Causal impact of the health extension program on child immunization and nutrition in rural ethiopia: evidence from a retrospective analysis

Ethiopia launched the Health Extension Program (HEP) in 2003 to improve the health of children and women in the targeted rural states of Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and Peoples' Region. Here we conduct a retrospective analysis of the HEP's causal effects on child health before the nationwide scaling-up of the program starting in 2010. We apply the doubly robust difference-in-differences estimator developed by Sant'Anna and Zhao (2020) using two waves of the Ethiopian Demographic Health Survey. Our findings show that the HEP had a limited effect on children's vaccination uptake, as only the coverage for poliomyelitis vaccines 1 and 2 significantly improved. The program's impact on anthropometric scores proved more conclusive but masked significant disparities. Regarding vaccination uptake, the HEP's impact was more pronounced for girls and limited exclusively to children from poor families. Conversely, positive effects on anthropometric variables were primarily observed among boys and those from non-poor households.