Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

• DOI: 10.1371/journal.pgph.0002888
• Publication Date: 2024-03-12T17:30:19Z
• Authors: Bénédicte Razafin...; Luc Rakotonirina; Laura F. Cordier; Anna Rasoarivao; Mamy Andrianomenj...; Lanto Marovavy; Feno Hanitriniaina; Isaïe Jules Andri...; Alishya Mayfield; Daniel Palazuelos; Giovanna Cowley; Andriamanolohaja ...; Felana Ihantamalala; Rado J. L. Rakoto...; Ann C. Miller; Andres Garchitorena; Meg G. McCarty; Matthew H. Bonds; Karen E. Finnegan
• Keywords: Community Health; Health intervention

Despite widespread adoption of community health (CH) systems, there are evidence gaps to support global best practice in remote settings where access care is limited and workers (CHWs) may be the only available providers. The nongovernmental organization Pivot partnered with Ministry Public Health (MoPH) pilot a new enhanced (ECH) model rural Madagascar, one CHW provided at stationary CH site while additional CHWs via proactive household visits. program included professionalization workforce (i.e., targeted recruitment, extended training, financial compensation) twice monthly supervision CHWs. For first eighteen months implementation (October 2019-March 2021), we compared utilization proxy measures quality intervention commune (local administrative unit) five comparison communes strengthened programs under different model. This allowed for quasi-experimental study design impact ECH on outcomes using routinely collected programmatic data. substantial other CHWs, results show statistically significant improvements nearly every indicator. Sick child visits increased by more than 269.0% following implementation. Average per capita under-five were 0.25 0.19 (p<0.01). In commune, 40.3% completed care. all steps iCCM protocol 85.4% observed (vs 57.7% communes, p-value<0.01). evaluation demonstrates that can improve service delivery district. Further research needed assess generalizability feasibility national scale-up as MoPH continues define program.