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In Ethiopia, major policy reforms to increase equitable access to pre-primary education were instigated in 2010, leading to a surge in pre-primary school enrolment. This paper investigates the effects of the expansion on who gets access to pre-primary education and on readiness for primary school. We find that inequalities in pre-primary access between advantaged and disadvantaged regions of the country persist following the reforms, with girls less likely to attend school, particularly in more disadvantaged regions. More than half of children enrolled in pre-primary classrooms are below the official age of 6 years. Children from more advantaged backgrounds (those whose parents are literate, have reading materials at home, and live in urban areas) are more likely to participate in pre-primary schools both before and after the reform. Yet pre-primary education could play a role in equalizing opportunities in primary school: we find pre-primary participation to be positively associated with children's reading skills in Grades 2 and 3 of primary school after the expansion. These findings highlight the need to focus policy attention on efforts to reduce barriers to pre-primary access for children in disadvantaged circumstances.

This paper assesses the factors underpinning trends in mathematics learning for Grade 4 pupils in Ethiopia based on data collected in 2012-13 (the Young Lives surveys, YL) and 2018-19 (the RISE surveys). It combines comparable data on attainments on tests of students’ mathematics knowledge with information on their family background, their teachers, and the schools they attend. The period covered by the study encompasses an education reform, the General Education Quality Improvement Program – Phase II (GEQIP-II). GEQIP-II’s goals included increasing access to primary education and the quality of education that was provided. We find that mathematics teachers’ educational qualifications and teacher content knowledge in mathematics improved between 2012 and 2018. Despite this, students in 2018 have learning levels lower than students in 2012. This reflects, in part, changes in the composition of the samples, with the 2018 sample coming from poorer and rural households. However, students in 2018 show greater learning progress over the course of a school year compared to students in 2012. Using a value-added model, we show that learning outcomes in mathematics at the end of the school year are associated with teacher content knowledge, that this association has increased in magnitude over time, and that this content knowledge is especially important for weaker students. The key to reconciling these paradoxical findings is, thus, to recognize that the reforms that underpin these improvements in school quality may well be working in multiple ways, changing the composition of the student body who attend school as well as increasing the amount of learning that takes place in the classroom, particularly for weaker students. This, juxtaposed with the fact that the education reforms implemented over the last decade have sought to both include students from disadvantaged backgrounds and to improve teacher quality, is suggestive of the possibility that the GEQIP initiatives were producing positive learning results.

This paper focuses on research from the RISE Ethiopia team and addresses two major objectives: analysing the progress made towards achieving key goals under the four focus areas of GEQIP-E (internal efficiency, quality, equity, and system strengthening for policy formulation and reform) and whether the indicators of GEQIP-E implementation have been associated with estimated improvements in numeracy over one academic year. The analysis is based on longitudinal data collected as part of the RISE Ethiopia programme during the academic years 2018/19 and 2021/22, as they coincide with the implementation of GEQIP-E (GEQIP-E was disrupted by the dual shocks of COVID-19 and the violent civil conflicts that erupted in November 2020). Findings are presented under the four areas of intervention (school internal efficiency, quality, equity and system strengthening) and the final section links these areas of intervention with learning outcomes.

Background Chronic disease-related catastrophic health spending is frequent in Ethiopia affecting several households, particularly the poorest ones. A community-based health insurance (CBHI) scheme has been in place in Ethiopia since 2011. The scheme aims to provide financial protection against health expenditure but there is little evidence of how well it protects chronic patients financially. Objective The objective of the study was to evaluate the effect of community-based health insurance in reducing the incidence of catastrophic health expenditure among patients attending chronic disease follow-up departments in Asella referral hospital, Southeast Ethiopia. Method A health facility-based comparative cross-sectional study was conducted in Asella referral hospital from March 2022 to May 2022. Systematic random sampling was used to select 325 chronic patients. Data were collected using an open data kit (ODK) collect app and then imported to STATA version 16 for analysis. Propensity score matching was used to evaluate the effect of community-based health insurance on catastrophic health expenditure. Result The study enrolled a total of 325 chronic patients (157 insurance members and 168 nonmembers). More than 30% of the study participants incurred health spending that could be catastrophic based on the 15% nonfood threshold. Catastrophic health expenditure was found in 31% of insured and 47% of uninsured participants. Overshoot and mean positive overshoot were 10% and 33% for insured members, respectively and the corresponding figures were 18% and 39% for nonmembers. Community-based health insurance contributes to a 19% ((ATT = -0.19, t = -2.97)) reduction in the incidence of catastrophic health expenditure among chronic patients. This result is found to be consistent for alternative measurements of the outcome variable and the use of alternative matching algorithms. Conclusion Chronic patients, particularly those in uninsured households, had a high incidence and intensity of catastrophic health expenditure. Hence, it is relevant to expand community-based health insurance to provide financial protection for people suffering from chronic conditions.

