In: Human Resources for Health, 17 (2019), Nr. 23. pp. 1-8. ISSN 1478-4491

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PDF, English - main document Download (1MB) | Lizenz: 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 by Larson, Elysia ; Geldsetzer, Pascal ; Mboggo, Eric ; Lema, Irene Andrew ; Sando, David ; Ekström, Anna Mia ; Fawzi, Wafaie ; Foster, Dawn W. ; Kilewo, Charles ; Li, Nan ; Machumi, Lameck ; Magesa, Lucy ; Mujinja, Phares ; Mungure, Ester ; Mwanyika-Sando, Mary ; Naburi, Helga ; Siril, Hellen ; Spiegelman, Donna ; Ulenga, Nzovu ; Bärnighausen, Till underlies the terms of Creative Commons Attribution 4.0

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