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. 2018 Sep 24;18(Suppl 1):373.
doi: 10.1186/s12884-018-1975-y.

Correlates of the Women's Development Army strategy implementation strength with household reproductive, maternal, newborn and child healthcare practices: a cross-sectional study in four regions of Ethiopia

Zufan Abera Damtew  1 , Ali Mehryar Karim  2 , Chala Tesfaye Chekagn  3 , Nebreed Fesseha Zemichael  2 , Bantalem Yihun  2 , Barbara A Willey  4 , Wuleta Betemariam  2
Affiliations

Correlates of the Women's Development Army strategy implementation strength with household reproductive, maternal, newborn and child healthcare practices: a cross-sectional study in four regions of Ethiopia

Zufan Abera Damtew et al. BMC Pregnancy Childbirth. .

Abstract

Background: To address the shortfall in human resources for health, Ethiopia launched the Health Extension Program (HEP) in 2004, establishing a health post with two female health extension workers (HEWs) in every kebele (community). In 2011, the Women's Development Army (WDA) strategy was added, using networks of neighboring women to increase the efficiency of HEWs in reaching every household, with one WDA team leader for every 30 households. Through the strategy, women in the community, in partnership with HEWs, share and learn about health practices and empower one another. This study assessed the association between the WDA strategy implementation strength and household reproductive, maternal, newborn and child health care behaviors and practices.

Methods: Using cross-sectional household surveys and community-level contextual data from 423 kebeles representing 145 rural districts, an internal comparison group design was applied to assess whether HEP outreach activity and household-level care practices were better in kebeles with a higher WDA density. The density of active WDA leaders was considered as WDA strategy implementation strength; higher WDA density in a kebele indicating relatively high implementation strength. Based on this, kebeles were classified as higher, moderate, or lower. Multilevel logit models, adjusted for respondents' individual, household and contextual characteristics, were used to assess the associations of WDA strategy implementation strength with outcome indicators of interest.

Results: Average numbers of households per active WDA team leader in the 25th, 50th and 75th percentiles of the kebeles studied were respectively 41, 50 and 73. WDA density was associated with better service for six of 13 indicators considered (p < 0.05). For example, kebeles with one active WDA team leader for up to 40 households (higher category) had respectively 7 (95% CI, 2, 13), 11 (5, 17) and 9 (1, 17) percentage-points higher contraceptive prevalence rate, coverage of four or more antenatal care visits, and coverage of institutional deliveries respectively, compared with kebeles with one active WDA team leader for 60 or more households (lower category).

Conclusion: Higher WDA strategy implementation strength was associated with better health care behaviors and practices, suggesting that the WDA strategy supported HEWs in improving health care services delivery.

Keywords: Community health workers; Ethiopia; Health extension workers; RMNCH; Women’s development Army.

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Conflict of interest statement

Ethics approval and consent to participate

Verbal consent was sought and documented by the interviewers. If the respondent was under 18 years old, then consent was sought from her husband, parents or guardian. As it was expected that most of the respondents could not read or write, written consent was not sought. Ethical clearance was obtained from the Institutional Review Boards of the respective Regional Health Bureaus and that of JSI Research & Training Institute, Inc.

Consent for publication

This manuscript does not contain data from any individual person.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The Women’s Development Army 1–30 network. The Women’s Development Army 1–30 network is organised in the community, with five participating neighboring households creating a women’s development team, and groups of five or six teams brought together as a network, under one leader
See this image and copyright information in PMC

References

    1. World Health Organization. Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 2015. http://www.who.int/reproductivehealth/publications/monitoring/maternal-m.... Accessed 24 Feb 2017.
    1. Alkema Leontine, Chou Doris, Hogan Daniel, Zhang Sanqian, Moller Ann-Beth, Gemmill Alison, Fat Doris Ma, Boerma Ties, Temmerman Marleen, Mathers Colin, Say Lale. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet. 2016;387(10017):462–474. doi: 10.1016/S0140-6736(15)00838-7. - DOI - PMC - PubMed
    1. van de Poel E, O’Donnell O, van Doorslaer E. What explains the rural-urban gap in infant mortality: household or community characteristics? Demography. 2009;46(4):827–850. doi: 10.1353/dem.0.0074. - DOI - PMC - PubMed
    1. UNICEF, World Health Organization, World Bank, United Nations DESA/population division. Levels & Trends in child mortality. Report 2015. Estimates developed by the UN inter-agency Group for Child Mortality Estimation. New York: UNICEF; 2015. http://www.who.int/maternal_child_adolescent/documents/levels_trends_chi.... Accessed 15 Feb 2017.
    1. Mullan Zoë. Transforming health care in Ethiopia. The Lancet Global Health. 2016;4(1):e1. doi: 10.1016/S2214-109X(15)00300-9. - DOI - PubMed

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