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Dagu aims to develop Ethiopian excellence in public health evaluation and improve quality and utilisation of primary and community-based health care services.

DAGU

Dagu aims to develop Ethiopian excellence in public health evaluation and improve quality and utilisation of primary and community-based health care services.

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About us

The Dagu project gets its name from a northeast Ethiopian word for communication. Dagu works to develop Ethiopian excellence for public health evaluation: measurement, learning and evaluation of improved integrated community case management and community-based newborn care in Ethiopia.

Who we are

The Dagu project is led by a team of researchers from the London School of Hygiene & Tropical Medicine based at the Ethiopian Public Health Institute. The project evaluates the Optimising the Health Extension Program in Ethiopia (OHEP) project which was initiated by the Ethiopian Federal Ministry of Health and implemented by UNICEF, PATHSave the Children, and the Last 10 Kilometers Project.

Resources & publications

Find the latest publications and resources produced by the Dagu project.

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DAGU project

Ethiopia has made significant progress reducing the number of child deaths, but there is potential for further reductions if the use of good quality primary health services is increased.

The Dagu project focuses on three main areas of work. The independent evaluation of the Optimising the Health Extension Program in Ethiopia (OHEP) project which addresses the critical under-utilisation of community-based services, particularly the use of Integrated Community Case Management (iCCM) services and Community Based Newborn Care (CBNC) services. The Ethiopian Federal Ministry of Health initiated the OHEP project and UNICEF, PATHSave the Children, and the Last 10 Kilometers Project implement it. 

Evaluation

The Dagu led evaluation aims to estimate the effectiveness and evaluate the process of the innovations implemented in the OHEP on care-seeking and treatment for suspected pneumonia, diarrhoea, fever, and neonatal sepsis.

The evaluation will use data from baseline and endline surveys in OHEP intervention districts and comparison districts. These surveys are part of the evaluation strategy that uses a plausibility design and analyses ‘difference-in-differences’. In addition, information will be collected regarding the OHEP interventions in order to map the intervention process over time. The PhD students from the four collaborating universities will address different aspects of the evaluation in accordance with their doctoral study plans. The Dagu team and partners will produce reports and scientific papers and will communicate these to stakeholders in Ethiopia and the international research community.

Working with Ethiopian universities

The Dagu team works with the Gondar, Hawassa, Jimma and Mekelle Universities and EPHI to strengthen their capacity for health system research by co-supervising the Dagu PhD students and arranging courses and workshops for PhD students, supervisors and others.

Dagu is cooperating with four Ethiopian universities for mutual capacity development. This includes supporting PhD students who are working on research that contributes to the Dagu project.

The students

University of Gondar

Amare Tariku is focusing on respiratory tract infections and nutrition.

Tigist Getahun is interested in the primary health services for newborn babies.

Hawassa University

Habte Bolka is focusing on the management of diarrhoeal diseases in children.

Habtamu Beyene is addressing referral of sick children within the primary health system.

Jimma University 

Dawit Wolde is studying the quality of the integrated community case management of childhood illnesses and the effect of the OHEP interventions on quality of the service provided.

Alemayehu Hunduma is working on the formulation of his research question.

Mekelle University

Alem Desta studies equity in service utilization cost of the OHEP innovations and cost- effectiveness of the innovations in improving primary child health services utilization.

Fisseha Ashebir is studying the role of the Women’s Development Army in primary maternal, newborn and child health services.

EPHI

Atkure Defar is interested in the spatial (geographic) and time variation in child health problems and service utilisation before and after the OHEP intervention.

Theodros Getachew is studying the quality of care for common childhood illnesses within the integrated community case management.

Supporting implementation partners

A third area of focus for the Dagu project is the support provided to PATH and UNICEF, the implementation partners, in measurement, learning and evaluation.

Who we are
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Professor Joanna Schellenberg
Principal Investigator
Professor Lars Ake Persson
Professor of Public Health Evaluation
Della Berhanu
Research Fellow
Suzanne Welsh
Programme Manager
Yemisrach Okwaraji
Research Fellow
Martha Zeweldemariam
Project Administrator
Atkure Defar
Dagu lead at EPHI
Desta Wolassa
Data Manager
 

The Dagu project has a Steering Committee, which oversees the activities of the Dagu project, regularly reviews progress and plans, and makes recommendations to support effective implementation of the project’s objectives.

For the duration of the project, the Steering Committee meets twice a year, usually in Addis Ababa.

Members of the Dagu Steering Committee comprise the following institutions and their representatives: The Ethiopian Federal Ministry of Health, the Ethiopian Public Health Institute, the London School of Hygiene & Tropical Medicine, PATH, UNICEF, Save the Children, Last 10 Kilometres, and the Universities in Gondar, Mekelle, Jimma, and Hawassa.

The Dagu project collaborates closely with the IDEAS project and the ORCA project at the London School of Hygiene & Tropical Medicine, to foster mutual capacity building for large-scale public health evaluation in Ethiopia. 

Dagu team photo
Events
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Overcoming adversities: completing the Dagu endline survey data collection 

All data collection for the Dagu endline survey has now been completed. The survey team visited a total of 180 enumeration areas and collected data from 11,292 households and corresponding health posts and health centres. The tablets were programmed using CSPro 7.1 software to collect the data. The survey used Dagu PhD students as regional data correctors and a supervision plan was developed by the students and controlled by the central office.

