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Background: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities.Methods: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components.Discussion: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond.Trial Registration: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017. [ABSTRACT FROM AUTHOR]

Fiscal decentralization is one component of decentralization that gives authority to local governments to collect revenue through taxes and responsibility over spending decisions. Even though fiscal decentralization has given revenue raising and spending decision powers to lower levels of government, the implementation process has often been a daunting task for many local authorities in the developing world. In the case of Ethiopia, decentralization has been implemented since 1991. However, revenue raising and expenditure management are not efficiently and effectively exercised, especially in lower level government units of Ethiopia. Insufficient revenue collection and reprehensible expenditure management leads to financial incapability such that public infrastructure and services could not be financed amply. Dangila municipality faces the problem of financial capacity to deliver infrastructure and services to its citizens. While a number of studies have documented the financial incapacities of Ethiopian municipalities, they have been very shy to articulate the discrepancies and deficiencies that link financing to service delivery. It is interesting to know what the driving factors are in this case. Therefore, the main focus of this paper is to assess the efficiency and effectiveness of revenue collection and expenditure management of Dangila Municipality. To obtain edifying data the paper used a positivist survey study. Municipality financial documentation and questionnaires were the main sources of secondary and primary data respectively. Parametric descriptive statistical methods were applied in the analysis of data to arrive at measures of efficiency and effectiveness in revenue collection and expenditure management of the municipality. The study revealed that the municipality is not efficient and effective in its revenue collection and expenditure management. The main explanation for such inefficiency comprise; derisory assessment of taxable sources, poor organizational structure, inadequate accounting system, absence of clear operational guidelines, poor planning and data base management, lack of awareness by taxpayers and lack of skilled manpower. To resolve such challenges, we recommend the following actionable measures; widening the revenue base of local sources of revenue, improving planning and implementing capacity, establishing adequate data base systems, continuous awareness creation for taxpayers, establishing appropriate guidelines and methods of revenue collection, revision of the tariff structure regularly, installing accounting system that produces timely and reliable information, encouraging community participation in planning and resource allocation and municipal restructuring that take into account needs and welfare of employees. [ABSTRACT FROM AUTHOR]

Achieving sustainable food and nutrition security calls for multi-sectoral coordination mechanisms in implementing, among others, nutrition-sensitive agricultural interventions. Despite progresses made in evaluating the effectiveness/impact of these interventions in some countries, very little is known about the nature and causal effect of these interventions in Ethiopia. Therefore, this systematic review aims to provide evidence on the impact of nutrition-sensitive agricultural interventions and pathways linking agriculture to improved nutrition. Based on a comprehensive advanced literature search using keywords in various databases and setting inclusion/screening criteria, we identify 25 relevant studies conducted between 2008 and 2018. Overall, we find positive effects on knowledge, attitude, and practice of complementary feeding and economic indicators (income, poverty and asset accumulation). We also find an overwhelming positive effect on food consumption, dietary diversity, and food security indicators. However, we also note mixed effectiveness in relation to child anthropometry. The most important pathways linking agriculture to improved nutrition center on its role as a source of food and income, and its effect on food prices/market. Hence, enhancing community-based nutrition education, accelerating adoption of improved technologies, improving access to farm inputs and technical information, integrating farmers to markets, and boosting enabling environments and capacities should be emboldened. [ABSTRACT FROM AUTHOR]

The importance of internal audit as element of a strong public sector governance foundation is increasing from time to time. Therefore, the purpose of the study was to assess the effectiveness of the internal auditing in improving corporate governance of Bule Hora University. Descriptive research design has been used with primary and secondary data by using structured questionnaire, in-depth interview & documentary review. The study reveals that the internal audit unit has low technical proficiency, did not have adequate resource, internal audit recommendations are not afforded enough attention and there was no audit charter and audit committee in the university. Thus, the study forwarded the following recommendations. Internal audit unit technical proficiency should be improved, provision of sufficient resources and should have audit committee that ensures the independence of internal audit, and finally, the University should establish internal audit charter for internal auditors. [ABSTRACT FROM AUTHOR]

