Publications
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Policy Briefs are concise, policy-relevant documents written for policymakers. The briefs present lessons learned and best practices from the L10K project in non-technical language.
Newsletters provide updates, editorials, and success stories about L10K activities.
Reports present program findings in a mix of technical and non-technical language, including both quantitative and qualitative results.
Surveys include documentation of L10K community surveys, including questionnaires and in-depth discussion of surveys results.
Peer-Reviewed Papers are based on major findings that were presented at a 2009 Ethiopian national scoping conference on maternal and neonatal health.
Policy Briefs
Findings from Implementing Non-Financial Incentives for Voluntary Community Health Workers (L10K Policy Brief 4)
This brief summarized the findings of a qualitative study of the implementation of non-financial incentives with voluntary community health workers, as well as the L10K project's "community anchors" approach. (2012)
Correlates of Health Extension Program Outreach Activities With Maternal Healthcare Seeking Behaviors in Ethiopia (L10K Policy Brief 3)
This brief looks at whether some of the improvements in maternal health indicators can be explained by HEP outreach activities. The brief presents results derived from a survey, which was conducted in all four L10K intervention regions. (2011)
Participatory Community Quality Improvement Approach (PCQI) in Ethiopia (L10K Policy Brief 2)
This brief provides an overview on participatory community quality improvement (PCQI), which is a community-based strategy implemented by L10K. The brief explains the PCQI approach and presents some of the headway made as a result. (2011)
Community Health Workers: Exploring Volunteerism as a Sustainability Model (L10K Policy Brief 1)
This brief presents the findings of a qualitative study exploring the potential of non-financial incentives (NFIs) in motivating voluntary community health workers (vCHWs) in four of the largest regions in Ethiopia. (2010)
Newsletters
News from the Last Ten Kilometers (Volume 3, Issue 4)
The June 2015 newsletter focuses on L10K’s family planning intervention. It gives details on how the Bill and Melinda Gates Foundation’s fund helps to further expand family planning services by enhancing demand for and improving quality of the service. This issue also consists of an insight into women’s understanding of family planning. Updates on what’s been happening in and around L10K in the last quarter is also given.
News from the Last Ten Kilometers (Volume 3, Issue 3)
The March 2015 newsletter focuses on L10K’s new intervention - expanded program on immunization. The newsletter gives details on how USAID/L10K’s EPI helps to contribute to the reduction of incidences of vaccine preventable diseases. This issue also consist of a brief story on an immediate change that took place by a health center since the recent commencement of the intervention. Updates on what’s been happening in and around L10K in the last quarter is also given.
News from the Last TEN Kilometers (Volume 3, Issue 2)
This issues of December 2014 is dedicated to finding out the thoughts of our readers regarding the L10K newsletter. We would like to know changes you’d like to see, what should we drop, what should we introduced, etc. Hence, we have developed a brief questionnaire (inside) and would like you to share your thoughts with us. The newsletter has also updates on what’s been happening in and around L10K in the last quarter.
News from the Last TEN Kilometers (Volume 3, Issue 1) 
The September 2014 newsletter focuses on Respectful Maternity Care. This has been recently introduced into the work of L10K as a strategy to improve women’s health care seeking behavior. The issue of the newsletter includes the voice of women and health workers regarding their experience of disrespect and abuse that occur in health facilities. The newsletter has also updates on what’s been happening in and around L10K in the last quarter with special attention on developments regarding respectful maternity care..
News from the Last Ten Kilometers (Volume 2, Issue 4)
The June 2014 newsletter focuses on Community Based Newborn Care (CBNC) intervention. This is an intervention that improves the survival of newborns incorporated with the Integrated Community Case Management (iCCM). This issue of the newsletter includes a story that narrates the benefits gained from CBNC. It also includes updates on various activities undertaken during the past quarter.
News from the Last Ten Kilometers (Volume 2, Issue 3)
The March 2014 newsletter focuses on Basic Emergency Obstetric and Newborn Care (BEmONC) intervention. This is a set of intervention that helps to manage complications of pregnancy which are the major causes of maternal deaths. This issue of the newsletter includes a story that narrates the benefits gained from BEmONC services. It has also updates on new activities undertaken during the past quarter.
