Improving Community Health Worker Treatment for Malaria, Diarrhoea and Pneumonia in Uganda Through inSCALE Community and Mhealth Innovations: A Cluster Randomised Controlled Trial

2021 ◽  
Author(s):  
Karin Elena Källander ◽  
Seyi Soremekun ◽  
Daniel LL Strachan ◽  
Zelee Hill ◽  
Frida Kasteng ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Cluster Randomised ◽  
Randomised Controlled

scholarly journals A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

2021 ◽  
Vol 6 (9) ◽  
pp. e006535
Author(s):  
Emily B Wroe ◽  
Basimenye Nhlema ◽  
Elizabeth L Dunbar ◽  
Alexandra V Kulinkina ◽  
Chiyembekezo Kachimanga ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
Disease Specific

BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).MethodsWe conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.FindingsThe intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.InterpretationCHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.

scholarly journals Effects of team-based goals and non-monetary incentives on front-line health worker performance and maternal health behaviours: a cluster randomised controlled trial in Bihar, India

2019 ◽  
Vol 4 (4) ◽  
pp. e001146 ◽  
Author(s):  
Suzan L Carmichael ◽  
Kala Mehta ◽  
Hina Raheel ◽  
Sridhar Srikantiah ◽  
Indrajit Chaudhuri ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Maternal Health ◽  
Health Worker ◽  
Controlled Trial ◽  
Health Behaviours ◽  
Cluster Randomised Controlled Trial ◽  
Front Line ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
The Impact

IntroductionWe evaluated the impact of a ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition.MethodsThis study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention’s team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year.ResultsThe TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial’s goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning.ConclusionResults suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW–beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes.Trial registration numberNCT03406221

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