Exploring community health systems interventions that strength implementation of maternal and child health services: The case of community health assistants in Zambia

Abstract

Introduction: Many low-and middle-income countries, including Zambia experience human resource for health challenges, which affect the delivery of maternal and child health (MCH) services. The Clinton Health Access Initiative (CHAI) in collaboration with Ministry of Health in Zambia through its community health systems (CHS) initiative provided additional support to the Community Health Assistants (CHA) programme from 2019 to 2021 to enhance provision of MCH services. In this study, we explore the different interventions that influenced the CHA’s ability to deliver MCH the services. Methodology: The study was conducted in November and December 2021 using data from the HealthManagement Information System (HMIS) and qualitative interviews with the CHA and program staff. A total of 244 qualitative interviews were conducted in 10 provinces and 2,506 respondents participated in quantitative interviews. Qualitative data were analysed using thematic analysis while for quantitative data we used descriptive statistics. Results: The HMIS data showed that health facilities that had CHAs performed better than those without. Survey data further indicated that health facilities where CHAs had worked for two or more years recorded better access to MCH services compared those where CHAs had only worked for a year. The CHS strengthening interventions including provision of training manuals, enhanced recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration to some CHAs contributed to improved delivery and acceptability of MCH services. Further, the involvement of community networks, linkages and partnerships when delivering these services, including the traditional and religious leaders contributed to improved delivery, coverage and acceptability of MCH services. Meanwhile, health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide the CHA recruitment and selection criteria affected delivery and acceptability of MCH services. Conclusion: This study builds on existing evidence on importance of building a stronger community–based primary health care to effectively address maternal and child health related. We emphasize the need to integrate strategies such as provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA programme to enhance provision of maternal and child health services.