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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

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...

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Autores principales: Baynes, Colin, Kanté, Almamy Malick, Exavery, Amon, Tani, Kassimu, Sikustahili, Gloria, Mushi, Hildegalda, Baraka, Jitihada, Ramsey, Kate, Sherr, Kenneth, Weiner, Bryan J., Phillips, James F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508634/
https://www.ncbi.nlm.nih.gov/pubmed/37725612
http://dx.doi.org/10.1371/journal.pgph.0002050
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author Baynes, Colin
Kanté, Almamy Malick
Exavery, Amon
Tani, Kassimu
Sikustahili, Gloria
Mushi, Hildegalda
Baraka, Jitihada
Ramsey, Kate
Sherr, Kenneth
Weiner, Bryan J.
Phillips, James F.
author_facet Baynes, Colin
Kanté, Almamy Malick
Exavery, Amon
Tani, Kassimu
Sikustahili, Gloria
Mushi, Hildegalda
Baraka, Jitihada
Ramsey, Kate
Sherr, Kenneth
Weiner, Bryan J.
Phillips, James F.
author_sort Baynes, Colin
collection PubMed
description 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.
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spelling pubmed-105086342023-09-20 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 Baynes, Colin Kanté, Almamy Malick Exavery, Amon Tani, Kassimu Sikustahili, Gloria Mushi, Hildegalda Baraka, Jitihada Ramsey, Kate Sherr, Kenneth Weiner, Bryan J. Phillips, James F. PLOS Glob Public Health Research Article 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. Public Library of Science 2023-09-19 /pmc/articles/PMC10508634/ /pubmed/37725612 http://dx.doi.org/10.1371/journal.pgph.0002050 Text en © 2023 Baynes et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Baynes, Colin
Kanté, Almamy Malick
Exavery, Amon
Tani, Kassimu
Sikustahili, Gloria
Mushi, Hildegalda
Baraka, Jitihada
Ramsey, Kate
Sherr, Kenneth
Weiner, Bryan J.
Phillips, James F.
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508634/
https://www.ncbi.nlm.nih.gov/pubmed/37725612
http://dx.doi.org/10.1371/journal.pgph.0002050
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