The Ethiopian education system has been very dynamic over recent years, with a series of large-scale education program interventions, such as the Second Phase of General Education Quality Improvement Project (GEQIP-II) that aimed to improve student learning outcomes. Despite the large-scale programs, empirical studies assessing how such interventions have worked and who benefited from the reforms are limited. This study aims to understand the impact of the reform on Grade 4 students’ maths learning outcomes over a school year using two comparable Grade 4 cohort students from 33 common schools in the Young Lives (YL, 2012-13) and RISE (2018-19) surveys. We employ matching techniques to estimate the effects of the reform by accounting for baseline observable characteristics of the two cohorts matched within the same schools. Results show that the RISE cohort started the school year with a lower average test score than the YL cohort. At the start of Grade 4, the Average Treatment Effect on the Treated (ATT) is lower by 0.36 SD (p

Background. As part of the efforts being made to achieve universal health coverage, Ethiopia plans to introduce a social health insurance scheme for the formal sector. Although the contribution will be collected as 3% of an employee’s gross salary from both the employee and employer, there is a concern that the premium may not be affordable for the majority of civil servants and that there could be limited interest in joining the scheme. As a result, the purpose of this study was to assess public servants’ awareness, willingness to join, and affordability of social health insurance in Arba Minch, south Ethiopia. Methods and Materials. A cross-sectional study design was used with 713 randomly chosen public employees from Arba Minch town from January 1 to 30, 2019. The survey participants were selected based on a multistage stratified random sampling method. Descriptive statistics were used to summarize awareness and affordability of the scheme, and both bivariate and multivariable logistic regressions were used to examine factors driving the outcome variables. Variables that had a p value of less than 0.25 in bivariate analysis were changed to multivariate analysis, and a p value of less than 0.05 was cutoff point for multivariate analysis. The odds ratio and 95% CI were used to report the findings. Result. In this study, 692 people voluntarily participated, which corresponds to a response rate of 97%. As the results revealed, 347 (50.1%) respondents had never heard of SHI before, 607 (87.7%) were able to afford the 3% of gross salary per month as a scheme premium, and 254 (36.7%) were willing to join the scheme. Working sector, regularly listening for health information through mass media, and social network participation were significantly associated with awareness of the SHI scheme. Also, educational status, family size, and net income were found to be significant factors associated with the affordability of the SHI scheme. On the other hand, awareness of SHI, family size, regularly listening for health information, and participation in social networks were significantly associated with willingness to join SHI during multivariate analysis. Conclusion. Half of the participants were unaware of social health insurance, suggesting that the program is not well known. Although only one-third of respondents were willing to join and pay for the program, the majority were able to afford the proposed contribution of 3% of gross wages per month.

The outbreak of COVID-19 pandemic has disrupted the education sector in unprecedented ways. As with many other countries around the world, the Ethiopian government closed schools following the first identified case in the capital city, Addis Ababa, on the 16th of March 2020. Across the country, these closures resulted in more than 26 million learners staying at home for almost eight months (UNESCO, 2021). In addition to this hiatus in their education, pupils were promoted automatically to the next grade with only 45 days of catch-up classes (Ministry of Education, 2020). In other words, those attending a specific school grade in March 2020 were then promoted to the next grade when school resumed in October 2020. For a significant proportion of Ethiopian pupils, learning during school closures was extremely limited despite the government’s efforts to create educational programmes via national television and radio stations (Kim et al., 2021a; Yorke et al., 2020). School closures, combined with barriers to accessing remote educational resources, meant potential learning losses for a significant number of pupils. Several studies have already indicated that COVID-19 resulted in learning losses, especially among the poorest and most disadvantaged groups. A study in Indonesia found that pupils lost 11 points on the PISA3 reading scale due to the four-month school closure from March to July 2020 (Yarrow, Masood & Afkar, 2020). It was also estimated that Grade 4 pupils in South Africa experienced losses equivalent to more than 60 percent of an academic year (Ardington, Wills & Kotze, 2021), while pupils in the UK lost a third of their expected learning during pandemic-related school closures (Major, Eyles & Machin, 2021). It is anticipated that school closures in Ethiopia could similarly result in learning losses and challenges for pupils to catch up with their learning, particularly for those from disadvantaged backgrounds. Our related emerging findings in Ethiopia have indicated that school closures exacerbated pre-existing inequalities in education, where progress was much lower for rural students compared to those in urban areas who were tracked from Grade 4 to Grade 6 (Kim et al., 2021b; Bayley et al., 2021). Building on this work in Ethiopia, this Insight Note provides a new perspective on numeracy achievements of Grade 1 and Grade 4 pupils by comparing learning at the start of each academic year and the gains over the course of the year across two academic years: 2018-19 and 2020-21. During the 2018-19 academic year, the Research on Improving Systems of Education (RISE) Ethiopia programme collected data on students’ numeracy achievement from 168 schools. After schools reopened in October 2020, and with additional support from the Bill and Melinda Gates Foundation, data on students’ numeracy achievements were collected for two new cohorts of pupils in Grades 1 and 4 in the same schools using the same instruments. This has enabled us to compare learning patterns between two cohorts in the same grades and schools before and during the pandemic. More specifically, in this Insight Note, we aim to: -Compare foundational numeracy levels of pupils entering Grade 1 in the 2020-21 academic year relative to those in 2018-19. -Compare progress in foundational numeracy for Grade 1 pupils over the course of the 2020-21 academic year relative to that seen during the 2018-19 academic year. -Compare numeracy levels of pupils entering Grade 4 in the 2020-21 academic year relative to those entering the same grade in 2018-19. -Compare progress in numeracy for Grade 4 pupils over the course of the 2020-21 academic year relative to the progress seen during the 2018-19 academic year. -Estimate the magnitude of learning loss attributable to the pandemic by calculating the difference in numeracy levels and progress between the two cohorts.

