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As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia's Health Extension Program (HEP) has contributed to the country's move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia's experiences of HEP when designing their own path to UHC. HEP is one of the government's UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of "health development army" to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country's move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

Community Health Worker --- Ethiopia Health --- Health Extension Workers --- Health Policy --- Health worker training --- Human Resources for Health --- Primary Health Care --- Recruitment and retention --- Rural Health --- Universal Health Coverage --- Ethiopia --- Economic policy.

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Nutrition investments affect human capital formation, which in turn affects economic growth. Malnutrition is intrinsically connected to human capital-undernutrition contributes to nearly half of child mortality, and stunting reduces productivity and earnings in adulthood. Improving nutrition requires a multisectoral effort, but it is difficult to identify and quantify the basic financing parameters as used in traditional sectors. What is being spent and by whom and on what? To address these questions, nutrition public expenditure reviews (NPERs) determine the level of a country's overall nutrition public spending and assess whether its expenditure profile will enable the country to realize its nutrition goals and objectives. When done well, NPERs go beyond simply quantifying how much is spent on nutrition; they measure how well money is being spent to achieve nutrition outcomes and identify specific recommendations for improvement. A Guiding Framework for Nutrition Public Expenditure Reviews presents the key elements of an NPER and offers guidance, practical steps, and examples for carrying out an NPER. The book draws upon good practices from past NPERs as well as common practices and expertise from public expenditure reviews in other sectors. This handbook is intended for practitioners who are tasked with carrying out NPERs. Other target audiences include country nutrition policy makers, development partner officials, government technical staff, and nutrition advocates. The book presents data and analytical challenges faced by previous NPER teams and lays out the kinds of analyses that past NPERs have been able to carry out and those that they were unable to perform because of data or capacity constraints. It concludes with further work needed at the global and country levels to create the conditions necessary to conduct more comprehensive NPERs.

Expenditures, Public.

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GEO Biogeography

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Recent surveys show considerable progress in maternal and child health in Ethiopia. The improvement has been in health outcomes and health services coverage. The study examines how different groups have fared in this progress. It tracked 11 health outcome indicators and health interventions related to Millennium Development Goals 1, 4, and 5. These are stunting, underweight, wasting, neonatal mortality, infant mortality, under-five mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. The study explores trends in inequalities by household wealth status, mothers' education, and place of residence. It is based on four Demographic and Health Surveys implemented in 2000, 2005, 2011, and 2014. Trends in rate differences and rate ratios are analyzed. The study also investigates the dynamics of inequalities, using concentration curves for different years. In addition, a decomposition analysis is conducted to identify the role of proximate determinants. The study finds substantial improvements in health outcomes and health services. Although there still exists a considerable gap between the rich and the poor, the study finds some reductions in inequalities of health services. However, some of the improvements in selected health outcomes appear to be pro-rich.

Adolescent health --- Early child and childrens health --- Health inequality --- Health monitoring & evaluation --- Health systems development & reform --- Health, nutrition and population --- Maternal and child health --- Population policies

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The main purpose of this Guiding Framework document is to present the key elements of a Nutrition Public Expenditure Review (NPER) and offer guidance, practical steps, and examples on carrying out an NPER. It targets a wide-ranging audience, including country nutrition policy makers, development partners (DPs), government technical staff, and advocates and practitioners who are tasked with carrying out NPERs (who are also the main target audience). The Guiding Framework draws upon good practices from the growing body of NPERs as well as common practices and expertise from Public Expenditure Reviews (PERs). However, given the limited number of existing NPERs, this document should be considered as a starting point, or a 'living document,' and is not meant to provide a comprehensive coverage of a standard methodology for NPERs, as this would require further work and analysis. Specifically, this Guiding Framework aims to be a useful tool for practitioners involved in developing an NPER. It does this by: (i) situating NPERs within the context of other similar efforts such as a nutrition budget analysis or sector-specific PERs; (ii) presenting the literature of existing NPERs and related literature to serve as reference; (iii) providing guidance on preparatory work before beginning an NPER (i.e., defining the scope, setting up an NPER team, and identifying data sources); (iv) providing guidance on conducting the core analysis (i.e.,framing the analysis, analyzing the institutional framework, and linking the analysis to the policy dialogue); and (v) clearly identifying knowledge gaps and necessary additional work to enhance the robustness of future NPER analysis.

Health Economics and Finance --- Health, Nutrition and Population --- Nutrition --- Public Sector Development --- Public Spending