Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis

Shelley, Katharine D.; Mpembeni, Rose; Frumence, Gasto; Stuart, Elizabeth A.; Killewo, Japhet; Baqui, Abdullah H; Peters, David H.

doi:10.1007/s10995-019-02783-8

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…International organisations such as the African Union have called for scrapping the user fees for pregnant women and children, and several African countries have adopted this policy 4–6 8. This ambitious programme, evaluated in several countries such as Kenya, Zambia, Ethiopia and Tanzania, resulted in an increase in the usage of public health facilities by pregnant women4–6 8–10 and sick children 3. In April 2016, Burkina Faso launched a national free healthcare policy targeting pregnant women and children under 5 years; this policy consists of a total fee exemption for their health provider consultations, laboratory and radiological procedures, and medications in all government-owned health facilities nationwide 11.…”

Section: Introductionmentioning

confidence: 99%

Effects of the free healthcare policy on health services’ usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis

Debe

Ilboudo²,

Kaboré³

et al. 2022

BMJ Open

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ObjectivesThis study aimed to analyse, at national level, the effects of the free healthcare policy for children on the use of health services by children under five in Burkina Faso. We hypothesised that this policy has led to an immediate and sustained increase in the use of health services for these children in the country.SettingWe conducted a controlled interrupted time series. Monthly data at district level, spanning from January 2013 to December 2018 and corresponding to 72 monthly data points (39 before and 33 after), were extracted from the Burkina Faso National Health Information System. The analysed dataset included data from all the 70 health districts of the country.ParticipantsThe study consisted of aggregated data from children under five as the target for the policy with children aged between 5 and 14 years old as control group.InterventionThe intervention was the introduction of the free healthcare policy for women and children under 5 years from April 2016.OutcomeThe primary outcome was the monthly mean rate of health services visits by children.ResultsAmong the children under five, the rate of visits increased of 57% (incidence rate ratio (IRR)=1.57; 95% CI 1.2 to 2.0) in the month immediately following the launching of the free healthcare policy. An increase in the rate of health facility visits of 1% (IRR=1.01; 95% CI 1.0 to 1.1) per month was also noted during postintervention. Compared with the control group, we observed an increase in the rate of visits of 2.5% (IRR=1.025; 95% CI 1.023 to 1.026) per month.ConclusionFindings suggest that the free healthcare policy increased the use of health facilities for care in Burkina Faso immediately after the implementation of the policy with a small increase in the rate overtime. Strategies to maintain the policy effect over time are necessary.

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Section: Introductionmentioning

confidence: 99%

Effects of the free healthcare policy on health services’ usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis

Debe

Ilboudo²,

Kaboré³

et al. 2022

BMJ Open

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“…In a constrained health system, there are perennial concerns about overburdening CHWs with new tasks, thereby resulting in poor programme outcomes on the existing tasks. 47–49 In this context, it is encouraging that involvement of CHWs in TB ACF activities did not adversely affect their performance on tasks related to maternal and child health. Any changes in indicators were small and of limited pragmatic significance ( table 4 ).…”

Section: Discussionmentioning

confidence: 89%

Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India

Garg¹,

Bhardwaj²,

Deo

2020

BMJ Open

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ObjectivesCost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers’ (CHW) knowledge about families’ health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible.DesignQuasi-experimental design.InterventionsWe evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases.Primary and secondary outcome measuresWe compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs.FindingsCHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (−0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively.ConclusionsACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.

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“…[11][12][13] Community health workers (CHWs) have been shown to improve access to quality services, including ANC and institutional delivery. [14][15][16][17] However, there is little agreement on the best package or delivery strategy of services to optimise impact. In 2018, the WHO guidelines on CHW programmes highlighted the research need to better understand CHW workflow that would optimise community engagement and care.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Effect of community health worker home visits on antenatal care and institutional delivery: an analysis of secondary outcomes from a cluster randomised trial in Mali

et al. 2023

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IntroductionThough community health workers (CHWs) have improved access to antenatal care (ANC) and institutional delivery in different settings, it is unclear what package and delivery strategy maximises impact.MethodsThis study reports a secondary aim of the Proactive Community Case Management cluster randomised trial, conducted between December 2016 and April 2020 in Mali. It evaluated whether proactive home visits can improve ANC access at a population level compared with passive site-based care. 137 unique village clusters, covering the entire study area, were stratified by health catchment area and distance to the nearest primary health centre. Within each stratum, clusters were randomly assigned to intervention or control arm. CHWs in intervention clusters proactively visited all homes to provide care. In the control clusters, CHWs provided the same services at their fixed community health post to care-seeking patients. Pregnant women 15–49 years old were enrolled in a series of community-based and facility-based visits. We analysed individual-level annual survey data from baseline and 24-month and 36-month follow-up for the secondary outcomes of ANC and institutional delivery, complemented with CHW monitoring data during the trial period. We compared outcomes between: (1) the intervention and control arms, and (2) the intervention period and baseline.ResultsWith 2576 and 2536 pregnancies from 66 and 65 clusters in the intervention and control arms, respectively, the estimated risk ratios for receiving any ANC was 1.05 (95% CI 1.02 to 1.07), four or more ANC visits was 1.25 (95% CI 1.08 to 1.43) and ANC initiated in the first trimester was 1.11 (95% CI 1.02 to 1.19), relative to the controls; no differences in institutional delivery were found. However, both arms achieved large improvements in institutional delivery, compared with baseline. Monitoring data show that 19% and 2% of registered pregnancies received at least eight ANC contacts in the intervention and control arms, respectively. Six clusters, three from each arm had to be dropped in the last 2 years of the trial.ConclusionsProactive home visits increased ANC and the number of antenatal contacts at the clinic and community levels. ANC and institutional delivery can be increased when provided without fees from professional CHWs in upgraded primary care clinics.Trial registration numberNCT02694055.

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Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis

Cited by 4 publications

References 34 publications

Effects of the free healthcare policy on health services’ usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis

Effects of the free healthcare policy on health services’ usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis

Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India

Effect of community health worker home visits on antenatal care and institutional delivery: an analysis of secondary outcomes from a cluster randomised trial in Mali

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