Implementation research on CHW-delivered MNH services (Benadir and Galgaduud, Somalia)
While medical care provided at a health facility is recommended, it is not always possible in crisis-affected communities where health systems are weak, facilities are damaged or distant, and trained providers are limited. In these cases, community health systems – including the support of community health workers (CHWs) -- are often the only option for delivering life-saving services. Despite this, there is limited evidence around how community health programs can be used to ensure women and newborns have continuous access to quality care. EQUAL aims to fill this evidence gap with research on using community health systems for MNH service delivery.
Objective:
To evaluate the ability of a community health programme to deliver high quality, evidence-based, beneficiary- demanded and –utilized MNH services in rural LI-CACs, examining additional elements such as CHW and supervisory workload and retention, and resilience during shocks.
To evaluate the ability of a community health programme to deliver high quality, evidence-based, beneficiary- demanded and –utilized MNH services in rural LI-CACs, examining additional elements such as CHW and supervisory workload and retention, and resilience during shocks.
Methods:
This mixed-methods implementation research will be a quasi-experimental study with an embedded process evaluation.
1. Baseline data collection on intrapartum and immediate postpartum knowledge and practice, pregnancy experience, and CHW working condition. We will conduct a population-based survey on knowledge and practices around labor, delivery, and immediate postpartum care. The survey will also generate an estimate of institutional delivery and SBA rates. Case histories will be collected. Existing literature recognizes large CHW work loads, particularly in areas of weak health systems. The working condition of the CHW, their rights and protections, and feedback mechanisms to their supervisors are largely unknown. We will conduct mixed methods, data collection, including gender analysis, to understand the current state of CHW programs, with a goal to identify ways to ensure fair, respectful working conditions for CHWs.
2. Co-design of service package. To ensure acceptability and sustainability of the service delivery mechanism, we will, in collaboration with MoH, develop a community-based preventive and curative service delivery package for MNH. User-centered job aids, tools, and messaging will be created to ensure better performance and beneficiary utilization, as well as integration of MNH services to existing CHW-delivered services.
3. Quasi-experimental study and process evaluation. The study area will be divided into intervention and control areas. CHWs in both areas will receive a refresher training on the current service delivery. The intervention group will receive additional training for MNH services. For a process evaluation, we will track CHW retention, utilization of services, supervision quantity and quality, and perception of QoC by community members via routine monitoring and qualitative data collection with community members (including direct beneficiaries), CHWs, and their supervisors.
4. Endline survey on MNH and community health service. A survey will be repeated to capture differences in the intervention and control areas in knowledge, practice, and SBA rate.
This mixed-methods implementation research will be a quasi-experimental study with an embedded process evaluation.
1. Baseline data collection on intrapartum and immediate postpartum knowledge and practice, pregnancy experience, and CHW working condition. We will conduct a population-based survey on knowledge and practices around labor, delivery, and immediate postpartum care. The survey will also generate an estimate of institutional delivery and SBA rates. Case histories will be collected. Existing literature recognizes large CHW work loads, particularly in areas of weak health systems. The working condition of the CHW, their rights and protections, and feedback mechanisms to their supervisors are largely unknown. We will conduct mixed methods, data collection, including gender analysis, to understand the current state of CHW programs, with a goal to identify ways to ensure fair, respectful working conditions for CHWs.
2. Co-design of service package. To ensure acceptability and sustainability of the service delivery mechanism, we will, in collaboration with MoH, develop a community-based preventive and curative service delivery package for MNH. User-centered job aids, tools, and messaging will be created to ensure better performance and beneficiary utilization, as well as integration of MNH services to existing CHW-delivered services.
3. Quasi-experimental study and process evaluation. The study area will be divided into intervention and control areas. CHWs in both areas will receive a refresher training on the current service delivery. The intervention group will receive additional training for MNH services. For a process evaluation, we will track CHW retention, utilization of services, supervision quantity and quality, and perception of QoC by community members via routine monitoring and qualitative data collection with community members (including direct beneficiaries), CHWs, and their supervisors.
4. Endline survey on MNH and community health service. A survey will be repeated to capture differences in the intervention and control areas in knowledge, practice, and SBA rate.