Dagu endline survey data collectors
The Dagu endline survey data collection team in Mekele Credit: IDEAS/Christopher Smith 2019

Oftentimes the data collectors had to overcome difficult conditions to access all selected areas. “Many of the villages where we collected data have difficult terrain and are hard to reach. Some villages are located deep in a valley and the only way to get there is by climbing down with ladder and some villages can only be accessed using a mule.  In such sites the data collectors will have to take with them sleeping bags and dry food and have to stay 2- 3 days until they complete collecting the data for that village." says Yemisrach Okwaraji, who is part of the team of Dagu researchers based in Ethiopia and was coordinating the survey. Atkure Defar, who is Dagu lead at EPHI highlighted the strength of the field team in coping with difficult circumstances. "The field teams were very hard workers in doing this survey while it has all these hardships. Teams were supposed to use a field guide to direct them where the villages are located in the kebele (lowest administrative level). These guides have lived there longer than anyone and are well-known in the community. Identifying the right household needs extra care of the field staff and understanding of the maps of the area to delineate which households are within the enumeration area."

The volatile security situation in Guje zone meant that 13 clusters had to be excluded from the endline survey. The Dagu partner Jarco Consulting has started with cleaning the data, which includes merging data sets and removing duplications. Once Jarco completes the data cleaning process the Dagu team will begin the analysis and preparation of the final evaluation report. 


Dagu endline survey: December 2018 to February 2019 

The Dagu endline survey started in December 2018 in 200 clusters. The survey extended across 100 intervention and 100 comparison areas. The distribution of the clusters is as follows: Tigray with 29 clusters, SNNP with 23 clusters, Oromia with 69 clusters, and Amhara including 73 clusters.

Data collectors in Mekele during the Dagu endline survey
Data collectors in Mekele during the Dagu endline survey. Copyright: IDEAS/Christopher Smith 2019

Advanced Implementation Science Workshop at EPHI, June 9-13 2018


R workshop 

The software that helps students and teachers - learning how to use software without writing code

“Currently there are so many different statistical programmes for the analysis of health data. The “R” software is free and robust, being able to use it is a skill which will be beneficial for my future research career and in advising and mentoring students.” Dr Kassalen Alemu, the Director of JPH and Phd supervisor summarised his experience of a recent Dagu organised workshop.

Researchers, students and data analysts are faced daily with daunting tasks of analysing, visualising and interpreting vast amounts of data. The Dagu team together with the Associate Professor Katarina Selling and Senior Statistician Jonas Selling working on International Maternal and Child Health at Uppsala University, Sweden therefore worked with Dagu PhD students, staff from the Ethiopian Health Institute and partner organizations to learn how to use “R” software in data analysis and visualisation. This specialized software is a powerful and comprehensive tool to manage complex tasks, however is not without its challenges for users. “R” is a programming language, which means users have to learn to write code, a substantial threshold for many users. The workshop therefore introduced participants to the use of R-commander, which comes with a simpler user interface bridging the gap for users wanting to use “R”, but without the time to learn to write code.

The main objectives of the workshop were for participants to learn how to use R-commander for data management, visualisation, descriptive statistics, basic statistical tests and their assumptions, and as an introduction to statistical models including their assumptions.

The course consisted of a series of interactive lectures combined with computer labs. The teaching was conducted in an interactive manner, encouraging participants to reflect by sharing their own experience. Participants showed a lot of enthusiasm pointing out the benefits of using R-commander for certain tasks. Girum, Senior Researcher at EPHI remarked: “I will try to shift from “SPSS” to “R-commander” for data visualisation.” The usefulness of the workshop and learning to work with this software was moreover highlighted by Dr Mezaebu Yitayal explaining how this would improve his ability to teach and provide guidance to his students: “This workshop will improve my advice to students as well as my data management and analysis for my own research work.” Learning to master R-commander was clearly a benefit for students and PhD supervisors alike.

Resources & publications
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2019

Theodros Getachew , a PhD student supported through the Dagu project, authored and published his first paper in Acta Peadiatrica. 

The paper entitled: Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross-sectional study looks into the capacities of Health Extension Workers in Ethiopia to correctly classify common childhood diseases. Data were collected through a survey, as well as observations and re-examinations. Findings show that most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. The paper calls for increased efforts to improve the quality of HEW's diagnosticc ability for childhood illnesses and their adherence to the guidelines for the examination, classification and treatment of childhood illness.

2018

Dagu workshop at Gondar University May 14-18, 2018

Dagu Implementation Science Workshop II June 9-13, 2018

Second Paper Writing Workshop, EPHI, Addis Ababa, November 5-7, 2018

 

2017

December 9-13, 2017: Qualitative research methods workshop at EPHI 

December 6, 2017:  Release of the Dagu Baseline Survey Report 

21 -25 August 2017: Implementation science workshop in Hawassa University 

10-14 July 2017: Writing scientific research papers workshop for PhD students at Gondar University 

30 January - 1 February 2017: Workshop for PhD supervisors 

Dagu R-workshop update March 2018