Multiple Impacts of Ethiopia’s Health Extension Programme on Adolescent Health and Wellbeing: A Quasi-Experimental Study 2002-2013

Abstract

Purpose. Ethiopia has registered remarkable achievements in reaching global development goals, including reducing child marriage. Policymakers are keen to understand which investments have contributed to this. We evaluated the association between Ethiopia’s Health Extension Programme (HEP) and twelve adolescent health and wellbeing outcomes.

Methods. We used Young Lives Ethiopia cohort data between 2002-2013. We evaluated associations between household support from HEP at age 15 and 12 adolescent outcomes spread across health, gender based-violence, education and employment at age 19 using the inverse probability of treatment weighting propensity score approach, stratifying by sex. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP vs. no exposure.

Results. Of 775 adolescents with complete follow-up, 46% were female. Sixty-six percent of adolescents reported support from HEP, with higher rates of support in poorer, less educated, and rural households, particularly in Tigray Province. In boys, HEP was positively associated with education enrolment (APD: +20 percentage points [ppts], 95% CIs: +9ppts; +31ppts) and literacy (AMD: +6ppts, 95% CIs: +0.2; +11), and negatively associated with >4hrs in income-generating activities per day (APD: -19ppts, 95% CIs: -30ppts; -9ppts). In girls, HEP was positively associated with no child marriage (APD: +16ppts, 95% CIs: +4ppts; +27ppts), no adolescent pregnancy (APD: +17ppts, 95% CIs: +6ppts; +28ppts), education enrolment (APD: +27ppts, 95% CIs: +15ppts; +39ppts), literacy (AMD: +5ppts, 95% CIs: +0.2; +11), and numeracy (AMD: +8ppts, 95% CIs: +3; +13).

Discussion. Policies promoting HEP are likely to have supported improvements in multiple areas of adolescents’ lives in Ethiopia.

Note: Funding: This study was funded by the UK Research and Innovation Global Challenges Research Fund (UKRI GCRF) Accelerate Hub [ES/S008101/1], and the Oak Foundation [OFIL-20-057]. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. The authors received no financial support for the research, authorship, and/or publication of this article from a pharmaceutical company or other agency. All authors have full access to the data in the study and accept responsibility to submit for publication.

Declaration of Interests: All authors have declared that no competing interests exist.

Ethics Approval Statement/Informed Consent Statement: Research data used in this analysis were accessed under safeguarded conditions of use from the UK Data Archive website.36 Details of approvals from formal ethics committees, and informed consent obtained from participants in the primary research are available online at: https://www.younglives.org.uk/content/research-ethics.

Keywords: Adolescent, Pregnancy, Marriage, Education, Community Health Programme, Health Extension Programme, Ethiopia, Quasi-Experimental