Ethiopia Lowlands Health Activity
The Lowlands Health Activity (LHA) was a holistic primary health care program rooted in local partnerships and underpinned by an innovative, data-driven, and people-centered strategy and a commitment to adaptive learning and management.
Our team built off the significant achievements of existing healthcare workers, further strengthening the achievements through the LHA consortium’s capacities, as well as harnessing the gains and learnings of USAID’s prior investments.
The LHA Consortium partners included international partners JSI Research & Training Institute, Inc. (JSI) who, alongside EngenderHealth, worked to strengthen the Ministry of Health’s and local stakeholders’ capacity in newborn and child health, immunization and nutrition, and provided technical assistance on health systems strengthening; and University of North Carolina at Chapel Hill’s Carolina Population Center who provided targeted technical assistance to local universities and to the consortium in collaborating, learning, and adapting and Learning, Monitoring, and Evaluation. Local partners included Pastoralist Concern, the Ethiopian Muslims Relief & Development Association, and the Ethiopian Women Lawyers Association, who meaningfully engaged communities and local leaders in pastoral areas. Beyond the core consortium, EngenderHealth collaborated with local resource partners, the Ethiopian Health Education and Professionals Association, e-TECH, and local medical manufacturers to support, respectively, social and behavior change, digital health solutions, and availability of medical technologies.
Healthcare workers in the lowlands of Ethiopia have a lot of challenges to overcome. They must navigate weak health systems, lack of supplies and equipment, extreme weather (e.g. drought), multiple emergencies and conflict, and deeply embedded harmful social norms that hamper progress in improving RMNCAH-N outcomes. These factors limit the capacity of the healthcare workers to effectively deliver health services to their communities.
Over the past two decades, Ethiopia has achieved tremendous advances in making high-quality essential health services available. Despite this progress, regional disparities in health system performance persist, revealing gaps in equity.
Pastoralist communities face distinctive challenges in accessing RMNCAH-N services due to the remote and nomadic nature of their lifestyle, making it difficult to access health facilities located primarily in larger towns or mobile or outreach services offered at inconvenient times or locations.
Looking at our thematic health areas across the regions, performance varies. For example, for child health, the majority (71%) of woredas have high and medium performance, while nearly half (49%) of woredas performance was poor for both immunization and maternal health. The majority of woredas in Afar, Borena, and South Omo performed poorly on immunization and 90% of woredas in Afar performed poorly on maternal health.
Our analysis demonstrated the need to understand the challenges by individual woreda, facility, and thematic area and frame different technical assistance package according to performance level. Based on the challenges USAID identified and our additional analysis, we worked to build on existing policies, investments, and platforms to deliver a range of tailored, high-quality RMNCAH-N interventions that were informed by high-impact practices at the individual, family, community, system, and policy levels.
This program tailored our intervention packages to the specific health area needs of each of the 35 selected woredas. We focused on six implementation strategies:
- Gender, Youth, and Social Inclusion (GYSI)
- Tailored, data-driven approaches
- Contextualized innovations and technology solutions
- Integrated, multi-sectoral approach
- Local actors as drivers of sustainable change
- Strengthening health system resilience to shocks
