Volume 3, Issue 2 DECEMBER 2014

I n the last two years L10K has produced nine issues of its quarterly newsletter which has been distributed widely within Ethiopia and posted on the L10K website for an even wider coverage.

In the first year it covered issues on integrated community case management, mobile health, community based data for decision making, and early care seeking and referral solutions. The second

year it covered issues on participatory community quality improvement, community based nutrition, basic emergency obstetric and newborn care, and community based newborn care were shared. The latest issue bringing us into the third year of print was respectful maternity care one of L10Ks newest interventions. We hope to follow this up with other new initiatives L10K has currently taken up: EPI, continuity of care, and family planning.

Nonetheless, we believe we should pause to listen to the needs of our readers. Taking that time now, this issues is dedicated to finding out the thoughts of our readers regarding the L10K newsletter. We would like to know changes you’d like to see, what should we drop, what should we introduced, etc. Hence, we have developed a brief questionnaire (inside) and would like you to share your thoughts with us.

Summary of each issue covered by the L10K newsletter in the past two years:

The Last Ten

Kilometers (L10K) What it takes to improve health

outcomes in rural Ethiopia

L10K aims to strengthen the bridge between households and Primary Health Care Unit, Ethiopia’s basic health service delivery structure. It works to improve quality and increase demand, access and utilization of high impact reproductive, maternal, newborn and child health interventions.

L10K is funded by the Bill & Melinda Gates Foundation, UNICEF, and USAID, and implemented by JSI Research & Training Institute Inc.

L10K works with local partners, in the four most populated regions of Ethiopia: Amhara, Tigray, Oromia, and Southern Nations, Nationalities and Peoples’ (SNNP) regions.

Cont. on page 2

In an effort to contribute to the attainment of Millennium Development

Goal 4 (reducing child mortality by two-thirds by 2015) in Ethiopia, L10K

is one of several partners that has been supporting the government’s

effort to initiate integrated Community-Case Management (iCCM) of

common childhood illnesses.

October 2012, Volume 1, Issue 1

The m-Health based supportive supervision management information

system (MIS) initiative, described in this newsletter, is one of the major

components of L10K’s M&E framework. The m-Health MIS

complements and supplements L10K’s M&E framework to measure the

contribution of community-based strategies .

December 2012, Volume 1, Issue 2

News from the Last Ten Kilometers 2 DECEMBER 2014, Vol. 3, Issue 2

Cont. from page 1

In a country like Ethiopia where more than 85% of the population lives in rural

areas, L10Ks Community Based Data for Decision Making (CBDDM) strategy

enables communities to actively own, lead, inform, plan, and monitor their own

health interventions. Data on household health practices is gathered through

simple surveillance mechanism and are mapped in a visual form.

March 2013, Volume 1, Issue 3

Referral, which is the focus of this newsletter, is not simply a problem of transport or

access but it is about infrastructure, staffing, facility management, attitude, and

accountability, and about the whole relationships among households, communities,

Health Extension Workers/Health Development Army and the health facility.

June 2013, Volume 1, Issue 4

The PCQI approach has helped HEWs improve their skills through practical experience

working with experienced staff at health centers based on quality, acceptability, and

responsiveness of health care services to community needs. Today PCQI has become a

comprehensive process which communities use in various non-health activities as well.

September 2013, Volume 2, Issue 1

L10K’s nutrition activities at the community level hopes to improve mothers’ knowledge about good health and nutrition practices and prevent malnutrition. Mothers are helped to take charge of the healthy growth of their children. Hence, community based nutrition activities not only will contribute to decreasing infant and under-5 mortality but will also help to alleviate poverty, improve health, and consequently improve the economy of a country.

December 2013, Volume 2, Issue 2

3 News from the Last Ten Kilometers DECEMBER 2014, Vol. 3, Issue 2

Most maternal and newborn deaths can be averted with evidence‐based and high impact

health interventions. However, the low health care service utilization and supply side

challenges; like availability of well‐trained and motivated providers and the readiness of

facilities in terms of availability of supplies and drugs including standard operating

procedures, for the provision of quality maternal health services, have slowed down

progress in preventing such deaths. Consequently, achieving the Millennium Development

Goal 5 of improving maternal health by 2015, is still distant.