News from the Last Ten Kilometers (Volume 2, Issue 2)
The December 2013 newsletter focuses on Community Based Nutrition (CBN) activities. Nutrition activities at the community level are hoped to help mothers take charge of the healthy growth of their children. This will contribute to decreasing infant and under-five mortality. This issue of the newsletter includes updates on networking efforts made during the quarter. It also includes a success story of a particular kebele in Amhara that brought favorable changes as a result of CBN activities.
News from the Last Ten Kilometers (Volume 2, Issue 1)
The September 2013 newsletter focuses on Participatory Community Quality Improvement intervention. This is a community based strategy that has resulted in a good number of community driven initiatives. This issue of the newsletter includes updates on new areas of engagement for L10K and activities that took place in the quarter. It also includes a success story of a particular kebele in Tigray.
News from the Last Ten Kilometers (Volume 1, Issue 4)
This June 2013 newsletter focuses on Early Care Seeking and Referral Solutions intervention. The issue includes updates on a new area of engagement for L10K and activities that took place in the quarter. It also includes a ‘before’ and ‘after’ experience of a health center in improving their services through positive initiatives resulting from the Early Care Seeking and Referral Solutions intervention.
News from the Last Ten Kilometers (Volume 1, Issue 3)
This March 2013 newsletter focuses on the Community Based Data for Decision Making (CBDDM) strategy. The strategy is one of the community based strategies of L10K that is in the process of being scaled up in 115 L10K operational woredas. Updates on new initiatives, surveys undertaken and visits made to project sites by donor agencies are included. A story of a Health Development Team Leader on using CBDDM is also part of this issue. (2013)
News from the Last Ten Kilometers (Volume 1, Issue 2)
This December 2012 newsletter focuses on the Mobile Health (M-Health). This issue includes updates on a new area of engagement for L10K and activities that took place in the quarter. It also includes a story on the experience of using M-Health in the Project. (2012)
News from the Last Ten Kilometers (Volume 1, Issue 1)
This October 2012 newsletter focuses on the integrated Community Case Management (iCCM) of common childhood illnesses. This issue includes updates on a new area of engagement for L10K, as well as a success story about making health services more accessible for remote health posts. (2012)
Reports
Responsiveness to COVID-19 pandemic and its Immediate Impacts on Essential RMNCH Services in Addis AbabaL10K has been supporting the Ethiopian Federal Ministry of Health and Addis Ababa City Health Bureau to address impacts of the COVID-19 pandemic on the health system and mitigate its effect on essential reproductive, maternal, newborn, and child health services. In collaboration with the International Institute for Primary Health Care in Ethiopia, L10K conducted a rapid assessment of selected health facilities to understand the immediate effects of COVID-19 on the continuity of essential maternal and child services in Addis Ababa city. (2020)
L10K 2020 Baseline Surveys (2016) of Households, Health Centers, Health Posts, and Health Development Army Team LeadersThe first phase of L10K Project, supported Ethiopia's flagship Health Extension Program (HEP) then Bill & Melinda Gates Foundation provided a new grant to implement the L10K 2020 Project. Building on L10K's experience to implement a set of new and modified community based strategies, L10K 2020 supported the implementation of the key priorities of the HSTP. To lay the foundation for monitoring and evaluating the effectiveness of its strategies, L10K 2020 conducted baseline household, health center, health post and HDA surveys. The estimates of the key indicators of interest from the baseline surveys are reported here. (2016)
Trends in reproductive, maternal, newborn and child health care practices
Over the course of the L10K project, three rounds of household and community surveys were conducted to measure the impact of L10K's innovations on RMNCH care behavior and practices. This report presents the changes observed across these three surveys on 1) the kebele health system supporting the Health Extension Program, 2) access and exposure to RMNCH messages and services, and 3) RMNCH behaviour and practices. The report also discusses the adequacy of these changes and identifies gaps that need further attention. (2015)
Community based family planning at selected health facilities in Ethiopia: Situational analysis
L10K is working closely with the Government of Ethiopia to demonstrate innovative solutions for addressing barriers to demand and quality of community-based long acting family planning services provided by primary health-care units (PHCUs). This study, was thus, conducted to improve understanding of family planning service provision and inform the design of the solutions. The study was conducted in eight PHCUs comprised of eight health centers and 41 health posts.
Trend in the Maternal and Newborn Health Care Practices in L10K Areas
The survey monitored the performance of two scaled-up interventions of L10K: community based data for decision making and non-financial incentives. It compared the findings with the L10K baseline (December 2008) and midterm (December 2010) surveys. The findings indicate that while some maternal health care activities increased significantly between the midterm survey and the rapid community survey, there were other health care services that did not improve as much and require more attention.
