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

Bénédicte Razafinjato, Luc Rakotonirina, Laura Cordier, Anna Rasoarivao, Mamy Andrianomenjanahary, Lanto Marovavy, Feno Hanitriniaina, Isaïe Jules Andriamiandra, Alishya Mayfield, Daniel Palazuelos, Giovanna Cowley, Andriamanolohaja Ramarson, Felana Ihantamalala (), Rado Rakotonanahary, Ann C. Miller, Andres Garchitorena (), Meg Mccarty, Matthew Bonds and Karen Finnegan
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Bénédicte Razafinjato: PIVOT [Ifanadiana, Madagascar]
Luc Rakotonirina: PIVOT [Ifanadiana, Madagascar]
Laura Cordier: PIVOT [Ifanadiana, Madagascar]
Anna Rasoarivao: PIVOT [Ifanadiana, Madagascar]
Mamy Andrianomenjanahary: PIVOT [Ifanadiana, Madagascar]
Lanto Marovavy: PIVOT [Ifanadiana, Madagascar]
Feno Hanitriniaina: PIVOT [Ifanadiana, Madagascar]
Alishya Mayfield: HMS - Harvard Medical School [Boston]
Daniel Palazuelos: HMS - Harvard Medical School [Boston]
Giovanna Cowley: PIVOT [Ifanadiana, Madagascar]
Andriamanolohaja Ramarson: PIVOT [Ifanadiana, Madagascar]
Felana Ihantamalala: PIVOT [Ifanadiana, Madagascar], HMS - Harvard Medical School [Boston]
Rado Rakotonanahary: PIVOT [Ifanadiana, Madagascar], HMS - Harvard Medical School [Boston]
Ann C. Miller: PIVOT [Ifanadiana, Madagascar], HMS - Harvard Medical School [Boston]
Andres Garchitorena: MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle - CNRS - Centre National de la Recherche Scientifique - IRD [Occitanie] - Institut de Recherche pour le Développement - UM - Université de Montpellier, PIVOT [Ifanadiana, Madagascar]
Meg Mccarty: PIVOT [Ifanadiana, Madagascar]
Matthew Bonds: PIVOT [Ifanadiana, Madagascar], HMS - Harvard Medical School [Boston]
Karen Finnegan: PIVOT [Ifanadiana, Madagascar], HMS - Harvard Medical School [Boston]

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

Date: 2024
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Published in PLOS Global Public Health, 2024, 4 (3), pp.e0002888. ⟨10.1371/journal.pgph.0002888⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04543860

DOI: 10.1371/journal.pgph.0002888

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