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The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach

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  • Rieger, Matthias
  • Wagner, Natascha
  • Mebratie, Anagaw
  • Alemu, Getnet
  • Bedi, Arjun

Abstract

The Ethiopian government has implemented nationwide strategies to improve access to basic health services and enhance health outcomes. The Health Extension Program (HEP) launched in 2003, expanded basic health infrastructure and local human resources. In 2011, the government introduced the Health Development Army (HDA). HDA is a women-centered community movement inspired by military structures and discipline. Its special objective is to improve maternal health outcomes. This paper uses a synthetic control approach to assess the effects of HEP and HDA on maternal mortality ratios (MMR). The MMR data are from the Global Burden of Diseases (GBD) database. A pool of 42 Sub-Saharan African countries, covering the period 1990 to 2016, is used to construct a synthetic comparator which displays a mortality trajectory similar to Ethiopia prior to the interventions. On average, since 2004, maternal mortality in the control countries exhibits a moderate downward trend. In Ethiopia, the downward trend is considerably steeper as compared to its synthetic control. By 2016, maternal mortality in Ethiopia was lower by 171 (p-value 0.048) maternal deaths per 100,000 live births as compared to its synthetic control. Between 2003 and 2016, Ethiopia's maternal mortality ratio declined from 728 to 357. These estimates suggest that a substantial proportion of this decline may be attributed to HEP/HDA. The Ethiopian experience of enhancing nation-wide access to and use of maternal health services in a short time-span is remarkable. Whether such a model may be transplanted is an open question.

Suggested Citation

  • Rieger, Matthias & Wagner, Natascha & Mebratie, Anagaw & Alemu, Getnet & Bedi, Arjun, 2019. "The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach," Social Science & Medicine, Elsevier, vol. 232(C), pages 374-381.
    • Handle: RePEc:eee:socmed:v:232:y:2019:i:c:p:374-381
    DOI: 10.1016/j.socscimed.2019.05.037
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    References listed on IDEAS

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    1. Eli Ben-Michael & Avi Feller & Jesse Rothstein, 2021. "The Augmented Synthetic Control Method," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 116(536), pages 1789-1803, October.
    2. Rieger, Matthias & Wagner, Natascha & Bedi, Arjun S., 2017. "Universal health coverage at the macro level: Synthetic control evidence from Thailand," Social Science & Medicine, Elsevier, vol. 172(C), pages 46-55.
    3. Alberto Abadie & Javier Gardeazabal, 2003. "The Economic Costs of Conflict: A Case Study of the Basque Country," American Economic Review, American Economic Association, vol. 93(1), pages 113-132, March.
    4. World Health Organization & UNICEF & UNFPA & World Bank Group & United Nations, 2015. "Trends in Maternal Mortality," World Bank Publications - Books, The World Bank Group, number 23550, April.
    5. Sebastian Galiani & Brian Quistorff, 2017. "The synth runner package: Utilities to automate synthetic control estimation using synth," Stata Journal, StataCorp LLC, vol. 17(4), pages 834-849, December.
    6. Andreas Billmeier & Tommaso Nannicini, 2013. "Assessing Economic Liberalization Episodes: A Synthetic Control Approach," The Review of Economics and Statistics, MIT Press, vol. 95(3), pages 983-1001, July.
    7. Pramila Krishnan & Manasa Patnam, 2014. "Neighbors and Extension Agents in Ethiopia: Who Matters More for Technology Adoption?," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 96(1), pages 308-327.
    8. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
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    1. Rokicki, Slawa, 2021. "Impact of family law reform on adolescent reproductive health in Ethiopia: A quasi-experimental study," World Development, Elsevier, vol. 144(C).
    2. Lavers, Tom, 2021. "Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment," Social Science & Medicine, Elsevier, vol. 282(C).
    3. Amos Z. B. Flomo & Elissaios Papyrakis & Natascha Wagner, 2023. "Evaluating the economic effects of the Ebola virus disease in Liberia: A synthetic control approach," Journal of International Development, John Wiley & Sons, Ltd., vol. 35(6), pages 1478-1504, August.
    4. Jaume Puig‐Junoy & Jaime Pinilla, 2020. "Free prescriptions for low‐income pensioners? The cost of returning to free‐of‐charge drugs in the Spanish National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1804-1812, December.
    5. Hampshire, Kate & Mwase-Vuma, Tawonga & Alemu, Kassahun & Abane, Albert & Munthali, Alister & Awoke, Tadesse & Mariwah, Simon & Chamdimba, Elita & Owusu, Samuel Asiedu & Robson, Elsbeth & Castelli, Mi, 2021. "Informal mhealth at scale in Africa: Opportunities and challenges," World Development, Elsevier, vol. 140(C).

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