Participatory Community Quality Improvement (PCQI)- A Process Evaluation of
What is Working and What Can Be ImprovedThis report summarizes the findings of a study conducted to determine what is working and what can be improved with L10K's Participatory Community Quality Improvement (PCQI) approach. In depth interviews were conducted with community members, health workers, and health administrators, and key maternal and newborn health indicators were compared between the 12 months prior to, and the 12 months following initiation of PCQI. (2013)
Management Information System (MIS) of the Integrated Community Case Management (iCCM) of common childhood illnesses of the L10K ProjectL10K is supporting the Government of Ethiopia’s scale-up of integrated Community Case Management (iCCM) of common childhood illnesses by incorporating the strategy with the health extension program (HEP). To monitor and evaluate iCCM in terms of its access, availability, quality and performance, L10K established a management information system (MIS), designed by UNICEF. This document outlines the iCCM Monitoring & Evaluation (M&E) framework of L10K and its implementation.
Emergency referral for pregnant women and newborns: A Rapid Community and Health System Assessment
This report is a rapid assessment of basic emergency obstetric and newborn care (EmONC) in selected L10K project areas, prepared by the Beta Development Group and commissioned by the Averting Maternal Death and Disability (AMDD) Program. The assessment helped L10K evaluate shortcomings in rural obstetric care, in preparation for efforts to improve effective care-seeking and responding to these critical maternal and newborn health conditions. The report describes a mixed methods study, including quantitative surveys and focus group discussion revealed major problems with transportation to health facilities, as well as financial and other hindrances. (2012)
Implementing the Most Significant Change Technique by L10K: A Process Evaluation, September 2009 – September 2010Since 2009, the JSI-managed Last 10 Kilometers project has been implementing the Most Significant Change (MSC) technique to regularly record qualitative data regarding the progress and impact of project activities. The technique identifies unexpected results and undefined health indicators through interviews with community members about their health and experiences with L10K-supported care provision. MSC was designed to complement the existing quantitative monitoring and evaluation tools used to assess project outcomes.
This report presents the process evaluation of L10K's use of the Most Significant Change technique, which was carried out in the months of November and December, 2010. (2012)
Impact of the HEP on Maternal, Newborn and Child Health
This paper looks at the impacts made by the Health Extension Program (HEP) on maternal, newborn, and child health in four of the most populous regions of Ethiopia (Amhara, Oromia, SNNPR, and Tigray) between 2008 and 2010. (2011)
Impact of L10K on Enhancing Maternal and Newborn Health in Ethiopia
This paper presents the results of the midterm survey conducted by the Last Ten Kilometers project (L10K) in 2010. The study looks at changes in maternal and newborn health, between 2008 (when it conducted its baseline survey) and 2010, in all four of the L10K project regions. (2011)
Non-Financial Incentives for Voluntary Community Health Workers: A Qualitative Study L10K Working Paper No. 2 One of L10K's community-based strategies is to ensure the sustained engagement of voluntary community health workers (vCHWs) in the Health Extension Program (HEP) through the implementation of non-financial incentives (NFIs), which aim to strengthen volunteerism among vCHWs. This study utilizes in-depth interviews and focus group discussions to explore the potential efficacy of NFIs proposed by the project. The results of the study describe the factors motivating the vCHWs and concur with the NFIs proposed by the project. It also proposes other NFI mechanisms for consideration. (2011)
Addressing Community Maternal and Neonatal Health in Ethiopia. Report from National Scoping Exercise and National Workshop to Increase Demand, Accesses and Use of Community Maternal and Neonatal Health Services.This report was developed following the National Workshop on Addressing Community Maternal & Neonatal Health in Ethiopia, which was held at the Addis Ababa Hilton Hotel from May 12 to 14, 2009. (2009)
Non-Financial Incentives for Voluntary Community Health Workers: A Qualitative Study L10K Working Paper No. 1 One of L10K's community-based strategies is to ensure the sustained engagement of voluntary community health workers (vCHWs) in the Health Extension Program (HEP) through the implementation of non-financial incentives (NFIs), which aim to strengthen volunteerism among vCHWs. This study utilizes in-depth interviews and focus group discussions to explore the potential efficacy of NFIs proposed by the project. The results of the study describe the factors motivating the vCHWs and concur with the NFIs proposed by the project. It also proposes other NFI mechanisms for consideration. (2009)
Rapid Appraisal of Health Extension Program: Ethiopia Country Report