Background The World Health Organization’s new roadmap for neglected tropical diseases (NTDs) 2021–2030 aims to prevent, control, eliminate or eradicate 20 tropical diseases that are affecting the lives of 1.5 billion people worldwide. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine and /or care has been little explored to inform the country’s NTD strategic plan. This scoping review aimed to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine and /or care in Ethiopia. Methods A systematic search was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022 and without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) was followed and the findings were synthesized narratively. Results The search resulted in 4,532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to medicine/drug, care and diagnostics. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. Conclusions The review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.

While Ethiopia has seen a rapid expansion of school enrollment over the past 25 years, especially in primary education, dropout, absenteeism, and grade repetition remain key challenges to achieving the education-related Sustainable Development Goals. This article uses the 2017/18 Gender and Adolescence: Global Evidence (GAGE) survey of 6800 Ethiopian adolescents and regression analysis to examine how exposure to and /or experience of violence (from peers and at home), adolescent decision-making power in the household, and paid and unpaid child work are related to absenteeism, dropout, and on-time completion in primary school. The findings provide empirical evidence on the positive association between adolescent decision-making power in the household and educational outcomes and the negative relationships between adolescent education and both exposure to and /or experience of violence and paid and unpaid child work. We explore variations in the magnitude and robustness of these associations across gender, age cohort, and rural/urban residential location. Our findings suggest that programs which enhance decision-making power of adolescents in the household reduce exposure to and/or experience of violence among peers and at home and reduce participation in paid and unpaid child work which can improve adolescent educational attainment.

Given increasing policy attention to the consequences of youth marginalisation for development processes, engaging with the experiences of socially marginalised adolescents in low- and middle-income countries (including those who are out of school, refugees, married, with disabilities or adolescent parents) is a pressing priority. To understand how these disadvantages—and adolescents’ abilities to respond to them—intersect to shape opportunities and outcomes, this Special Issue draws on the Gender and Adolescence: Global Evidence conceptual framework which accounts for gender roles and norms, family, community and political economy contexts in shaping adolescents’ capabilities. Implicitly critiquing a focus within youth studies on individual agency, the articles advance our understanding of how adolescents’ marginalisation is shaped by their experiences, social identities and the contexts in which they are growing up. An analytical framework foregrounding intersectionality and collective capabilities offers a means to politicise these findings and challenge uncritical academic celebration of individual agency as the means to address structural problems.

The COVID-19 pandemic and subsequent lockdown has shattered the everyday lives of young people, limiting peer interactions and disrupting privacy, with potential for long-term detrimental impacts. This study uses rapid virtual quantitative and qualitative surveys undertaken from April to July 2020 with over 4,800 adolescents affected by displacement in Bangladesh and Jordan to explore adolescent girls’ experiences of social isolation and lack of privacy. Our mixed-methods findings suggest that the pandemic and policy response has caused sharp restrictions on privacy and substantially limited interactions with peers, with larger impacts on girls, particularly those with disabilities. For girls, digital exclusion exacerbates these gender differences. Given that privacy and peer interactions are paramount during adolescence, age-, gender-, and disability-responsive programming is essential to ensure future wellbeing.

