A Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers’ and households’ practices.PCQI engages communities in identifying barriers to access and quality of services, and developing, implementing, and monitoring solutions. Thirty-four intervention kebeles (communities), which included the L10 K Platform, BEmONC, and PCQI, and 82 comparison kebeles, which included the L10 K Platform and BEmONC, were visited in December 2010–January 2011 and again 48 months later. Twelve women with children aged 0 to 11 months were interviewed in each kebele. Propensity score matching was used to estimate the program’s average treatment effects (ATEs) on women’s care-seeking behavior, providers’ service provision behavior, and households’ newborn care practices. First individuals were compared, and then household and kebele-level sample characteristics were measured in the follow-up survey across study arms using Pearson’s chi-squared statistics adjusted for cluster survey design effects. Similar statistical tests were done to 1) compare the outcome variables between the study arms during the baseline and the follow-up surveys; and 2) to assess statistically significant changes in the outcome variables during the observation period within each of the study arms. Stata 14.2 was used for the statistical analysis conducted for this study. The ATEs of PCQI were statistically significant (p < 0.05) for two care-seeking behaviors — four or more antenatal care (ANC) visits and institutional deliveries at 14% (95% CI: 6, 21) and 11% (95% CI: 4, 17), respectively — and one service provision behavior — complete ANC at 17% (95% CI: 11, 24). We found no evidence of an effect on remaining outcomes relating to household newborn care practices, and postnatal care performed by the provider.

• Maternal
• Newborn
• Quality improvement
• Community engagement
• Evaluation
• multi satge sampling
• Ethiopia

no

This study was nested in a broader program evaluation for the L10 K Project and drew from the before-and-after household surveys conducted in January 2010–February 2011 and January 2014–February 2015, comparing areas with both PCQI and BEmONC strengthening in addition to the L10 K Platform, to the areas with BEmONC strengthening with the L10 K Platform alone. The sample size for the PCQI intervention area was based on precision and not based on detecting effect estimates of the PCQI strategy about 324 kebeles from the L10 K intervention areas were visited during both the survey periods of the broader evaluation. The broader L10 K evaluation was a two-stage cluster survey, stratified by administrative regions and the L10 K Project strategy (including PCQI). Kebeles were selected as primary sampling units (clusters) with the probability proportionate to their population size. At the second stage, the sampling strategy described by Lemeshow and Robinson was used to select the household with the target respondents. First individuals were compared, and then household and kebele-level sample characteristics were measured in the follow-up survey across study arms using Pearson’s chi-squared statistics adjusted for cluster survey design effects. Similar statistical tests were done to:

1) compare the outcome variables between the study arms during the baseline and the follow-up surveys; 

2) to assess statistically significant changes in the outcome variables during the observation period within each of the study arms. Stata 14.2 was used for the statistical analysis conducted for this study.

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