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This study evaluates the health system response to the introduction of the community-based newborn care programme in Ethiopia. A programme that was launched to address high levels of neonatal mortality in the country.

This study was published as part of journal supplement on Reimagening health systems for better health and social justice in Health Policy and Planning.

Global efforts to increase neonatal survival include measures such as the introduction of innovative service-delivery packages for community health workers. One such package introduced in Ethiopia, is the Community-Based Newborn Care (CBNC) programme, which encompasses simplified treatment for neonatal illness, integrated outreach services and task-shifting.

This study uses the Community Health Worker (CHW) functionality model by the WHO, to evaluate the Ethiopian health system response to the CBNC programme, including quality of care.

A before-and-after study was conducted with three survey time points: baseline (November 2013), midline (December 2015) and follow-up (December 2017). Data were collected at primary healthcare facilities from 101 districts across four regions.

The analysis took two perspectives: (1) health system response, through supplies, infrastructure support and supervision, assessed through interviews and observations at health facilities and (2) quality of care, through CHWs’ theoretical capacity to deliver services, as well as their performance,
assessed through functional health literacy and direct observation of young infant case management.

Results showed gains in services for young infants, with antibiotics and job aids available at over 90% of health centres. However, services at health posts remained inadequate in 2017. In terms of quality of care, only 37% of CHWs correctly diagnosed key conditions in sick young infants at midline. CHWs’ functional health literacy declined by over 70% in basic aspects of case management during the study. Although the frequency of quarterly supportive supervision visits was above 80% during 2013–2017, visits lacked support for managing sick young infants. Infrastructure and resources improved over the course of the CBNC programme implementation. However, embedding and scaling up the programme lacked the systems-thinking and attention to health system building-blocks needed to optimize service delivery.

Despite the global push to improve neonatal survival, the evidence around implementation, scaling-up and effective integration into the health system is limited in scope, quality and the extent to which information is available. Authors of this study call for further research into the role of supervision in primary health care services, especially that which would identify and address maternal and newborn service-delivery gaps in LMICs.

Listen here to find out more on this study which is part of a special supplement published in Health Policy and Planning on Reimagening health systems for better health and social justice.


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Dr Bilal Avan

Associate Professor

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Dr Della Berhanu

Assistant Professor

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Emma Beaumont

Research Fellow in Medical Statistics

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Keith Tomlin

IDEAS Data Manager 2012 - 2017

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Professor Elizabeth Allen

Professor in Medical Statistics

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Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

Yirgalem Mekonnen

JaRco Consulting