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Improving child survival through behavioral change and community engagement: the Farta, Ethiopia Child Survival Project

Despite 25 years of development assistance, Ethiopia experiences one of the highest child mortality rates in sub-Saharan Africa. In northwestern Ethiopia, CARE International implemented a five-year child survival project in the Farta district from 2002 to 2007.Although similar to other child survival projects in terms of behavioral change communication approaches, the Farta Child Survival Project exceeded targets, including those for exclusive breastfeeding, environmental hygiene, and health behaviors by using key agents at grassroots level such as religious leaders and positive deviant mothers to improve health outcomes. Health message sharing and social adaptation of new health information led to action which pervaded the whole of village life. As a consequence, healthy behaviors became the new social norm while individuals following old norms encountered community sanctions. This analysis reviews the Farta Child Survival Project to discern which factors in implementation encouraged effective behavioral change through the application of social cognitive theory. Understanding why and how this project was a success will help to duplicate its strategies elsewhere.