Primary school enrolment in Ethiopia has more than doubled over the past two decades. In spite of this impressive achievement, and as in many low and middle-income countries that have experienced rapid expansion, the Ethiopian education system is characterised by a ‘learning crisis’ in which many children are leaving school without basic numeracy and literacy skills. In this paper, we explore the relationship between low learning levels and the features of an education system characterised by a sudden increase in learners from disadvantaged backgrounds, including ‘first generation learners’, or students whose parents have never been to school. Using unique longitudinal school survey data, we examine whether first generation learner status represents an additional layer of disadvantage in the Ethiopian education system; the relationship between first generation learner status and learning outcomes; and the educational trajectories of first generational learners through primary school. Based on these findings, we consider the implications of a rising tide of access for Ethiopia as it seeks to provide equitable, quality education for all by 2030.

Despite its cultural and biological importance, limited knowledge about menstruation and cultural taboos in many contexts mean that menarche often brings fear and stigma. In Ethiopia, the context of this paper, lack of knowledge and the stigma around menstruation create challenges for adolescent girls related to menstrual hygiene management and their reproductive health more broadly. This paper uses a cluster-randomized controlled trial (cRCT), with 97 communities (kebeles) randomly assigned to treatment or control, to assess the impact of a gender-transformative life-skills intervention [Act With Her-Ethiopia (AWH-E)] on the menstrual health literacy of very young adolescent girls and boys (10–14) in two diverse regions of Ethiopia (South Gondar, Amhara and East Hararghe, Oromia). The evaluation employs a longitudinal mixed-methods design, with baseline data collected in late 2017/early 2018 and follow-up data collected in late 2019/early 2020. Quantitative surveys were undertaken with 2,492 very young adolescents and their primary caregivers, and complemented by qualitative interviews with 291 adolescents and their caregivers, as well as 96 key informants at community and district levels. Our quantitative findings highlight large and statistically significant improvements on norms around menstruation, knowledge about menstruation and biological function, and knowledge and behavior related to menstrual hygiene management, but with important differences by location and gender. Qualitative findings further unpack these gender and regional differences, highlighting the importance of adapting programming to the local context and, where possible, connecting to other health and gender initiatives. This analysis helps fill the evidence gap on “what works” to improve menstrual health literacy in rural low- and middle-income contexts.

This paper presents the findings of research undertaken in Ethiopia to examine the effects of COVID-19 school closures on children’s holistic learning, including both socio-emotional and academic learning. It draws on data collected in 2019 (prior to the pandemic) and 2021 (after schools reopened) to compare primary pupils’ learning before and after the school closures. In particular, the study adapts self-reporting scales that have been used in related contexts to measure Grade 3 and 6 children’s social skills, self-efficacy, emotional regulation and mental health and wellbeing, along with literacy and numeracy. Lesson observations were also undertaken to explore teachers’ behaviours to foster socio-emotional learning (SEL) in the classroom. The findings advance current knowledge in several respects. First, they quantify the decline in Ethiopian pupils’ social skills over the period of the school closures. Second, they identify a significant and strong relationship between learners’ social skills and their numeracy, even after taking other factors into account. Third, they reveal a significant association between children’s social skills and their mental health and wellbeing, highlighting the importance of interpersonal interactions to safeguard children’s holistic welfare. The paper concludes by proposing a model for understanding the relationship between learners’ SEL and academic outcomes, and with recommendations for education planning and practice, in Ethiopia and elsewhere.

This article assesses the financing of early childhood education (ECE) in three resource-constrained contexts: Ethiopia, Liberia, and Mainland Tanzania. Based on an analysis of policy documents and education administrative data, as well as surveys with key policymakers, school principals, and parents, it identifies that ECE is seen as a national priority in government policies across the three countries. However, this commitment is not aligned with the allocation of sufficient financial resources by each of the governments, which are extremely low in all three countries. This misalignment is associated with inequitable resource allocation, further reinforcing gaps in access to quality ECE between more advantaged and disadvantaged populations within the countries.

Funder: World Bank Group (US), Funder: Foreign and Commonwealth Office; doi: http://dx.doi.org/10.13039/501100000617, Recent research on the effects of COVID-19 on school closures has mainly focused on primary and secondary education, with extremely limited attention to early childhood education (ECE). To address this gap, we identify the extent to which parents and caregivers with pre-primary school-aged children were engaged in their children’s learning during school closures in Ethiopia. Our focus on Ethiopia is of particular relevance given that ECE provision has expanded dramatically in recent years, aimed at ensuring children are prepared for primary school. Using data collected through a phone survey with 480 parents and caregivers, the results revealed that learning disruption due to COVID-19 school closures is likely to be substantial and will probably widen existing inequalities further. Many poorer households and those where parents or caregivers are not literate, are less likely to have child-oriented learning resources, and home learning activities between parents and children in these households are limited. The study highlights that greater attention needs to be paid to mitigate the threats of COVID-19 on Ethiopia’s recent gains in ECE, to prevent the pandemic from further reinforcing inequalities between children from advantaged and disadvantaged households.

