The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania.

Autor:	Baynes C; Department of Global Health, University of Washington, Seattle, WA, United States of America., Kanté AM; Department of International Health, Johns Hopkins University, Baltimore, MD, United States of America., Exavery A; Pact/Tanzania, Dar es Salaam, Tanzania., Tani K; Ifakara Health Institute, Dar es Salaam, Tanzania., Sikustahili G; Ifakara Health Institute, Dar es Salaam, Tanzania., Mushi H; Ifakara Health Institute, Dar es Salaam, Tanzania., Baraka J; Ifakara Health Institute, Dar es Salaam, Tanzania., Ramsey K; Scope Impact, Brooklyn, NY, United States of America., Sherr K; Department of Global Health, University of Washington, Seattle, WA, United States of America., Weiner BJ; Department of Global Health, University of Washington, Seattle, WA, United States of America., Phillips JF; Department of Population and Family Health, Columbia University, New York, NY, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Sep 19; Vol. 3 (9), pp. e0002050. Date of Electronic Publication: 2023 Sep 19 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0002050
Abstrakt:	Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Baynes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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