Evaluation of a volunteer community-based health worker program for providing contraceptive services in Madagascar |
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Authors: | Maria F Gallo Jenny Walldorf Robert Kolesar Aarti Agarwal Athena P Kourtis Denise J Jamieson Alyssa Finlay |
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Institution: | 1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA;2. Department of Pediatrics and Tropical Medicine, University of Maryland, Baltimore, MD, USA;3. Health, Population, and Nutrition Office, United States Agency for International Development (USAID), Madagascar;4. Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA |
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Abstract: | BackgroundMadagascar recently scaled up their volunteer community health worker (CHW) program in maternal health and family planning to reach remote and underserved communities.Study designWe conducted a cross-sectional evaluation using a systematic sample of 100 CHWs trained to provide contraceptive counseling and short-acting contraceptive services at the community level. CHWs were interviewed on demographics, recruitment, training, supervision, commodity supply, and other measures of program functionality; tested on knowledge of injectable contraception; and observed by an expert while completing five simulated client encounters with uninstructed volunteers. We developed a CHW performance score (0–100%) based on the number of counseling activities adequately met during the client encounters and used multivariable linear regression to identify correlates of the score.ResultsCHWs had a mean performance score of 73.9% (95% confidence interval CI]: 70.3–77.6%). More education, more weekly volunteer hours, and receiving a refresher training correlated with a higher performance score. We found no other associations between measures of the components previously identified as essential for effective CHW programs and performance score.ConclusionsAlthough areas of deficiency were identified, CHWs proved capable of providing high-quality contraception services. |
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Keywords: | Community health workers Contraception Evaluation Multivariable linear regression |
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