The Rapid Appraisal Study was conducted by the Miz-Hasab Research Center in collaboration with L10K in 2008 to identify evidence that help strengthen the bridge between families, communities, governments, development partners, and the HEP in achieving sustainable rural maternal. The information provided in the Report of the Rapid Appraisal Study was mainly used for the national and regional consensus-building workshops organized by JSI/L10K to foster engagement and ownership of the L10K project at the policy-making level. (2008)
Surveys
Qualitative Evaluation of PC-Solutions Strategy
L10K 2020 implemented a participatory community quality improvement (PC-Solutions) strategy in eight primary health care units of Ethiopia to improve use and quality of MNH services. L10K 200 evaluated the strategy using quantitative methods. Analysis of the facility surveys showed access to and use of most maternal and newborn interventions improved over time. Analysis of the quasi-experimental study showed significant intervention effects for improving use of MNH practices including early care seeking for ANC and provision of PNC by providers. (2018)
Maternal and Newborn Health Care Behaviors and Practices in 115 L10K 2020 Districts of Ethiopia: Baseline and Follow-Up Surveys 2016-2017Between October 2015 and September 2017, L10K 2020 supported the health systems of 115 rural districts in Amhara; Oromia; Southern Nations, Nationalities and Peoples' (SNNP); and Tigray regions to implement the Federal Ministry of Health's Health Sector Transformation Plan transformation: woreda transformation; quality and equity of health services; caring, respectful and compassionate care; and information revolution. This study monitors the changes in the maternal and newborn health (MNH) care behavior and practice indicators during L10K 2020's first two years of implementation. (2018)
The Situation of Maternity Waiting Homes in Rural Health Centers of Amhara, Oromia, SNNP, and Tigray Regional States of EthiopiaThis survey assess the presence, infrastructure, referral linkage, management, and clients' perception of the maternity waiting homes to learn lessons from the existing experience. Thus, it looks into various issues such as type of houses that serve as waiting homes, facilities in these homes, provision of maternal health services and its challenges, etc.
Barriers to Access Comprehensive Emergency Obstetric and Newborn Health (CEmONC) among Emergency Referral Cases from Selected 16 Primary Health Care Units in Ethiopia: Obstetric Complication and Referral Audit and Learnings from Women's ExperiencesThis obstetric complication and referral audit study was conducted to explore barriers to access CEmONC. Sixteen referral hospitals that serve as the referral sites for the referral primary health care units, where L10K has been implementing its referral innovations, were studied. Hospital records were reviewed and follow-up interview of complication survivors in their respective communities were made.
Measuring Implementation Strength of Basic Emergency Obstetric and Newborn Care in 134 Health Centers of Amhara, Oromia, SNNP, and Tigray Regions of EthiopiaThis follow-up study was conducted to measure the strength of and changes in BEmONC implementation since the initiation of the program in 2013. The study helps to understand why some programs are successful and some fail and anticipate outcomes of future programs.
Trends in reproductive, maternal, newborn and child health care practices in Ethiopia.
Ethiopia reached its Millennium Development Goal 4 (reduce under five mortality) by 2015 three years early. The reduction in neonatal mortality rate and maternal mortality ration however, showed more modest changes. Low utilization of skilled personnel and facility-based services are some of the reasons to remain a challenge. Thus, L10K implemented community-based strategies to improve reproductive, maternal, newborn and child health care –seeking behavior and practices by strengthening relations between PHCU, health workers (health center service providers, HEWs, and HDA members) and communities. Over the course of L10K, the project conducted three rounds of household and community surveys to measure the impact of project innovations on care-seeking behavior and practices. The report discusses the adequacy of these innovations and identifies gaps that need closing.
Extended Program on Immunization (EPI) coverage in selected Ethiopian zones: A baseline survey for L10K’s Routine Immunization Improvement Initiative
The government of Ethiopia has been delivering routine immunization services through static, outreach and mobile strategies since 1980. Despite the huge efforts made the access and utilization of immunization remains low with wide regional variations and unacceptably high drop-out rates. Vaccination coverage is stagnating in Ethiopia. The Last Ten Kilometers (L10K) Project of the John Snow, Inc. (JSI) Research and Training Institute is supporting the Federal Ministry of Health (FMoH) in implementing the routine immunization improvement plan in seven selected zones with high numbers of unvaccinated children. Population-based information regarding vaccination status and the reasons for no or incomplete vaccination are essential for monitoring the Expanded Program on Immunization (EPI). As such, this study was conducted to establish baseline vaccination levels and inform implementation of the project.