Ethiopia has succeeded in rapidly expanding access to primary education over the past two decades. However, learning outcomes remain low among primary school children and particularly among girls and children from disadvantaged backgrounds. Starting with a systematic review of quantitative studies on the determinants of learning outcomes among primary school children in Ethiopia, this study then examined key determinants of students’ numeracy achievement over the 2018-19 school year. The study focused on Grade 4 children (N=3,353) who are part of an on-going longitudinal study. The two questions that guided this study are: what are the key determinants of numeracy achievement at Grade 4 in primary schools in Ethiopia, and how does our current empirical study contribute to understanding achievement differences in numeracy among primary school children in Ethiopia? We employed descriptive and inferential statistics to examine factors that determine differences in numeracy scores at the start and end of the school year, as well as determinants of numeracy scores at the end of the school year conditional on achievement at the start of the school year. We examined differences across gender, region, and rural-urban localities. We also used ordinary least squares and school ‘fixed effects’ approaches to estimate the key child, household and school characteristics that determine numeracy scores in Grade 4. The findings revealed that boys significantly outperformed girls in numeracy both at the start and end of the 2018/19 school year, but the progress in numeracy scores over the school year by boys was similar to that of girls. Besides, students in urban localities made a slightly higher progress in numeracy over the school year compared to their rural counterparts. Students from some regions (e.g., Oromia) demonstrated higher progress in numeracy over the school year relative to students in other regions (e.g., Addis Ababa). Key child (e.g., age, health, hours spent per day studying at home) and school- and teacher-related characteristics (e.g., provision of one textbook per subject for each student, urban-rural school location, and teachers’ mathematics content knowledge) were found to be significantly associated with student progress in numeracy test scores over the school year. These findings are discussed based on the reviewed evidence from the quantitative studies in Ethiopia.

This Insight provides an overview of the prevalence of inequity in access to quality primary education for children and particularly girls living in the emerging regions, and children with disabilities in Ethiopia.

ObjectiveTo provide evidence on the effect of the COVID-19 pandemic on the mental health of young people who grew up in poverty in low/middle-income countries (LMICs).DesignA phone survey administered between August and October 2020 to participants of a population-based longitudinal cohort study established in 2002 comprising two cohorts born in 1994–1995 and 2001–2002 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to examine associations between mental health and pandemic-related stressors, structural factors (gender, age), and lifelong protective/risk factors (parent and peer relationship, wealth, long-term health problems, past emotional problems, subjective well-being) measured at younger ages.SettingA geographically diverse, poverty-focused sample, also reaching those without mobile phones or internet access.Participants10 496 individuals were approached; 9730 participated. Overall, 8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) women. Non-inclusion was due to non-location or missing data.Main outcome measuresSymptoms consistent with at least mild anxiety or depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient Health Questionnaire-8 (≥5).ResultsRates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49–33.74)), and lowest in Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33–10.77)), mirroring COVID-19 mortality rates. Women were most affected in all countries except Ethiopia. Pandemic-related stressors such as health risks/expenses, economic adversity, food insecurity, and educational or employment disruption were risk factors for anxiety and depression, though showed varying levels of importance across countries. Prior parent/peer relationships were protective factors, while long-term health or emotional problems were risk factors.ConclusionPandemic-related health, economic and social stress present significant risks to the mental health of young people in LMICs where mental health support is limited, but urgently needed to prevent long-term consequences.

While Ethiopia has seen a rapid expansion of school enrollment over the past 25 years, especially in primary education, dropout, absenteeism, and grade repetition remain key challenges to achieving the education-related Sustainable Development Goals. This article uses the 2017/18 Gender and Adolescence: Global Evidence (GAGE) survey of 6800 Ethiopian adolescents and regression analysis to examine how exposure to and /or experience of violence (from peers and at home), adolescent decision-making power in the household, and paid and unpaid child work are related to absenteeism, dropout, and on-time completion in primary school. The findings provide empirical evidence on the positive association between adolescent decision-making power in the household and educational outcomes and the negative relationships between adolescent education and both exposure to and /or experience of violence and paid and unpaid child work. We explore variations in the magnitude and robustness of these associations across gender, age cohort, and rural/urban residential location. Our findings suggest that programs which enhance decision-making power of adolescents in the household reduce exposure to and/or experience of violence among peers and at home and reduce participation in paid and unpaid child work which can improve adolescent educational attainment.

