DECEMBER 2014

Volume 3, Issue 2

The Last Ten

Kilometers (L10K)
What it takes to
improve health
outcomes in rural
Ethiopia
L10K aims to
strengthen the
bridge between
households and
Primary Health
Care Unit,
Ethiopias basic
health service
delivery structure.
It works to
improve quality
and increase
demand, access
and utilization of
high impact
reproductive,
maternal,
newborn and child
health
interventions.
L10K is funded by
the Bill & Melinda
Gates Foundation,
UNICEF, and
USAID, and
implemented by
JSI Research &
Training Institute
Inc.
L10K works with
local partners, in
the four most
populated regions
of Ethiopia:
Amhara, Tigray,
Oromia, and
Southern Nations,
Nationalities and
Peoples (SNNP)
regions.

n the last two years L10K has produced nine issues of its quarterly newsletter which has been
distributed widely within Ethiopia and posted on the L10K website for an even wider coverage.

In the first year it covered issues on integrated community case management, mobile health,
community based data for decision making, and early care seeking and referral solutions. The second
year it covered issues on participatory community quality improvement, community based nutrition, basic
emergency obstetric and newborn care, and community based newborn care were shared. The latest issue
bringing us into the third year of print was respectful maternity care one of L10Ks newest interventions. We
hope to follow this up with other new initiatives L10K has currently taken up: EPI, continuity of care, and
family planning.
Nonetheless, we believe we should pause to listen to the needs of our readers. Taking that time now, this
issues is dedicated to finding out the thoughts of our readers regarding the L10K newsletter. We would like
to know changes youd like to see, what should we drop, what should we introduced, etc. Hence, we have
developed a brief questionnaire (inside) and would like you to share your thoughts with us.

Summary of each issue covered by the L10K newsletter in the past two years:

In an effort to contribute to the attainment of Millennium Development

Goal 4 (reducing child mortality by two-thirds by 2015) in Ethiopia, L10K
is one of several partners that has been supporting the governments
effort to initiate integrated Community-Case Management (iCCM) of
common childhood illnesses.
October 2012, Volume 1, Issue 1

The m-Health based supportive supervision management information

system (MIS) initiative, described in this newsletter, is one of the major
components of L10Ks M&E framework. The m-Health MIS
complements and supplements L10Ks M&E framework to measure the
contribution of community-based strategies .
December 2012, Volume 1, Issue 2
Cont. on page 2

DECEMBER 2014, Vol. 3, Issue 2

News from the Last Ten Kilometers

Cont. from page 1

In a country like Ethiopia where more than 85% of the population lives in rural
areas, L10Ks Community Based Data for Decision Making (CBDDM) strategy
enables communities to actively own, lead, inform, plan, and monitor their own
health interventions. Data on household health practices is gathered through
simple surveillance mechanism and are mapped in a visual form.
March 2013, Volume 1, Issue 3

Referral, which is the focus of this newsletter, is not simply a problem of transport or
access but it is about infrastructure, staffing, facility management, attitude, and
accountability, and about the whole relationships among households, communities,
Health Extension Workers/Health Development Army and the health facility.
June 2013, Volume 1, Issue 4

The PCQI approach has helped HEWs improve their skills through practical experience
working with experienced staff at health centers based on quality, acceptability, and
responsiveness of health care services to community needs. Today PCQI has become a
comprehensive process which communities use in various non-health activities as well.
September 2013, Volume 2, Issue 1

L10Ks nutrition activities at the community level hopes to improve mothers knowledge
about good health and nutrition practices and prevent malnutrition. Mothers are helped to
take charge of the healthy growth of their children. Hence, community based nutrition
activities not only will contribute to decreasing infant and under-5 mortality but will also
help to alleviate poverty, improve health, and consequently improve the economy of a
country.
December 2013, Volume 2, Issue 2