Disrespect and abuse during facility-based childbirth in four PHCUs in two
regions of Ethiopia – Baseline Study Findings
Facility-based delivery rates in Ethiopia are estimated to be as low as 15% (Mini DHS, 2014). One of the reasons is the poor quality of care experienced by women who seek delivery services at health facilities. The poor interpersonal care of skilled personnel may manifest as disrespect and abuse.
L10K has partnered with the Women and Health Initiative at the Harvard School of Public Health to promote respectful care. To determine the prevalence and manifestations of disrespect and abuse occurring in these facilities, a baseline study was conducted between July and September, 2013. The results of the study, presented in this report, will inform types of interventions for these facilities towards the promotion of respectful maternity care.
The results of the baseline assessment show that disrespectful and abusive behaviors are a prevalent issue at the health centers studied. The full report will be published shortly.
Integrated Community Case Management Survey in Amhara, SNNP and Tigray Regions
The objective of the survey was to assess the utilization of iCCM services and identify major barriers for accessing the service. The study found that adoption of iCCM within the health extension program at scale substantially increased the care-seeking behaviors for children sick with acute respiratory infection, diarrhea and fever. The improvement in care seeking behaviors for common childhood illnesses were mainly contributed by the increase in utilization of iCCM services from health posts.
Equity of Maternal, Newborn and Child Health Services in Rural Ethiopia
One of the objectives of the L10K project is to support the Health Extension Program of Ethiopia to provide equitable maternal, newborn, and child health services. This study uses the L10K baseline and midterm surveys to assess the status and the changes in equity in maternal, newborn, and child health in the intervention areas.
L10K Summary Midterm Report This summary of the midterm survey report describes in brief the survey methodology for the baseline and midterm surveys, as well as survey results in L10K project areas. Interactions between households and Health Extension Program frontline workers and health service utilization both increased between 2008 and 2010. The report highlights improvements in the coverage of health interventions, as well as areas needing further attention.
The midterm survey report describes the survey methodology for both the baseline (2008) and midterm (2010) surveys. The survey results describe changes in the availability, perceived quality, awareness, knowledge, demand, access, and utilization of the reproductive, maternal, neonatal, and child health (RMNCH) services in L10K project areas. The midterm survey obtained information from 9,960 women and 330 communities (kebeles). Interactions between households and Health Extension Program frontline workers and health service utilization both increased. The report highlights improvements in the coverage of health interventions, as well as areas needing further attention. The midterm survey protocol is also available.
Baseline Household Health Survey: Amhara, Oromiya, SNNP, Tigray - August 2009
The Baseline Household Health Survey Report presents survey results that describe the availability, perceived quality, awareness, knowledge, demand, access, and utilization of the reproductive, maternal, neonatal, and child health (RMNCH) services in L10K project areas. The report is the first of its kind to describe the neonatal health care practices in rural Ethiopia. The survey was conducted during the period of December 2008–January 2009 and gathered information from 204 communities, or kebeles, and 6,277 women using a two-stage cluster sampling methodology. Implications of the survey findings for the health extension program of the Ethiopian Government are also discussed. (2009)
Baseline Household Health Survey Report Summary
This document summarizes the 2009 Baseline Household Health Survey Report. (2009)
Baseline and Midterm Household Health Survey Questionnaires (2008 and 2010)
Four types of questionnaires were used during the baseline and midterm surveys conducted by the Last Ten Kilometers (L10K) project in 2008 and 2010, respectively. The surveys used for the baseline and midterm surveys were very similar, so only the baseline survey documents are available here for reference. Each one was crafted for different groups of interviewees:
Questionnaire for women aged 15 to 49;
Questionnaire for women with children aged 0 to 11 months;
Questionnaire for women with children aged 12 to 23 months; and a
Community Questionnaire for Health Extension Workers.
For detailed data regarding the results from the questionnaires, please contact us via email.
Peer-Reviewed Papers
"Community-based Newborn Care in Ethiopia: Implementation Strength and Lessons Learned"
Mathewos, Bereket, Yunis Musema, Abeba Bekele, Bantalem Yeshanew, Gizachew Tadele, Efrem Teferi, Agazi Ameha, and Tedbabe Degefie.
