Field evaluation · Ethiopia · 2022–2024
Bridging the gap: the Health Bazaar and reproductive health in Ethiopia
A demand-responsive, mobile health delivery model brought sexual and reproductive health (SRH) services directly to women in drought-prone, pastoralist communities — and significantly outpaced routine health system delivery on every primary indicator.
The access challenge
Barriers to SRH in rural and pastoralist communities
Systemic inequities and structural barriers continue to marginalize reproductive-age women across Ethiopia’s drought-prone clusters. In these pastoralist and rural regions, the pursuit of Sexual and Reproductive Health (SRH) is hindered by geographic inaccessibility, food insecurity, and deep-seated sociocultural norms that restrict female autonomy. During the implementation of the RESET Plus initiative (2022–2024), it became evident that traditional, stationary health models often fail to reach the most vulnerable, particularly as they lack the privacy and flexibility required to serve adolescents and unmarried youth without the risk of social stigma..
Contraceptive prevalence
Modern contraceptive use drops below 20% in many pastoralist zones, against a national average of 41%.
Institutional births
Remote rural clusters often stagnate below 30%, while urban centers exceed 80% — a stark urban–rural divide.
Service delivery gaps
Inflexible service models and a lack of privacy at traditional facilities deter youth from seeking SRH information and care.
The solution
The Health Bazaar mobile model
Implemented by Amref Health Africa as a core component of the RESET Plus family planning project, the Health Bazaar moves services beyond stationary clinics into a user-centered, inclusive framework. Events run quarterly in accessible open spaces within villages or adjacent to primary health facilities, augmenting the existing Health Extension Program (HEP). The model rests on three strategic pillars:
Strategic mobilization
Multi-sectoral collaboration between district health offices, NGOs, and local health extension workers to conduct evidence-based social mobilization and community sensitization.
Clinical integration
A comprehensive package at a single point of care: contraceptive counseling and provision, antenatal care (ANC), HIV testing and counseling (VCT), maternal health education, and referrals for skilled birth attendance.
Health promotion
Interactive, professional-led sessions that empower women with knowledge of their SRH rights, dismantle prevailing myths, and cultivate community-wide support for health-seeking behavior.
Impact metrics
Intervention vs. non-intervention outcomes
Comparative analysis shows the Health Bazaar model significantly outperformed routine delivery across all primary SRH indicators.
SRH service utilization
AOR 1.89 · p < 0.001Contraceptive prevalence
p = 0.001Institutional birth rate
Significant · p < 0.05SRH utilization confidence intervals — intervention: 95% CI 59.02–69.21; non-intervention: 95% CI 42.01–51.41.
Trend analysis · 2018–2024
Accelerated growth in service uptake
Longitudinal data shows intervention areas grew faster than non-intervention sites on every tracked service, quarter over quarter.
| Service | Intervention areas | Non-intervention areas | Difference |
|---|---|---|---|
| Antenatal care (ANC) | +10.2 / quarter | +3.2 / quarter | ≈ 3.2× faster |
| Institutional births | +5.8 / quarter | +4.6 / quarter | ≈ 1.3× faster |
| Postnatal care (PNC) | +9.5 / quarter | +4.4 / quarter | ≈ 2.2× faster |
Key drivers
Why it worked: supply-side quality, demand-side empowerment
The Health Bazaar’s efficacy is attributed to its simultaneous focus on supply-side quality and demand-side empowerment, creating a 61% higher likelihood of service uptake for women in intervention zones.
Participation in SRH discussions
Active engagement in SRH-related conversations was the single most powerful catalyst for behavior change: women who participated were three times more likely to utilize SRH services than those who did not.
Supply-side precision
Constant availability of high-demand commodities — injectables (45.8%) and implants (44.5%) — paired with providers trained to deliver youth-friendly, private, and efficient care.
Demand-side empowerment
Peer education and community-integrated outreach replaced misinformation with factual education, addressing the sociocultural barriers that traditionally inhibit service use.
Strategic conclusion and Future Scalability
A scalable pathway toward health equity
The Health Bazaar demonstrates that a user-centered, community-integrated mobile model can overcome systemic barriers inherent in traditional healthcare delivery. By fostering open dialogue and bringing comprehensive services directly to underserved populations, it offers a robust framework for reducing maternal mortality and achieving health equity in low-resource settings.
For stakeholders and policymakers, the model represents a scalable, high-impact solution aligned with the Sustainable Development Goals — a viable pathway toward universal health coverage and the empowerment of women and youth across the most challenging geographic frontiers.