This paper briefly summarizes definitions, approaches, and challenges to achieving “scale” in community-focused health programs as discussed at the 2005 CORE spring meeting and the USAID child survival and health grants program mini-university. This paper is meant to harmonize a vocabulary for use by NGOs and their partners as they further discuss, debate, and analyze how NGOs and their partners can reach more people with high quality maternal, child and neonatal health interventions.
This paper explores the effectiveness of child health interventions and how to improve health care access for children, mothers, and caregivers. Multi-sectoral approaches, including utilization of community-based programming and community health workers, can help extend the reach of health care to these populations.
Mobile health, or “mHealth”, seeks to address the use of mobile technology to provide health services and information. Due to the increased risk in a child’s life during those weeks after birth, mHealth technologies can be utilized through referral and tracking of mothers and infants, decision support for CHW, CHW supervision, scheduling and tracking postpartum and postnatal visits, and teaching and counseling for mothers and families, among other uses. These case studies from Afghanistan, India, Malawi, and Indonesia reflect some of these uses.
As community health workers gain more and more responsibility amidst shortages of skilled health workers, mobile technology for health (mHealth) is becoming more popular for health care delivery around the globe. In order to better understand the role mHealth applications have among CHWs, researchers tested whether short message services (SMS) could improve the reporting of pregnancies and pregnancy outcomes among CHWs. Findings from a cluster-randomized intervention show that groups that received motivational SMS, with or without data quality SMS, improved documentation of pregnancies.
Using a newly developed case-management job aid based upon the WHO Integrated Management of Childhood Illness guide, community health care providers (CHCPs) in Bangladesh were trained to measure changes in knowledge. After the training, the CHCPs clearly improved their knowledge and provided better quality care to patients. Results from this study could be used to improve community health programs in other communities, particularly in those that are struggling with poor quality care.
USAID's 2016 Acting on the Call Report provides updates from the program that aims to end preventable maternal and child deaths in 25 priority countries, which together accounted for more than two-thirds of child and maternal deaths worldwide.
A randomized trial evaluates the effectiveness of a CHW program in Kenya which implements home visits or calls to new mothers three days after delivery. Surveys were utilized to measure compliance, self-reported health problems, care-seeking behaviors, and postnatal knowledge and practices among new mothers who received one of three randomly assigned postnatal care practices. Results showed that mothers who received CHW home visits were more likely to recognize postnatal problems and seek care for those problems than mothers who received a phone call or standard care.
Deployment of resident female Community Health Extension Workers (CHEWs) to a remote rural community led to major and sustained increases in service utilization, including antenatal care and facility-based deliveries.
Key components for success include:
1) providing an additional rural residence allowance to help recruit and retain CHEWs;
2) posting the female CHEWs in pairs to avoid isolation and provide mutual support;
3) ensuring supplies and transportation means for home visits; and
4) allowing CHEWs to perform deliveries.