Ethiopia launched community-based newborn care in March 2013 with the goal of reducing newborn and child mortality. This article assesses the strength of the community-based newborn care program implementation in terms of inputs, process, and outputs, and documents key lessons learned through the implementation of the first phase of the program in four agrarian regions of Ethiopia. The article concludes that community-based newborn care can be implemented effectively in similar contexts if it is well planned, if there is good-coordination with partners and stakeholders, uninterrupted supply is ensured, and continuous support and supervision is in place. Shared via Creative Commons Attribution 4.0 International license. (2019)
"Effect of Community-based Distribution of Misoprostol on Facility Delivery: a scoping review"
Gizachew Tadele Tiruneh, Bereket Yakob, Wubegzier Mekonnen Ayele, Muluneh Yigzaw, Meselech Assegid Roro, Araya Abrha Medhanyi, Etenesh Gebreyohannes Hailu and Yibeltal Tebekaw Bayou.
Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse. Shared via Creative Commons Attribution 4.0 International license. (2019)
"Effectiveness of Supervision on the Consistency of Neonatal Sepsis Management Skills of Health Extension Workers"Gizachew Tadele Tiruneh, MPH, Ali Mehryar Karim, PhD, Bantalem Yeshanew Yihun, MSc, Bizuhan Gelaw Birhanu, PhD, Agazi Amaha, MSc, Bereket Mathiwos, MSc, Biruk Tensou Tessema, MSc, Abera Workneh Wanboru, MPH, Wuleta Aklilu Betemariam, MPH.
Ethiopia has implemented community-based neonatal sepsis management as one strategy to reduce its persistently high neonatal mortality rate since 2012. This paper examines the effects of supervision visits provided to health posts on the consistency of neonatal sepsis management skills of health extension workers in Ethiopia. The findings of the study suggest that at least three rounds of supervision are needed to ensure the optimum skills of management of neonatal sepsis at the community level. Shared via Creative Commons Attribution 4.0 International license. (2019)
"Distribution of maternity waiting homes and their correlation with perinatal mortality and direct obstetric complication rates in Ethiopia"Gizachew Tadele Tiruneh, Yayeh Negash Getu, Mahbub Ali Abdukie, Geremew Gonfa Eba, Emily Keyes, and Patricia E. Bailey.
Ethiopia has been expanding maternity waiting homes to bridge geographical gaps between health facilities and communities in order to improve access to skilled care. Little has been done to document their distribution, service availability and readiness. This paper addresses gaps as well as their association with perinatal mortality and obstetric complication rates. Shared via Creative Commons Attribution 4.0 International license. (2019)
"The potential of community engagement to improve mother and child health in Ethiopia — what works and how should it be measured?"Peter Byass.
The series of papers in this Supplement all examine community engagement factors which may have contributed to recent improvements in maternal and child health in Ethiopia, even though the authors are by no means claiming that observed overall improvements are solely attributable to these factors, nor even to community engagement as a whole. Shared via Creative Commons Attribution 4.0 International license. (2018)
"The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia"Gizachew Tadele Tiruneh, Ali Mehryar Karim, Bilal Iqbal Avan, Nebreed Fesseha Zemichael, Tewabech Gebrekiristos Wereta, Deepthi Wickremasinghe, Zinar Nebi Keweti1, Zewditu Kebede and Wuleta Aklilu Betemariam.
Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, in Ethiopia. This study measures implementation strength of BEmONC and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Shared via Creative Commons Attribution 4.0 International license. (2018)
"Correlates of the Women's Development Army Strategy Implementation strength with household reproductive, maternal, newborn and child health practice: a cross section study in four regions of Ethiopia"Zufan Abera Damtew, Ali Mehryar Karim, Chala Tesfaye Chekagn, Nebreed Fesseha Zemichael, Bantalem Yihun, Barbara A. Willey and Wuleta Betemariam.