News from the Last Ten Kilometers

DECEMBER 2014, Vol. 3, Issue 2

Most maternal and newborn deaths can be averted with evidencebased and high impact
health interventions. However, the low health care service utilization and supply side
challenges; like availability of welltrained and motivated providers and the readiness of
facilities in terms of availability of supplies and drugs including standard operating
procedures, for the provision of quality maternal health services, have slowed down
progress in preventing such deaths. Consequently, achieving the Millennium Development
Goal 5 of improving maternal health by 2015, is still distant.
March 2014, Volume 2, Issue 3

The core principle of the CBNC strategy is ensuring the continuum of care, i.e. is from
pregnancy to postnatal periods as well as from the home/community to the health
facilities. This allows for the provision of skilled care during pregnancy, child birth, and
postnatal periods and enables early detection and appropriate management of problems
which prevents complications. In such a way, CBNC will improve maternal and newborn
care practices and care seeking through health development army and other effective
community mobilization mechanisms.

June 2014, Volume 2, Issue 4

Most women and their families expect to receive care from a health facility which is well
equipped, comfortable and clean and has health providers who are caring, empathetic,
supportive, as well as respectful and who can effectively communicate to facilitate
informed decision. However, a significant number of women experience treatment and
care that does not correspond with their expectation and it is this memory of their
childbearing experience which is tainted with disrespect and abuse that stays with them
for a longtime.

September 2014, Volume 3, Issue 1

News from the Last Ten Kilometers

DECEMBER 2014, Vol. 3, Issue 2

Dear Readers,
L10K would like to improve its quarterly newsletter in ways that can respond to its readers information needs
on reproductive, maternal, newborn and child health. Thus, we have develop this questionnaire which will
take only five minutes to fill out. Thus, we hope you will be able to take time to respond to the questions
below.
Your honest feedback is of great value and is important for our processes of improvement. The information
you provide will be confidential so you will not need to write your name.
You may send your response in hard copy (by filling out these two pages) to the following address:
The Last Ten Kilometers Project,
P.O.Box 13898
Addis Ababa, Ethiopia
or an electronic copy is available on our website at http://l10k.jsi.com/ and alternatively you can fill this out
and send your response to aabebe@jsi-ltenk.org.et
Thank you for your time!
1. Are you familiar with the L10K newsletter News from the LAST TEN KILOMETERS?
a. Yes

b. No

2. How did you know about the L10K newsletter?

a. I receive a copy of the newsletter from L10K
b. Ive heard about it from a friend
c. I accessed it from L10K website
d. Ive seen it in an office somewhere
e. Other (please state)
________________________________________
________________________________________
________________________________________
3. How frequently do you receive the newsletter
a. Every quarter
b. Irregularly
c. Others (please state)

__________________________________________________
__________________________________________________

News from the Last Ten Kilometers

DECEMBER 2014, Vol. 3, Issue 2

4. How far apart is the gap between the time the newsletter is issued and the time you receive it?
a. One month

b. Two months

c. More (please state) ________________

5. Which section from the newsletter do you read regularly?

a. Cover page
Editorial
News updates
b. I have no preference

Success story

c. I usually read all pages

d. I just browse through the newsletter
6. How informative do you find the newsletter to be on RMNCH matters?
a. Very informative

b. Reasonably informative

c. Not informative

7. Do you think the newsletter needs improvements?

a. Yes, very much

b. Needs some improvement

c. No, not at all

8. If your answer to number 7 is yes, what improvements would you suggest? (E.g. change of layout,
addition or deletion of topics, quality of the writing, timeliness of the information, format of publication (hard and/or soft copy)). Please give details.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
9. Would you like to continue receiving the newsletter?
a. Yes
b. No
10. Would you like to submit information and/or articles to the newsletter?
a. Yes
b. No
11. How well have you learnt about the work of L10K through the L10K newsletter ?
a. Very well
b. Fairly well
c. Very little
d. Nothing at all
12. Please state your general impression of the L10K quarterly newsletter
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