March 2014, Volume 2, Issue 3

The core principle of the CBNC strategy is ensuring the continuum of care, i.e. is from

pregnancy to postnatal periods as well as from the home/community to the health

facilities. This allows for the provision of skilled care during pregnancy, child birth, and

postnatal periods and enables early detection and appropriate management of problems

which prevents complications. In such a way, CBNC will improve maternal and newborn

care practices and care seeking through health development army and other effective

community mobilization mechanisms.

June 2014, Volume 2, Issue 4

Most women and their families expect to receive care from a health facility which is well

equipped, comfortable and clean and has health providers who are caring, empathetic,

supportive, as well as respectful and who can effectively communicate to facilitate

informed decision. However, a significant number of women experience treatment and

care that does not correspond with their expectation and it is this memory of their

childbearing experience which is tainted with disrespect and abuse that stays with them

for a longtime.

September 2014, Volume 3, Issue 1

News from the Last Ten Kilometers DECEMBER 2014, Vol. 3, Issue 2

1. Are you familiar with the L10K newsletter News from the LAST TEN KILOMETERS?

a. Yes b. No

2. How did you know about the L10K newsletter?

a. I receive a copy of the newsletter from L10K

b. I’ve heard about it from a friend

c. I accessed it from L10K website

d. I’ve seen it in an office somewhere

e. Other (please state)

________________________________________

________________________________________

________________________________________

3. How frequently do you receive the newsletter

a. Every quarter

b. Irregularly

c. Others (please state) __________________________________________________

__________________________________________________

Dear Readers,

L10K would like to improve its quarterly newsletter in ways that can respond to its readers information needs

on reproductive, maternal, newborn and child health. Thus, we have develop this questionnaire which will

take only five minutes to fill out. Thus, we hope you will be able to take time to respond to the questions

below.

Your honest feedback is of great value and is important for our processes of improvement. The information

you provide will be confidential so you will not need to write your name.

You may send your response in hard copy (by filling out these two pages) to the following address:

The Last Ten Kilometers Project,

P.O.Box 13898

Addis Ababa, Ethiopia

or an electronic copy is available on our website at http://l10k.jsi.com/ and alternatively you can fill this out

and send your response to aabebe@jsi-ltenk.org.et

Thank you for your time!

News from the Last Ten Kilometers DECEMBER 2014, Vol. 3, Issue 2

4. How far apart is the gap between the time the newsletter is issued and the time you receive it?

a. One month b. Two months c. More (please state) ________________

5. Which section from the newsletter do you read regularly?

a. Cover page Editorial News updates Success story

b. I have no preference

c. I usually read all pages

d. I just browse through the newsletter

6. How informative do you find the newsletter to be on RMNCH matters?

a. Very informative b. Reasonably informative c. Not informative

7. Do you think the newsletter needs improvements?

a. Yes, very much b. Needs some improvement c. No, not at all

8. If your answer to number 7 is yes, what improvements would you suggest? (E.g. change of layout,

addition or deletion of topics, quality of the writing, timeliness of the information, format of publica-

tion (hard and/or soft copy)). Please give details.

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

9. Would you like to continue receiving the newsletter?

a. Yes b. No

10. Would you like to submit information and/or articles to the newsletter?

a. Yes b. No

11. How well have you learnt about the work of L10K through the L10K newsletter ?

a. Very well b. Fairly well c. Very little d. Nothing at all

12. Please state your general impression of the L10K quarterly newsletter

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

DECEMBER 2014 Volume 3, Issue 2

This quarterly

newsletter is

produced by the Last

Ten Kilometers

Project, funded by

the Bill & Melinda

Gates Foundation,

UNICEF and USAID.