To address the shortfall in human resource for health, in 2011, Women's Development Army (WDA) strategy was added, using networks of neighbouring women to increase the efficiency of Health Extension Workers in reaching every household. This study assessed the association between the WDA strategy implementation strength and household RMNCH care behaviours and practices. Shared via Creative Commons Attribution 4.0 International license. (2018)
"Effects of a participatory community quality improvement strategy on improving household and provider health care behaviors and practices: a propensity score analysis"Tewabech Wereta, Wuleta Betemariam, Ali Mehryar Karim, Nebreed Fesseha Zemichael, Selamawit Dagnew, Abera Wanboru and Antoinette Bhattacharya
The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services. A Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 rural woredas (districts) where the Last Ten Kilometers Project Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers' and households' practices. Shared via Creative Commons Attribution 4.0 International license. (2018)
"Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis"Dessalew Emaway Altaye, Ali Mehryar Karim, Wuleta Betemariam, Nebreed Fesseha Zemichael, Tesfaye Shigute and Pauline Scheelbeek
Ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices. Shared via Creative Commons Attribution 4.0 International license. (2018)
Effect of Ethiopia's Health Extension Program on maternal and newborn health care practices in 101 rural districts: A dose-response study
The scale-up of newborn survival interventions is essential to achieving Millennium Development Goal 4 which aims for a two-thirds reduction in deaths in children under five years between 1990 and 2015. Ethiopia's national Health Extension Program (HEP) implements innovative community based approaches to provide universal services for preventive, promotive, and basic curative health care, including newborn survival interventions, to about 68 million people living in rural areas. Evaluations of large-scale health programs are strongly encouraged by global health partners including the World Health Organization, public health research and donor communities.
JSI's L10K project, in partnership with the Federal Ministry of Health of the Government of Ethiopia, the London School of Hygiene and Tropical Medicine, and the Regional Health Bureaus of Amhara, Oromia, Southern Nations and Nationalities Peoples, and Tigray, evaluated the effectiveness of the HEP on maternal and newborn care practices in rural Ethiopia. The study indicates that improvements in key maternal and newborn health care practices were associated with the intensity of outreach activities of the health extension program in Ethiopia.
The paper can be accessed at http://dx.plos.org/10.1371/journal.pone.0065160
The following peer-reviewed articles are based on major findings that were presented at a 2009 Ethiopian national scoping conference on maternal and neonatal health. The conference was hosted by The Last 10 Kilometers project and the Ethiopian Society for Obstetricians and Gynecologists in partnership with the Federal Ministry of Health, and brought together foremost experts in the fields of women and children's health to share and discuss the results of their studies. The set of articles was published in a special 2010 issue of the Ethiopian Journal of Health Development and can be downloaded in full by clicking on the titles below.
Online distribution of the following articles has been authorized by the original publisher. You'll need the free Adobe Acrobat Reader program to view the PDF files on your computer.
Editorial by Mesganaw Fantahun Afework.
Solomon Tesfaye.
This paper describes the workshop's objectives, as well as the strategic recommendations developed at the workshop to advance community-level maternal and neonatal health.
"Programmatic correlates of maternal healthcare seeking behaviors in Ethiopia."
Ali Mehryar Karim, Wuleta Betemariam, Samuel Yalew, Hibret Alemu, Mary Carnell, Yared Mekonnen.
This paper uses the baseline survey conducted by L10K in 2008-9 to examine the associations between health extension program outreach activities and maternal healthcare use. The paper also discusses the policy implications of these findings.
"Care seeking for maternal health: challenges remain for poor women."
Charlotte Warren.
Focus group discussions and in-depth interviews with men, women, and children were conducted in communities across Ethiopia's 11 regions. This paper examines knowledge and attitudes related to giving birth and seeking care in health facilities.
"Responding to the maternal health care challenge: The Ethiopian Health Extension Program."
Marge Koblinsky, Frances Tain, Asheber Gaym, Ali Karim, Mary Carnell, Solomon Tesfaye.
This paper reviews available surveys and literature to determine the feasibility of reaching MDG 5 through Ethiopia's Health Sector Development Program, concluding with recommendations for accelerating progress toward the target.
"Care of the newborn: Community perceptions and health seeking behavior."
Charlotte Warren.
This paper describes the results of in-depth interviews and focus groups with mothers, older women, men with young children, health providers, religious leaders, and elders across Ethiopia's 11 regions. It explores traditions surrounding newborn care and perceptions of the causes of newborn mortality and morbidity.
"Maternal Mortality Trend in Ethiopia."
Ahmed Abdella.
This paper reviews trends in maternal mortality ratios and causes of maternal deaths in Ethiopia using available survey data.
"Utilization of post-abortion care services in three regional states of Ethiopia."
Yilma Melkamu, Mulugeta Betre, Solomon Tesfaye.
This paper describes the results of a mixed quantitative and qualitative research design in the three most populous regions of Ethiopia. Methods included structured interview questionnaires, focus group discussions, and in-depth interviews.