ObjectiveTo provide evidence on the effect of the COVID-19 pandemic on the mental health of adolescents and young adults who grew up in poverty in Low and Middle Income Countries (LMICs).DesignA phone survey implemented August-October 2020 to participants of a population-based cohort study since 2002 comprising two cohorts born in 1994-5 and 2001-2 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We examined associations between mental health and pandemic-related stressors, as well as structural factors (gender, location, wealth); and lifelong protective/risk factors (parent and peer relationship, past household wealth, long-term health problems, past emotional problems and subjective well-being) measured at younger ages.SettingA diverse, poverty focused sample, reaching those without mobile phones or internet access.Participants10,496 individuals were approached, 9,730 participated. Overall, 8,988 individuals were included in this study, 4,610 (51%) male and 4,378 (49%) female. Non-inclusion was due to non-location or missing data.Main outcome measuresAt least mild anxiety and depression were measured by Generalized Anxiety Disorder-7 (GAD-7, ≥5) and Patient Health Questionnaire-8 (PHQ-8, ≥5).ResultsRates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) [95% CI, 38.63-43.12; (29.49-33.74)], and lowest in Vietnam at 9% (9%) [95% CI, 8.16-10.58; (8.33-10.77)], mirroring COVID-19 mortality rates. Females were most affected in all countries but Ethiopia. In all countries, pandemic-related stressors were associated with increased rates of anxiety and depression, though with varying levels of importance across countries. Prior parent and peer relationships were protective factors for mental health while having a long-term health problem or prior emotional problems were risk factors.ConclusionThe COVID-19 pandemic presents significant risks to the mental health of young people. Mental health support is limited in LMICs and young people have to date been lower priority for COVID-19 interventions.Strengths and limitations of this studyThe study uses data from adolescents and young adults who grew up in poverty in four LMICs which were diversely affected by the COVID-19 pandemic, therefore investigating a globally vulnerable, but understudied group both in terms of age and wealth.This study reaches a broad sample of young people who grew up in poverty, including those without internet or mobile phone access.A key strength is combining a broad range of pandemic-related stressors from survey data on experiences of COVID-19 with previously measured information on longer-term risk and protective factors, therefore contributing to a more complete picture of COVID-19 effects.A limitation of the study is that it does not have a directly comparable pre-COVID baseline for depression/anxiety, however, proxy variables are used as a baseline and the explanatory variables capture dynamics that happened during the pandemic.A further limitation is possible underreporting due to stigma associated with mental health, despite piloting and validation, as well as possible bias in self-reported experiences of pandemic-related stressors due to feelings of anxiety or depression.

IntroductionCervical cancer is one of the most common causes of morbidity and mortality among women in developing countries including Ethiopia. Unlike other types of cancers, the grave outcomes of cervical cancer could be prevented if detected at its early stage. However, in Ethiopia, awareness about the disease and the availability of screening and treatment services is limited. This study aims to determine the role of health education on cervical cancer screening uptake in selected health facilities in Addis Ababa.MethodsTwo-pronged clustered randomized controlled trial was conducted in 2018 at eight public health centers that provide cervical cancer screening services using visual inspection with acetic acid (VIA) in Addis Ababa, Ethiopia. Each of the eight health centers were randomly assigned to serve as either an intervention or a control center. A two-pronged clustered randomized controlled trial was conducted in eight public health care centers. All the selected facilities provided cervical cancer screening services using visual inspection with acetic acid (VIA). Four health centers were randomly assigned to the intervention and control arms. The study participants were women aged 30-49 years who sought care at maternal and child health clinics but who had never been screened for cervical cancer. In the intervention health centers, all eligible women received one-to-one health education and educational brochures about cervical cancer and cervical cancer screening. In the control health centers, participants received standard care. Baseline data were collected at recruitment and follow-up data were collected two months after the baseline. For the follow-up data collection, participants (both in the intervention and control arms) were interviewed over the phone to check whether they were screened for cervical cancer.ResultFrom the 2,140 women who participated in the study, 215 (10%) screened for cervical cancer, where 152(71%) were from the intervention health centers. Seventy-four percent of these participants reported that they learned about the benefits of screening from the one-to-one health education or the brochure. Women from the intervention health centers had higher odds of getting screened (AOR = 2.43,95%CI;1.58-2.90) than the controls. Women with the educational status of the first degree and those who have a history of sexually transmitted infections (STIs) had higher odds of getting screened (AOR = 2.03,95%CI;(1.15-2.58) and (AOR = 1.55,95%CI;1.01-2.36), respectively.Conclusion and recommendationProviding focused health education supported by printed educational materials increased the uptake of cervical cancer screening services. Integrating one-to-one health education and providing a take-home educational material into the existing maternal and child health services can help increase cervical cancer screening uptake.