The Last Ten

Kilometers Project

P.O.Box 13898

Addis Ababa,

Ethiopia

http://l10k.jsi.com

Tel +251 11 662 0066

Fax +251 11 663

Disclaimer: Information, views or opinions expressed in this

newsletter do not necessarily represent or

reflect those of Bill & Melinda Gates

Foundation, UNICEF and

L10K L10K -- third round survey third round survey

L10K Project has been implementing innovative

strategies to enhance the interactions between

the primary health care unit frontline health

workers and families to increase the quality and

equitable coverage of reproductive, maternal,

newborn, and child health (RMNCH) care

interventions; ultimately contributing towards

the achievement of MDGs 4 & 5.

The Project was initiated in October 2007 and

lasted till September 2012. Nonetheless,

through a supplemental fund the Project period

extended up to September 2015 and its scope

was also modified. Two rounds of household

and community surveys have been conducted to

measure the impact of L10K innovations on

health care behavior and practices. Round I

survey was the baseline conducted from

December 2008 – January 2009 and Round II

was the midterm survey conducted from

December 2010 – January 2011. Now L10K has

carried out its Round III survey from December 2014 – February 2015 in four of its operational

regions: Oromia, Amhara, Tigray, and SNNP. It

has assessed the added value of interventions

introduced during the supplemental period.

Participants of the survey included women in

the reproductive age 15-49 years, women with

children age 0-11 months, and women with

children age12-23 months and health extension

workers (HEWs).

The study, in particular, tried to answer

questions such as,

What are the trends in MNCH care indicators

between Round I, Round II and Round III

surveys?

Were the changes in MNH indicators

between Round I and Round II surveys partly

attributable to the L10K platform strategy?

What was the added value of BEmONC to the

L10K platform in improving skilled delivery

rates?

What was the added value of Referral

Solutions in improving skilled delivery rates

in the L10K areas?

What was the effect of PCQI in improving

MNH indicators?

A Community of Practice team A Community of Practice team met in Rwandamet in Rwanda

A Community of Practice (CoP) team visited in

Kigali, Rwanda from November 18-21, 2014.

Participants were from Ghana (Project Fives

Alive!), Ethiopia (JSI/L10K), Nigeria (Society for

Family Health), and Partners In Health (PIH).

The aim of the team is to build a learning

community in order to share concepts, ideas,

tools, and methods on how to improve referral

processes and outcomes. Accordingly, each

participating organization takes turn to host a

visit to its country. For this year, the Institute for

Healthcare Improvement (IHI) organized the

visit.

The group that met in Kigali mainly exchanged

progress reports on their work since their last

trip to Addis Ababa in May 2013.

The Ethiopian team consisted of staff from L10K

and Averting Maternal Death and Disability

(AMDD). L10K also sponsored a Health

Extension Worker, Yitagesu Alemu from

Germama Gale health post in Dalocha Woreda,

Silte Zone of SNNP region to join the visiting

group. Yitagesu shared her experience on how

her work as a community health worker is

facilitated by a community initiative edir (a

traditional self-help group). She also told of the

positive impact that quarterly review meetings

held with health facilities and communities have

on her work. The CoP team appreciated to have

received first-hand information from a

community health worker and to be able to

discus with her at length.

The Ethiopia team in addition presented the

case of how a very low performing health center

in Amhara region made dramatic changes in

improving facility delivery by identifying

previous bottle necks and solutions working

together with the community. The presentation

illustrated the level of adherence to referral

protocols and improvements gained in maternal

and newborn health outcomes. As part of its

best practice L10K talked about how it

leveraged resources to balance supply with the

growing demand where it introduced Basic

Emergency Obstetric and Newborn Care

(BEmONC) as a result of the Referral Solution

initiative.

The briefings and discussions were then

followed by site visits which were made to a

district hospital, two health centers, and the

homes of community health workers. This

helped to understand the Rwanda health system

and appreciate the commitment of the

government

which was

evident in the

large number

of well-

equipped

health

facilities that

exist. Yitagesu works closely with edir

chairpersons

UPDATES