Evaluation report
Losing the immunisation gap in Ethiopia: a formative evaluation of ‘The Fifth Child Project’
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This formative evaluation describes the Fifth Child Project, implemented by the International Rescue Committee in Ethiopia starting in 2013 to improve childhood immunization coverage. The project addresses low vaccination rates in Benishangul Gumuz, where only 42% of children 12-23 months received the third pentavalent dose and 13% were completely unimmunized. The intervention combines community engagement through Health Extension Workers, a defaulter tracing tool, a colour-coded calendar for caregivers, and systems support to strengthen immunization services.
Key points
- Baseline immunization coverage in the target region was 41.7% for third pentavalent dose among children 12-23 months, with approximately 13% completely unimmunized
- The project equips Health Extension Workers and Health Development Army members with improved interpersonal communication skills for counselling and home visits
- A defaulter tracing tool was introduced to support systematic use of immunization data for local decision-making
- A colour-coded calendar called Enat Mastawesha was used as a planning tool for caregivers and a job-aide for health workers
- Systems support was provided to ensure cold chain functionality and support for outreach immunization sessions
Limitations
This is a formative evaluation that describes the intervention design and implementation strategy but does not present outcome data or evidence of effectiveness. The document cannot tell us whether the Fifth Child Project actually improved immunization coverage or what impact each component had.
Abstract
According to the 2011 Ethiopia Demographic Health Survey, 41.7% of children 12-23 months old in Benishangul Gumuz Regional State received the third dose of the pentavalent vaccine; approximately 13% were completely unimmunized, thus susceptible to vaccine-preventable diseases. Intervention overviewTo address low coverage and support Ethiopia's Health Extension Program, in 2013, the International Rescue Committee began implementing the 'Fifth Child Project'a multipronged community engagement strategy to improve timely utilization of maternal and child health services, with emphasis on immunization, across Assosa and Bambasi woredas.The intervention focuses on promoting systematic use of quality immunization data for local level decision-making, particularly around defaulter follow-up through the introduction of a defaulter tracing tool.It also applies an overarching community engagement approach by equipping existing cadres of Health Extension Workers and Health Development Army members with improved interpersonal communication skills for effective and tailored counselling sessions and leveraging them to conduct timely home visits targeted at defaulters.At the household level, it integrates the use of a colour-coded calendar known as Enat Mastawesha.The calendar serves as a planning tool for caregivers to keep track of upcoming for peri-natal appointments and serves as a job-aide for health workers.Essential systems support is also provided to ensure that immunization services meet basic policy standards (e.g.cold chain functionality, support for outreach sessions).