Abstract:
Introduction Ethiopia successfully reduced mortality in
children below 5 years of age during the past few decades,
but the utilisation of child health services was still low.
Optimising the Health Extension Programme was a 2-
year intervention in 26 districts, focusing on community
engagement, capacity strengthening of primary care
workers and reinforcement of district accountability
of child health services. We report the intervention’s
effectiveness on care utilisation for common childhood
illnesses.
Methods We included a representative sample of 5773
households with 2874 under-five children at baseline
(December 2016 to February 2017) and 10 788 households
and 5639 under-five children at endline surveys
(December 2018 to February 2019) in intervention and
comparison areas. Health facilities were also included. We
assessed the effect of the intervention using difference-indifferences analyses.Results There were 31 intervention activities; many were
one-off and implemented late. In eight districts, activities
were interrupted for 4months. Care-seeking for any
illness in the 2weeks before the survey for children aged
2–59 months at baseline was 58% (95% CI 47 to 68) in
intervention and 49% (95% CI 39 to 60) in comparison
areas. At end-line it was 39% (95% CI 32 to 45) in
intervention and 34% (95% CI 27 to 41) in comparison
areas (difference-in-differences −4 percentage points,
adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention
neither had an effect on care-seeking among sick
neonates, nor on household participation in communityengagement forums, supportive supervision of primary care workers, nor
on indicators of district accountability for child health services.
Conclusion We found no evidence to suggest that the intervention
increased the utilisation of care for sick children. The lack of effect could
partly be attributed to the short implementation period of a complex
intervention and implementation interruption. Future funding schemes
should take into consideration that complex interventions that include
behaviour change may need an extended implementation period.
Trial registration number ISRCTN12040912.
