The impact of a health facility construction campaign on health service utilisation and outcomes: analysis of spatially linked survey and facility location data in Ethiopia

Abstract

BackgroundAccess to health facilities in many low-income and middle-income countries remains low, with a strong association between individuals’ distance to facilities and health outcomes. Yet plausibly causal estimates of the effects of facility construction programmes are rare. Starting in 2004, more than 2800 government health facilities were built in Ethiopia. This study estimates the impact of this programme on maternal health service utilisation and birth outcomes.MethodsWe analyse the impact of Ethiopia’s health centre construction programme on health service utilisation and outcomes, using a difference-in-difference design. We match facility opening years to child birth years in four rounds of Demographic and Health Surveys (DHS) using georeferenced data. We also use event study models to test for pre-trends in the outcomes of interest.ResultsOpening of new health facilities within 5 km increases facility delivery by 7.2 percentage points (95% CI 5.2 to 9.1) and antenatal care by 0.38 visits (95% CI 0.24 to 0.52). It is not significantly associated with changes in caesarean section births or neonatal mortality. Opening of district hospitals increases facility delivery by 18.2 percentage points (95% CI 12.7 to 23.7), and caesarean section births by 6.8 percentage points (95% CI 2.5 to 11.2), but is not associated with reduction of neonatal mortality.ConclusionsEthiopia’s facility construction program improved access to antenatal and delivery care. However, there was no detectable association between facility construction and neonatal mortality. Increased access to care must be combined with health system quality improvements and broader social development initiatives to sustainably improve health outcomes.

Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design

“…While there is limited evidence of the impact of supply-side interventions, a notable exception is a recent study by Croke et al , which investigated the impact of national health facility construction programme on delivery rates in Ethiopia using similar data and study design. The authors find similar effect sizes: the construction of a new health facility led lead to a 7.2 percentage point increase in ID rates among treated facilities and the effects were observed almost immediately after the facilities had been constructed 24. Proportionally our results are smaller, due to higher baseline health service utilisation rates; however, taken together, our study and these findings suggest that supply-side interventions, when properly implemented, can also translate into meaningful gains in ID rates.…”

Health Care Readiness in Management of Preeclampsia/Eclampsia in Ethiopia: Evidence from National Facility-Based Survey

“…This is likely due to the high number of government health facilities having been built in Ethiopia since 2004. 23 This construction program significantly improved key elements of maternity care such as facilities for delivery including caesarean section delivery, ANC, postnatal care, and child health. 4 However, there are several barriers to equipping these health facilities with human resources, essential equipment and supplies, specific to providing services for women’s health in general and especially for women with preeclampsia and eclampsia.…”

Community‐Based Health Insurance scheme implementation in Ethiopia: A mini‐review on the experience and its implementation process

“…The HSDP has contributed to the continuous development of health infrastructure and health workforce and improved access to primary healthcare in Ethiopia (Ministry of Health of Ethiopia, 2014). In this regard, 35,000 health extension workers trained, more than 2800 government health centers, and 15,000 health posts were built within 10 years period (Croke et al, 2020).…”

“…The massive health facility construction and training of new health workers with less intensive training have resulted in the reduction of distance to health facilities (which has increased health facility delivery by 18.2%) and contributed to reducing child and maternal mortality. This ultimately enabled the achievement of the Millennium Development Goals ahead of time and the Ethiopian government received acknowledgment internally and internationally by the UN and other development partners (Berhan, 2008; Croke et al, 2020). Despite this achievement, Ethiopia has one of the lowest national UHC service coverage in the world with 34.3% in the year 2015 (Eregata et al, 2019).…”