UPDATES
L10K - third round survey
L10K Project has been implementing innovative
strategies to enhance the interactions between
the primary health care unit frontline health
workers and families to increase the quality and
equitable coverage of reproductive, maternal,
newborn, and child health (RMNCH) care
interventions; ultimately contributing towards
the achievement of MDGs 4 & 5.
The Project was initiated in October 2007 and
lasted till September 2012. Nonetheless,
through a supplemental fund the Project period
extended up to September 2015 and its scope
was also modified. Two rounds of household
and community surveys have been conducted to
measure the impact of L10K innovations on
health care behavior and practices. Round I
survey was the baseline conducted from
December 2008 January 2009 and Round II
was the midterm survey conducted from
December 2010 January 2011. Now L10K has
carried out its Round III survey from December
2014 February 2015 in four of its operational
regions: Oromia, Amhara, Tigray, and SNNP. It
has assessed the added value of interventions
introduced during the supplemental period.
Participants of the survey included women in
the reproductive age 15-49 years, women with
children age 0-11 months, and women with
children age12-23 months and health extension
workers (HEWs).
The study, in particular, tried to answer
questions such as,

What are the trends in MNCH care indicators

between Round I, Round II and Round III
surveys?

Were the changes in MNH indicators

between Round I and Round II surveys partly
attributable to the L10K platform strategy?

What was the added value of BEmONC to the

L10K platform in improving skilled delivery
rates?

What was the added value of Referral

Solutions in improving skilled delivery rates
in the L10K areas?

What was the effect of PCQI in improving

MNH indicators?

A Community of Practice team

met in Rwanda
A Community of Practice (CoP) team visited in
Kigali, Rwanda from November 18-21, 2014.
Participants were from Ghana (Project Fives
Alive!), Ethiopia (JSI/L10K), Nigeria (Society for
Family Health), and Partners In Health (PIH).

The aim of the team is to build a learning

community in order to share concepts, ideas,
tools, and methods on how to improve referral
processes and outcomes. Accordingly, each
participating organization takes turn to host a
visit to its country. For this year, the Institute for
Healthcare Improvement (IHI) organized the
visit.
The group that met in Kigali mainly exchanged
progress reports on their work since their last
trip to Addis Ababa in May 2013.
The Ethiopian team consisted of staff from L10K
and Averting Maternal Death and Disability
(AMDD). L10K also sponsored a Health
Extension Worker, Yitagesu Alemu from
Germama Gale health post in Dalocha Woreda,
Silte Zone of SNNP region to join the visiting
group. Yitagesu shared her experience on how
her work as a community health worker is
facilitated by a community initiative edir (a
traditional self-help group). She also told of the
positive impact that quarterly review meetings
held with health facilities and communities have
on her work. The CoP team appreciated to have
received first-hand information from a
community health worker and to be able to
discus with her at length.
The Ethiopia team in addition presented the
case of how a very low performing health center
in Amhara region made dramatic changes in
improving facility delivery by identifying
previous bottle necks and solutions working
together with the community. The presentation
illustrated the level of adherence to referral
protocols and improvements gained in maternal
and newborn health outcomes. As part of its
best practice L10K talked about how it
leveraged resources to balance supply with the
growing demand where it introduced Basic
Emergency Obstetric and Newborn Care
(BEmONC) as a result of the Referral Solution
initiative.
The briefings and discussions were then
followed by site visits which were made to a
district hospital, two health centers, and the
homes of community health workers. This
helped to understand the Rwanda health system
and appreciate the commitment of the
government
which was
evident in the
large number
of wellequipped
health
facilities that
exist.
Yitagesu works closely with edir
chairpersons

This quarterly
newsletter is
produced by the Last
Ten Kilometers
Project, funded by
the Bill & Melinda
Gates Foundation,
UNICEF and USAID.

DECEMBER 2014
Volume 3, Issue 2
The Last Ten
Kilometers Project
P.O.Box 13898
Addis Ababa,
Ethiopia
http://l10k.jsi.com
Tel +251 11 662 0066
Fax +251 11 663

Disclaimer: Information,
views or opinions
expressed in this
newsletter do not
necessarily represent or
reflect those of Bill &
Melinda Gates
Foundation, UNICEF and