evaluation Specialist, John Snow, Inc., Arlington, VA
Leanne Dougherty , Knowledge Management Services (KMS), John Snow Inc, Washington, DC
Brian Mulligan, MPH , John Snow Inc., Arlington, VA
Yared Mekonnen, PhD , Mela Research PLC, Addis Ababa, Ethiopia
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.

Learning Areas:
Administer health education strategies, interventions and programs
Biostatistics, economics
Implementation of health education strategies, interventions and programs
Program planning
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Assess the impact of USAID/ESHE project to improve evidence-based child health interventions. 2. Name the project's three pillars of strategy responsible for increasing population coverage of key child health indicators. 3. Describe the stregths of the Difference-in-Differences logistic regression model to assess program impact in a rapidly changing environment.

Keywords: Child Health, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was USAID/ESHE Project director. I am first author on a manuscript being submitted for peer reveiw publication on results of this impact evaluation. I have been Chief of Party of many USAID funded MCH projects in Bangladeseh, Madagascar and Ethiopia. I have made oral presentations at APHA, GHC and WFPHA. My particularly interest is the power of community health teams in developing countries to contribute to reaching health goals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.