The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania

Abstract

Background There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered. Methods From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women’s satisfaction with the CHW program and with the public-sector health system in Dar es Salaam. Results In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27). Conclusions A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction. Trial registration ClinicalTrials.gov, EJF22802

Community perceptions of community health worker effectiveness: Contributions to health behaviour change in an urban health district in South Africa

“…A randomised controlled trial comparing households with and without CHW support showed that where CHW programmes had a strong maternal health component, women in the community rated these services highly. [19] The findings in our study showed that the configuration of the comprehensive CHW activities in Ekurhuleni, by providing continuity of care through regular follow-up visits, health education, social support services as well as the trust and friendship provided by the CHWs to the household members, was valued by the community. These would have contributed to the benefits experienced by the households in the same manner as found by Mohajer and Singh.…”

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria

“…In the assessment of the effects of a Community Health Worker (CHW) intervention with a specific focus on maternal and child health in Tanzania, satisfaction with the public health system in Dar es Salaam and satisfaction with the CHW program were key indicators. The respondents (currently pregnant and women who just delivered) in the intervention sites reported significantly higher satisfaction than women in the control sites [21]. Satisfaction with delivery care was one of the outcome indicators in the Saving Mothers, Giving Life intervention program in Uganda and Zambia.…”

“…Further studies established that women wait inordinately long periods before they obtain services in some referral health facilities [16], due largely to inadequate staffing and heavy workloads by staff [17,18]. While there is ample report of women's dissatisfaction with maternal health in many African countries [15,19,20], there are limited publications of interventions addressing this challenge [21,22]. In the assessment of the effects of a Community Health Worker (CHW) intervention with a specific focus on maternal and child health in Tanzania, satisfaction with the public health system in Dar es Salaam and satisfaction with the CHW program were key indicators.…”

Which delivery model innovations can support sustainable HIV treatment?

“…Shifting services to CHWs can be realised in both vertical and integrated systems, as CHWs can be associated with either specific HIV clinics or the general health system. In fact, community-based delivery does not need to be unique to HIV, and CHWs may also be able to provide pregnancy and maternal care (Geldsetzer et al, 2019;Larson et al, 2019;Lema et al, 2014), screening for hypertension, and distribute chronic medication to those in need, or provide counselling on where to access other required health services. Nevertheless, specialised HIV doctors and nurses will still be essential when dealing with more complex cases, such as people with poor viral suppression, resistance, or complex comorbidities.…”