Federal Ministry of Health of Ethiopia, Health Extension and Primary Health Service Directorate, Sudan Street, Addis Ababa, Ethiopia.
Last 10 Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs #, 2111, Addis Ababa, Ethiopia.
BMC Pregnancy Childbirth. 2018 Sep 24;18(Suppl 1):373. doi: 10.1186/s12884-018-1975-y.
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.
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.
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).
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.
为了解决卫生人力资源短缺的问题，埃塞俄比亚于 2004 年启动了卫生扩展计划（HEP），在每个村（社区）设立一个有两名女性卫生推广员（HEW）的卫生站。2011 年，妇女发展军（WDA）战略被纳入，利用邻近妇女的网络提高 HEW 到达每个家庭的效率，每个 WDA 团队负责人负责 30 户家庭。通过该战略，社区中的妇女与 HEW 合作，分享和学习卫生实践，并相互赋权。本研究评估了 WDA 战略实施力度与家庭生殖、孕产妇、新生儿和儿童保健行为和实践之间的关联。
利用来自 423 个村的横断面家庭调查和社区层面的背景数据（代表 145 个农村地区），采用内部比较组设计评估在 WDA 密度较高的村，HEP 推广活动和家庭一级的护理实践是否更好。活跃的 WDA 领导人数密度被认为是 WDA 战略实施力度；一个村的 WDA 密度较高表示实施力度相对较高。基于此，村被分为较高、中等或较低。多水平逻辑回归模型，调整了受访者的个人、家庭和背景特征，用于评估 WDA 战略实施力度与感兴趣的结果指标之间的关联。
在所研究村的第 25、50 和 75 百分位数中，每个活跃的 WDA 团队负责人平均负责的家庭数量分别为 41、50 和 73。WDA 密度与 13 项指标中的 6 项服务改善相关（p<0.05）。例如，WDA 密度较高的村（一个活跃的 WDA 团队负责人负责最多 40 户家庭），避孕药具使用率分别高 7（95%CI，2，13）、11（5，17）和 9（1，17）个百分点，四次或更多产前检查的覆盖率和机构分娩的覆盖率分别更高，而 WDA 密度较低的村（一个活跃的 WDA 团队负责人负责 60 户或更多家庭）。
更高的 WDA 战略实施力度与更好的保健行为和实践相关，表明 WDA 战略支持 HEW 改善保健服务的提供。
