Health systems, health workers & communities: We can't reach MDG 4 without them all!

Introduction: In 2003, Ethiopia ranked sixth globally in under-five deaths and was not on track to reach MDG 4. USAID/Essential Services for Health in Ethiopia (ESHE) project used a ‘three pillar' approach to strengthen health systems, improve health worker performance and engage communities to address child survival. The focus was to improve coverage of evidence-based child health interventions: immunization, nutrition and IMCI. Initiative was at scale: 16.4 million in three regions. Methodology: Four survey instruments- household, health facility, performance improvement and health care financing- were administered at baseline and endline in each of the three regions. Results: Discussion of findings across the four survey instruments are included. ESHE intervention areas significantly outperformed comparison areas in coverage of measles, DPT3, latrines, contraceptive prevalence rate, and vitamin A coverage. Exclusive breastfeeding and complementary feeding improvement were not significant. Health care financing reforms resulted in doubling of government financing over five years in intervention areas. Facilities with at least one supervisory visit three months prior to survey increased: 47% to 82%. Stock-outs of IMCI essential oral drugs decreased from 42% to 29%. Median consultation time increased: 9 to 15.5 minutes. Correct treatment of childhood pneumonia increased: 5% to 65%; correct treatment of dehydration increased: 16% to 47%; and correct treatment of malaria increased: 18% to 59%. DHS 2010 indicates Ethiopia is now on track to reach MDG 4. Conclusion: Reaching MDG 4 requires balanced attention to health systems, health worker performance and community engagement. USAID/ESHE project contributed to Ethiopia's acceleration towards MDG 4.