Last Ten Kilometers 2020 (L10K 2020) Project

Country: Ethiopia

Client(s): Bill & Melinda Gates Foundation

Services: Monitoring, Evaluation, and Research, Capacity Development

Technical Expertise: Maternal Health, Newborn and Child Health , Social and Behavior Change


Ethiopia’s remarkable achievement in reaching its Millennium Development Goal 4 three years early has been driven by a dramatic decline in under-5 mortality rate; yet challenges remain. Reduction in the neonatal mortality rate has been more modest and remains far below target. While the maternal mortality ratio remains high, recent data from the United Nations indicate a measurable reduction in recent years.

Implemented by JSI Research & Training Institute, Inc. (JSI) through funding from the Bill & Melinda Gates Foundation, the Last Ten Kilometers 2020 (L10K 2020) project will build upon the successful work of the Last Ten Kilometers: What it Takes to Improve Health Outcomes in Rural Ethiopia (L10K) project. L10K made significant contributions and improved several reproductive, maternal, neonatal, and child health (RMNCH) care behaviors and practices in four of the most populous regions of the country – Amhara, Oromia, Southern Nations, Nationalities and Peoples, and Tigray. The evidence-based practices from L10K informed strategies of the Federal Ministry of Health (FMOH) and have guided scale-up of programs region-wide and nationally, well beyond the project’s 115 rural districts (woredas). Over the course of eight years, the project expanded its impact through funding from UNICEF and USAID for distinct activities.

L10K 2020 will focus on improving maternal and newborn outcomes by linking communities to their primary health systems; strengthening provision of high-quality community-led interventions and facility-based care; and exploring new ways to generate demand for services. The project will institutionalize community-based approaches that promote equity and have been effective in changing RMNCH outcomes.

L10K 2020 seeks to achieve five primary outcomes over four years. Each will contribute to improved household and community health status.

  • Improved quality and increased use of RMNCH services
  • Increased early postnatal/newborn, equitable skilled birth attendance, and targeted family planning care-seeking behaviors
  • Increased quality of and demand for community-based long-acting family planning
  • Demonstrated mobile solutions to improve PNC in 48 hours
  • L10K 2020 experiences measured, learned, evaluated, and disseminated
L10K 2020 will continue to collaborate with the FMOH and the regional health bureaus, woreda health offices, and primary health care units. We will continue to support selected local civil society organizations and will partner with experts in emerging areas including quality improvement, social network analysis, and mobile solutions.

L10K 2020 will demonstrate how communities can take ownership of their health and how the primary health care system must respond to client needs and expectations if improved RMNCH outcomes are to be achieved and sustained.