Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study.

BACKGROUND: Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women's Development Army (WDA), was added to extend Ethiopia's Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA's Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy. METHODS: Using data from cross-sectional surveys in 2010-11 and 2014-15 from 177 kebeles, we estimated self-reported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level random-effects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys. RESULTS: Kebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth. CONCLUSIONS: This study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.

Effectiveness of supportive supervision on the consistency of integrated community cases management skills of the health extension workers in 113 districts of Ethiopia.

BACKGROUND: Consistency in the adherence to integrated Community Case Management (iCCM) protocols for common childhood illnesses provided by Ethiopia's Health Extension Program (HEP) frontline workers. One approach is to provide regular clinical mentoring to the frontline health workers of the HEP at their health posts (HP) through supportive supervision (SS) following the initial training. OBJECTIVE: To Assess the effectiveness of visits to improve the consistency of iCCM skills (CoS) of the HEWs in 113 districts in Ethiopia. METHODS: We analyzed data from 3,909 supportive supervision visits between January 2011 and June 2013 in 113 districts in Ethiopia. From case assessment registers, a health post was classified as consistent in managing pneumonia, malaria, or diarrhea cases if the disease classification, treatment, and follow-up of the last two cases managed at the health posts were consistent with the protocol. We used regression models to assess the effects of SS on CoS. RESULTS: All HPs (2,368) received at least one supportive supervision visit, 41% received two, and 15% received more than two. During the observation period, HP management consistency in pneumonia, malaria, and diarrhea increased by 3.0, 2.7 and 4.4-fold, respectively. After controlling for secular trend and other factors, significant dose-response relationships were observed between number of SS visits and CoS indicators. CONCLUSIONS: The SS visits following the initial training were effective in improving the CoS.