Evidence based scaling-up an innovative community-based maternal and newborn health strategy in Ethiopia

The health extension program (HEP) is Ethiopia's major vehicle to reach its health related MDGs. Since 2008 the Last Ten Kilometers (L10K) project has been implementing and testing innovative community-based strategies in 115 districts covering a population of about 14 million people, to enhance the capacity of the front-line health workers (FHWs) of the HEP to improve maternal and newborn health (M&NH) care behavior. As an innovative strategy the community-based data for decision-making (CBDDM) is being implemented in 14 L10K districts covering a population of about 1.6 million to enhance its primary objective. CBDDM fosters partnership between the grassroots public administration, HEP FHWs, community institutes, and community members to implement a community-based surveillance system to track pregnant mothers and ensure utilization of the M&NH services provided by HEP.

Difference-in-difference analysis using multilevel mixed-effects regressions of data from baseline (December 2008) and midterm (December 2010) surveys indicated that increase in M&NH coverage was statistical significantly higher in the CBDDM areas compared to other L10K areas where CBBDM was not implemented. Face value analysis of data obtained from 4,217 supportive supervisory visits during the period January to December 2012 indicated that increase in skilled delivery and early postnatal care has continued to be higher in the CBDDM areas. Latter findings support the decision to spread CBDDM to all the 115 L10K districts which was based on the earlier findings. Data from L10K supportive supervision will inform the effectiveness of the scaling-up strategy. CBDDM can be potentially adapted by community-based programs elsewhere.