TY  - JOUR
PB  - Biomed Central
KW  - Community health workers
KW  -  Satisfaction
KW  -  Sub-Saharan Africa
KW  -  Maternal and child health
KW  -  Task shifting
A1  - Larson, Elysia
A1  - Geldsetzer, Pascal
A1  - Mboggo, Eric
A1  - Lema, Irene Andrew
A1  - Sando, David
A1  - Ekström, Anna Mia
A1  - Fawzi, Wafaie
A1  - Foster, Dawn W.
A1  - Kilewo, Charles
A1  - Li, Nan
A1  - Machumi, Lameck
A1  - Magesa, Lucy
A1  - Mujinja, Phares
A1  - Mungure, Ester
A1  - Mwanyika-Sando, Mary
A1  - Naburi, Helga
A1  - Siril, Hellen
A1  - Spiegelman, Donna
A1  - Ulenga, Nzovu
A1  - Bärnighausen, Till
SP  - 1
TI  - 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
IS  - 23
AV  - public
VL  - 17
CY  - London
N2  - 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
SN  - 1478-4491
JF  - Human Resources for Health
ID  - heidok26243
UR  - https://archiv.ub.uni-heidelberg.de/volltextserver/26243/
Y1  - 2019///
EP  - 8
ER  -