The study aimed to assess the association between the WDA strategy implementation strength and household reproductive, maternal, newborn, and child health care behaviors and practices. This study was conducted in the four most populous regions of Ethiopia: Oromia, Amhara, Tigray, and SNNP. According to the Central Statistical Agency population projection, these four regions account for 86% of the total population. Including health posts, 18,107 health facilities are providing services in these regions using cross-sectional household surveys and community-level contextual data from 423 kebeles representing 145 rural districts, an internal comparison group design was applied to assess whether HEP outreach activity and household-level care practices were better in kebeles with a higher WDA density. The density of active WDA leaders was considered as WDA strategy implementation strength; higher WDA density in a kebele indicating relatively high implementation strength. Based on this, kebeles were classified as higher, moderate, or lower. Multilevel logit models, adjusted for respondents’ individual, household, and contextual characteristics, were used to assess the associations of WDA strategy implementation strength with outcome indicators of interest STATA14.2 was used for statistical analysis. First, whether the individual and household level characteristics of the 2668 respondents from the 55 kebeles that were excluded from the analysis were different from those that were included was assessed using Pearson’s chi-squared statistics adjusted for survey design effect. The average numbers of households per active WDA team leader in the 25th, 50th, and 75th percentiles of the kebeles studied were respectively 41, 50, and 73. WDA density was associated with better service for six of the 13 indicators considered (p < 0.05). For example, kebeles with one active WDA team leader for up to 40 households (higher category) had respectively 7 (95% CI, 2, 13), 11 (5, 17), and 9 (1, 17) percentage-points higher contraceptive prevalence rate, coverage of four or more antenatal care visits, and coverage of institutional deliveries respectively, compared with kebeles with one active WDA team leader for 60 or more households (lower category).

• Ethiopia
• Community health workers
• Health extension workers
• Women’s development Army
• RMNCH
• cross sectional study
• maternal health
• health extension

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This study was a cross-sectional survey conducted to assess the association between the women development army (WDA) strategy implementation strength and household reproductive, maternal, newborn, and child health care behaviors and practices in Amhara, Oromia, the Southern National, Nationalities, and Peoples’ Region, and Tigray regions of Ethiopia. The survey addresses around 14,049 women in 478 kebeles. The independent variable of interest was the WDA density, a measure of the WDA strategy implementation strength. For each kebele, it was defined as the ratio of the number of households in the kebele per active WDA team leader. Active WDA team leaders were those who were recorded by the HEW as having met with her and discussed RMNCH issues within the WDA team leaders’ network during the three months preceding the survey. Multilevel logit models, adjusted for respondents’ individual, household, and contextual characteristics, were used to assess the associations of WDA strategy implementation strength with outcome indicators of interest. STATA 14.2 was used for statistical analysis. First, whether the individual and household level characteristics of the 2668 respondents from the 55 kebeles that were excluded from the analysis were different from those that were included was assessed using Pearson’s chi-squared statistics adjusted for survey design effect.

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