The Journal of Health, Population and Nutrition
Vol. 32, No. 4, 2014, pp. 549-563
Bioline Code: hn14120
Full paper language: English
Document type: Research Article
Document available free of charge
The Journal of Health, Population and Nutrition, Vol. 32, No. 4, 2014, pp. 549-563
© Copyright 2014 - The Journal of Health, Population and Nutrition
Effectiveness of Scaling up the ‘Three Pillars’ Approach to Accelerating MDG 4 Progress in Ethiopia|
Carnell, Mary A.; Dougherty, Leanne; Pomeroy, Amanda M.; Karim, Ali M.; Mekonnen, Yared M. & Mulligan, Brian E.
This paper describes the integrated approach taken by the Government of Ethiopia with support from the
Essential Services for Health in Ethiopia (ESHE) Project and assesses its effect on the coverage of six child
health practices associated with reducing child mortality. The ESHE Project was designed to contribute to
reducing high child mortality rates at scale among 14.5 million people through the ‘three pillars’ approach.
This approach aimed to (i) strengthen health systems, (ii) improve health workers’ performance, and (iii)
engage the community. The intervention was designed with national and subnational stakeholders’ input.
To measure the Project’s effect on the coverage of child health practices, we used a quasi-experimental
design, with representative household survey data from the three most populous regions of Ethiopia, collected
at the 2003-2004 baseline and 2008 endline surveys of the Project. A difference-in-differences analysis
model detected an absolute effect of the ESHE intervention of 8.4% points for DTP3 coverage (p=0.007),
12.9% points for measles vaccination coverage (p<0.001), 12.6% points for latrines (p=0.002), and 9.8%
points for vitamin A supplementation (p<0.001) across the ESHE-intervention districts (woredas) compared
to all non-ESHE districts of the same three regions. Improvements in the use of modern family planning
methods and exclusive breastfeeding were not significant. Important regional variations are discussed.
ESHE was one of several partners of the Ministry of Health whose combined efforts led to accelerated
progress in the coverage of child health practices.
Child health; Community; Evaluation; Health system strengthening; Scale up; Ethiopia
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