London School of Hygiene & Tropical Medicine

A project that aims to reduce child deaths in Ethiopia by increasing uptake of community care services will be evaluated by the School, following a major grant from the Bill & Melinda Gates Foundation.

The School's evaluation, called Dagu (an Afar word meaning 'exchange of information'), also aims to build capacity for large-scale public health evaluation at four leading universities in the country.

Earlier programmes in Ethiopia have successfully led to an increase in the provision of child health services in the community, including trained health extension workers and pharmaceutical supplies at health posts. However, the uptake of local services to manage childhood illness remains low.  Around 184,000 children under the age of five die each year in Ethiopia, often from preventable illnesses that could be treated at a community level.

The School has received £3 million to lead a five-year evaluation of the Optimising the Health Extension Program in Ethiopia. This project, initiated and led by the Ethiopian Federal Ministry of Health and implemented by UNICEF and PATH, aims to increase the uptake of existing community health services for children under five and address barriers that limit access to care. This could lead to a further reduction in child deaths, and effective evaluation will be a critical component.

Dagu brings together academics, policy makers from regional health bureaus, and implementers as well as the Ministry of Health, to spearhead new ways of delivering services. It integrates research activities at the University of Gondar, Hawassa University, Mekelle University and Jimma University, coordinated through the Ethiopian Public Health Institute, while strengthening their research degree programmes and research systems - boosting their capacity to carry out public health evaluation within their regions in the future.

Professor Joanna Schellenberg, an epidemiologist at the School and Principal Investigator of the evaluation, said: "Child survival in Ethiopia has improved dramatically in recent years, but it will be hard to sustain the pace of change. Left untreated, common childhood illness, such as acute respiratory infection or diarrhoea, can quickly become life-threatening. In many communities health workers and services are available to treat these conditions, but they are not always used."

Dr Ephrem T Lemango, Director of Maternal and Child Health at the Ethiopian Federal Ministry of Health said: "This funding will allow us to find out whether and how efforts to increase uptake of community based care are working, and to help us to make important changes to further increase their uptake. I am delighted that the London School of Hygiene & Tropical Medicine will be working with four leading Ethiopian universities, strengthening their ability for future evaluation within their country."

The Ethiopian government, UNICEF and PATH will work to increase the uptake of two existing programmes: Integrated Community Case-Management and Community Based Newborn Care, both of which have previously been rolled out on a large scale in four regions in Ethiopia. The project will boost the availability of these services at health posts, while promoting health service uptake and increased community knowledge around childhood illnesses.

Dagu will study the ways in which the root causes of low demand for community child health services are addressed, and track the project's progress. PhD students from the four Ethiopian universities will be supported by grants to work on the evaluation. By the end of the project, the researchers will be able to assess whether the interventions to increase uptake of community care for sick children have been successful and cost-effective. The findings will be used to advise the Ethiopian Federal Ministry of Health on policy development and plans to roll out the programme more widely across the country.