Impact of the health bazaar initiative on sexual and reproductive health service use in Ethiopia

Abstract

Access to Sexual and Reproductive Health (SRH) services remains a significant public health challenge, particularly in rural and underserved areas. The Health Bazaar initiative was introduced as a community-based intervention to improve SRH service utilization and family planning uptake among reproductive-age women in Ethiopia. This study evaluates the effectiveness of the Health Bazaar model in improving access to SRH services in intervention (Health Bazaar) compared to non-intervention areas (running SRH services in the routine health system). A comparative cross-sectional study was conducted in five Ethiopian regions where the Health Bazaar model was implemented. Data were collected from 1,284 reproductive-age women (15–49 years), equally distributed between intervention (n = 642) and non-intervention (n = 642) areas. Additionally, secondary data from the District Health Information System (DHIS2) (2018–2024) were analysed to assess trends in SRH service utilization. A multistage cluster sampling approach was used, and data were analysed using descriptive statistics, trend analysis, and multilevel mixed-effects logistic regression to identify factors associated with SRH service uptake. The study found that SRH service utilization was significantly higher in intervention areas (65.1%, 95% CI:59.02, 68.21) compared to non-intervention areas (47.6%;95% CI: 42.01, 51.41) (p < 0.001). Contraceptive prevalence was also higher in intervention areas (53.3% vs. 41.8%, p = 0.001), with injectables (45.8%) and implants (44.5%) being the most commonly used methods. ANC service utilization was higher in intervention areas (87.3%) compared to non-intervention areas (77.1%), and institutional birth rates were 89.4% in intervention areas compared to 80.6% in non-intervention areas. Trend analysis showed a greater increase in ANC (10.2 per quarter), institutional births (5.8 per quarter), and PNC utilization (9.5 per quarter) in intervention areas compared to non-intervention areas. These differences remained statistically significant after adjusting for potential confounding factors, including age, marital status, education, household income, region, and participation in SRH-related discussions. The study highlights that individual factors, particularly participation in SRH discussions, are major drivers of service use, while community-based interventions such as the Health Bazaar program further enhance uptake. Age and marital status also shape service-seeking behaviour, underscoring the need for tailored approaches for different subgroups. The Health Bazaar intervention notably improved SRH service utilization, family planning uptake, and maternal health access in Ethiopia, demonstrating the potential of this community-driven model for scaling up in similar low-resource settings. Many women in rural and hard-to-reach areas of Ethiopia face serious challenges when it comes to accessing sexual and reproductive health (SRH) services, such as family planning, antenatal care, and skilled birth assistance. These challenges include long distances to health facilities, lack of information, cultural beliefs, and economic hardship. To address this problem, Amref Health Africa implemented a new approach called the Health Bazaar—a mobile, community-based health event that brings SRH services directly to the people. These events provide information, free health services, and create safe spaces for women to learn and ask questions about their health. This study compared health outcomes between areas where Health Bazaars were held and areas that continued with regular health services. We collected data from over 1,200 women and reviewed health system records to see if the intervention made a difference. The results showed that women in Health Bazaar areas were more inclined to use contraceptives, attend antenatal care, birth at health facilities, and receive postnatal care. These improvements were much greater than in areas without the intervention. Women also reported feeling more informed and supported in making decisions about their reproductive health. Our findings suggest that the Health Bazaar model is a promising strategy to improve access to SRH services in underserved communities. With proper support and investment, this approach could be scaled up across similar low-resource settings to help ensure that all women—no matter where they live—can access the care they need.