Purpose The effectiveness of any government interventions to support small firms is always a concern in achieving improvements in enterprise performances. The purpose of this paper is to evaluate thoroughly the impact of micro and small enterprises’ (MSEs’) support programs on core intermediate and final outcomes of interest. Design/methodology/approach The impact evaluation employs a non-parametric matching procedure for parametric outcome analysis using the propensity score matching (PSM) method. Aiming at a doubly robust evaluation process, the study applies parametric analyses than non-parametric permutation-based tests to investigate the causal effects of the public intervention. Findings The study reveals that the public intervention encouraged MSEs to develop innovative business practices and improve their human capital development process. Moreover, the intervention had a positive effect in expanding employment opportunities in urban areas. Contrariwise, the study shows that support beneficiaries are not at an advantage in investment intensity. The lower level of investment intensity on fixed capital resulted inefficiency among the recipients. Moreover, the intervention did not have an effect on changing the net-asset over time for the recipients. Practical implications This study implies that the support programs need to be dynamic and also targets on creating innovative high-growth MSEs. Originality/value This paper is fairly original and provides policy makers and MSE promoters/facilitators evidence-based information on the effectiveness of the support services, with looking at firm-level analysis.

This paper draws on the results of telephone surveys conducted to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the young people of two longitudinal cohorts (aged 19 and 26 years old at the time) of the four countries that participate in the Young Lives research programme: Ethiopia, India, Peru and Vietnam. We first review the pandemic experiences of these four countries, which differed significantly, and report on the responses of the individual young people to the pandemic and the measures taken by governments. Our main focus is on how the pandemic and policy responses impacted on the education, work and food security experiences of the young people. Unsurprisingly the results show significant adverse effects in each of these areas, though again with differences by country. The effects are mostly more severe for poorer individuals. We stress the challenges that COVID-19 is creating for meeting the United Nations’ Sustainable Development Goals, in particular in making it more difficult to ensure that no one is left behind.

In this paper, we use a unique panel dataset of tracked migrants and non-migrants that originate from 18 villages in Ethiopia to examine the welfare impacts of internal migration. Using a number of techniques and various objective and subjective measures, we measure the impacts of migration on the welfare of migrants versus non-migrants. We find large gains to objective welfare measures such as consumption, around 110 percent. Gains are larger among male and urban migrants. Howev-er, we also find that relative to household heads subjective welfare measures are similar for migrants. The large welfare gains to migration suggest that barriers exist, even within countries such as Ethiopia, against the free movement of people to places where they would be objectively better off.

Social protection is at the centre of Ethiopia’s development policy. It is instrumental in reducing poverty and increasing the resilience of the population. The Government of Ethiopia (GoE) has published a new set of policy frameworks for social protection that envisage the expansion of social protection to cover a greater proportion of Ethiopians against a broader range of risks, and that call for social protection to be increasingly financed from domestic sources rather than by donors. A financing strategy for the implementation of this vision has been identified as a priority by the GoE. This study responds to this requirement. It provides a comprehensive mapping of social protection spending across the five focus areas of the national social protection policy and analyses the fiscal space available for different spending scenarios up to 2025/26. The study focuses on two issues in particular: the role of donor financing for social protection and the relationship between humanitarian relief and social protection spending.

This study used longitudinal data from the Young Lives Project in Ethiopia to examine the main factors relating to preschool access and their potential effects on cognitive performance of children aged five and eight years. The results show that only one quarter of the preschool-aged children have the opportunity to attend this vital stage of education, with significant disparities by family wealth, education and regional location. Regardless of its limited coverage, preschool attendance is shown to have statistically significant positive effects on cognitive performance, measured by receptive vocabulary and mathematics tests. The effects do not also seem to fade away at a later age, as the inequality in cognitive abilities at age five continues to exist at the age of eight. Furthermore, using mediation analyses, causal chains between family backgrounds and cognitive performance were thoroughly analyzed. Bootstrap results show that preschool attendance mediates about one third of the direct effects of family wealth, education and regional location on child cognitive performance. Nevertheless, despite the importance of preschool education, public investment in this area is currently very limited, with the private sector taking the key role and exacerbating the inequality that exists between children of the rich and poor. These findings thus emphasize the need for government involvement in the form of public investment to this subsector to increase access for all children and reduce future educational inequalities.

