Online Program

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

Wednesday, November 6, 2013 : 8:45 a.m. - 9:00 a.m.

Mary A. Carnell, MD MPH, Center for Maternal, Newborn & Child Health, John Snow Inc., Arlington, VA
Amanda Pomeroy, MS, John Snow, Inc., Arlington, VA
Leanne Dougherty, John Snow Inc, Arlington, VA
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.

Learning Areas:

Biostatistics, economics
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess the impact of USAID/ESHE project to improve evidence-based child health interventions. Discuss the results from four survey instruments to measure the impact of ESHE strategy to improve health systems, health worker performance and community engagement. Describe the strengths of the Difference-in-Differences logistic regression model to assess program impact in a rapidly changing environment

Keyword(s): Child Health Promotion, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the project director of ESHE/USAID project and Senior Advisor.
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.