Background: Water, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children—known as "BabyWASH"—reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia. Methods: A mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings. Results: The multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p < 0.001), handwashing with soap or ash (t-test = 8.85; p < 0.001), maintaining separate playgrounds for young children (t-test = 2.83; p < 0.001), washing of child's body, hands, and faces (t-test = 15.78; p < 0.001), and food hygiene practices (t-test = 2.74; p < 0.05). The findings of the qualitative assessment also revealed that the multimedia intervention packages and the approaches used were successful in influencing key BabyWASH and diarrhea prevention behaviors in the intervention implementation woredas. In addition, providing capacity building training to local actors and community leaders and recording radio talk shows and sharing them with community members were recognized as effective intervention implementation strategies. Conclusion: The endline evaluation found that the multimedia educational intervention improved awareness, perception, and practice of BabyWASH and diarrhea prevention behaviors in intervention woredas compared to control woredas. Sanitation and hygiene promotion interventions in pastoralist settings can be effective when using locally and contextually appropriate intervention strategies. However, considerations for integrating both behavioral and structural components in WASH interventions is essential. [ABSTRACT FROM AUTHOR]

Addis Ababa is one of the eleven cities in Africa that have been taking bold action in meeting the objectives of the Paris Agreement. At the present time, the city is working toward reducing greenhouse gas emissions and enabling the city to be resilient to the impacts of climate change. To make the city carbon neutral and resilient to climate change, the coordination of different sectors and actors is crucial. To this end, the planning and implementation of mitigation and adaptation measures needs effective climate change governance. Thus, this study was intended to explore the effectiveness of climate change governance in Addis Ababa City, Ethiopia. The study followed both quantitative and qualitative research approaches and relied on both primary and secondary data sources. A survey of 232 respondents, who were environment experts at different levels, was conducted using questionnaires. In addition, interviews and observations were conducted to gather relevant data. Secondary data were collected from different sources. The quantitative data were analysed using relative importance index (RII) analysis. The study found that existing environmental policies, strategies, regulations, proclamations, laws, and implementations in the city were facing major challenges in terms of weak accountability, the poor enforcement of regulation, and the failure to involve key actors, especially NGOs, communities, and private sectors; these failures were characterized by weak institutional setup and a lack of formal systems allowing actors (private sectors, communities, and NGOs) to interact to respond to climate change. Hence, climate change governance was ineffective in terms of accountability, participation, law enforcement, equity, institutions, the role of actors, and partnership. Thus, the Addis Ababa City Environmental Protection and Green Development Commission should give more emphasis to the coordination of other actors (NGOs, communities, private sectors, and research institutions) to respond to climate change in the city. In addition, the commission should provide training to the lower layers of experts and mobilise the community for climate change response, particularly in the undertaking of adaptation measures. Furthermore, Addis Ababa City administrators should give due attention to climate change response through an established strong accountability system to enforce regulation, rules, proclamations, laws, policies, and strategies in different sectors. [ABSTRACT FROM AUTHOR]

Learning is a fundamental human right, the basis of developing human capital and the foundation of human development. Basic skills provide individuals, their families and communities with the foundations needed to participate in society and to achieve better life chances. The shift in focus from mass access to mass learning has drawn attention to the question of who is and is not attaining these skills, and why. Opportunities to learn depend on access to schooling, but also the effectiveness of that schooling. There is considerable evidence of learning inequalities, both across and within countries. However, less is known about whether these patterns of inequality are rooted in variations in school effectiveness. In this paper we use evidence from Young Lives school surveys in Ethiopia, India and Vietnam to consider differences in girls' and boys' learning outcomes and progress and investigate how these patterns relate to school effectiveness. We explore whether girls or boys are 'sorted' into more or less effective schools and whether the same schools are differentially effective for boys and girls. Findings from India are perhaps closest to the 'typical' story that is often heard, in which girls, particularly those in rural areas, have lower attainment and attend less effective schools. In comparison, in Vietnam, girls have higher test scores and attend more effective schools on average, with this pattern driven by the higher performance of girls in rural areas. In Ethiopia, the divide between urban and rural areas is predominant in this context, over and above other areas of inequality including gender. Comparing results from these different areas of analysis and from three very different countries reveals the complexities of understanding how gender relates to educational outcomes. It demonstrates the importance of understanding gendered outcomes and school effectiveness in context. • Educational outcomes depend on access to education and the quality of that education. • Cross-country analysis reveals the complexities of how gender and school effectiveness relate to educational outcomes. • In India, where there is greatest school choice, girls have lower attainment and attend less effective schools than boys. • In Vietnam, the opposite is true - girls perform better and attend more effective schools. • In Ethiopia, the divide between urban and rural areas is predominant, over other axes of inequality including gender. [ABSTRACT FROM AUTHOR]

Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the 'backlog cohort', comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries' plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction. [ABSTRACT FROM AUTHOR]