The study investigated the policy and business constraints influencing the growth and expansion of youth-owned Micro- and Small-Enterprises (MSEs) using mainly descriptive statistics and the econometrics framework of the Logit model on 909 youth-owned sample MSEs in Ethiopia. The findings showed that high collateral requirement of finance providers was a very severe problem constraining the growth of youth-owned MSEs, followed by limited access to credit, lack of business premise, lack of business support services, frequent interruption of infrastructure services (such as, telecom, power, and water), and lack of raw material inputs. However, since the youth-owned MSEs have heterogeneous characteristics, they are affected differently by the policy and business constraints. As per the econometric results, tax rate and administration, corruption, labour law, and licensing were found to be insignificant constraints influencing the growth of youth-owned MSEs. Although lack of access to finance and shortage of capital were identified as key challenges, they were found to be insignificant variables in influencing the growth of youth-owned MSEs. Policy predictability was found to have a positive and significant effect on growth of youth-owned MSEs. On the other hand, lack of marketing space for products and lack of business support services were found to have negative and significant effects on growth and expansion of MSEs. Owners attributes (household size, age and education), type of ownership structure and the sector the respondents engaged in were found to have a strong positive effect on the growth of youth-owned MSEs. Moreover, sole owners of MSEs were found to have higher likelihood of growth in employments. Contrary to the researchers’ expectation, type of enterprise (micro or small enterprises) was found to have negative effect on the growth of MSEs. From the results of the study, it can be concluded that the growth of youth-owned MSEs was affected more by owner and firm attributes than by policy and regulatory constraints. Keywords: policy and regulatory challenges, development of youth-owned MSEs,Ethiopia

The global market, variable agricultural production and irregular trading practices have marked food price volatility in Ethiopia over the last decade. However, the recent decline in global prices of food and fuel, coupled with state intervention in managing the supply of consumer goods, have brought some stability to food prices in 2014/15. While the safety net and price control measures could help mitigate the aggravation of impacts of food price increases on poor families, a more comprehensive food security approach is necessary. The article argues the importance of enhancing the purchasing power of the people.

This paper investigates the impact of idiosyncratic and covariate economic shocks, on the likelihood of children dropping out of primary school. In this endeavour, an Accelerated Failure Time Hazard model was estimated using data from the Young Lives study of childhood poverty. The estimated results indicate that both idiosyncratic shocks and covariate shocks have a statistically significant effect on the risk of children dropping out of primary school. Considering the fact that both idiosyncratic and area-wide economic shocks are experienced at the household level, the study concludes that it is vital to link social protection programmes to education policy as well so as to reduce the vulnerability of households to the shocks and keep children from dropping out from school.

Ethiopia’s productive safety net is the second largest Social Protection Program in sub-Saharan Africa and has been rolled out to almost 10 million beneficiaries since 2005; its effects are therefore of general interest. We provide the first estimates of its impact on children’s cognitive abilities. To identify impacts of this program, we exploit four rounds of data on a cohort of children surveyed repeatedly between 2002 and 2013. We find a small but significant positive effect of the programme on both numeracy skills and vocabulary. This is driven mainly by children in households that had graduated (left) the programme just before 2013. We argue that this is at least partially related to time allocation: graduates of the programme spent more time in school than continuing beneficiaries. We also find evidence that the maths (though not language) improvement is more pronounced for boys.

Summary Remittances are used by households for insurance, investment, and income. Flows from internal migrants are relatively understudied in Africa, where migrants are less likely to remit to their origin households. We use a unique matched migrant sample to study what drives the low remittance rates in Ethiopia. Descriptive statistics suggest remitters are positively selected in terms of wealth characteristics compared with the average tracked migrant. Limited skill transferability and liquidity largely explain low remittance rates in Ethiopia. Migrants are additionally motivated to remit as a form of self-insurance against own shocks to income and to protect their family’s productive assets.

This chapter describes how the standardized PLEASe computer code stream based on Arndt and Simler’s (2010) utility-consistent approach can be adapted to analyse poverty in Ethiopia in 2000, 2005, and 2011. Several data-related issues create challenges to estimating the spatial and temporal distribution of poverty in a manner that meets both consistency and specificity objectives. The chapter documents how the code stream is adapted to address changes in data collection periods and strata for the respective surveys over time. Changes in the duration and time of year for data collection can be especially problematic for consistency in the presence of annual inflation of over 30 per cent. In addition, the Ethiopia case provides an example of how to address convergence problems encountered when running the PLEASe code. Careful consolidation of spatial domains and limiting the number of iterations in the estimation of poverty lines are potential solutions.