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EVALUATION OF THE ETHIOPIAN MILLENNIUM RURAL INITIATIVE: IMPACT ON MORTALITY AND COST-EFFECTIVENESS

Friday, 17th of January 2014

• EVALUATION OF THE ETHIOPIAN MILLENNIUM RURAL INITIATIVE: IMPACT ON MORTALITY AND COST-EFFECTIVENESS

Leslie A. Curry mail,

* E-mail: leslie.curry@yale.edu

Affiliation: Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America

Patrick Byam,

Affiliation: Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America

Erika Linnander,

Affiliation: Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America

Kyeen M. Andersson,

Affiliation: Futures Institute, Glastonbury, Connecticut, United States of America

Yigeremu Abebe,

Affiliation: Clinton Health Access Initiative, Addis Abba, Ethiopia

Abraham Zerihun,

Affiliation: Clinton Health Access Initiative, Addis Abba, Ethiopia

Jennifer W. Thompson,

Affiliation: Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America

 

Elizabeth H. Bradley

Affiliation: Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America

Published: November 18, 2013

Abstract below; full text is at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0079847

Main Objective

Few studies have examined the long-term, impact of large-scale interventions to strengthen primary care services for women and children in rural, low-income settings. We evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI), an 18-month systems-based intervention to improve the performance of 30 primary health care units in rural areas of Ethiopia.

Methods

We assessed the impact of EMRI on maternal and child survival using The Lives Saved Tool (LiST), Demography (DemProj) and AIDS Impact Model (AIM) tools in Spectrum software, inputting monthly data on 6 indicators 1) antenatal coverage (ANC), 2) skilled birth attendance coverage (SBA), 3) post-natal coverage (PNC), 4) HIV testing during ANC, 5) measles vaccination coverage, and 6) pentavalent 3 vaccination coverages. We calculated a cost-benefit ratio of the EMRI program including lives saved during implementation and lives saved during implementation and 5 year follow-up.

Results

A total of 134 lives (all children) were estimated to have been saved due to the EMRI interventions during the 18-month intervention in 30 health centers and their catchment areas, with an estimated additional 852 lives (820 children and 2 adults) saved during the 5-year post-EMRI period. For the 18-month intervention period, EMRI cost $37,313 per life saved ($42,366 per life if evaluation costs are included). Calculated over the 18-month intervention plus 5 years post-intervention, EMRI cost $5,875 per life saved ($6,671 per life if evaluation costs are included). The cost effectiveness of EMRI improves substantially if the performance achieved during the 18 months of the EMRI intervention is sustained for 5 years. Scaling up EMRI to operate for 5 years across the 4 major regions of Ethiopia could save as many as 34,908 lives.

Significance

A systems-based approach to improving primary care in low-income settings can have transformational impact on lives saved and be cost-effective.

Citation: Curry LA, Byam P, Linnander E, Andersson KM, Abebe Y, et al. (2013) Evaluation of the Ethiopian Millennium Rural Initiative: Impact on Mortality and Cost-Effectiveness. PLoS ONE 8(11): e79847. doi:10.1371/journal.pone.0079847

Editor: John G. Meara, Boston Children’s Hospital, United States of America

Received: June 4, 2013; Accepted: September 25, 2013; Published: November 18, 2013

Copyright: © 2013 Curry et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This research was funded through a grant from the Children’s Investment Foundation Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.