@article{fdi:010092774,
  title = {{E}valuation of a novel approach to community health care delivery in {I}fanadiana {D}istrict, {M}adagascar},
  author = {{R}azafinjato, {B}. and {R}akotonirina, {L}. and {C}ordier, {L}. {F}. and {R}asoarivao, {A}. and {A}ndrianomenjanahary, {M}. and {M}arovavy, {L}. and {H}anitriniaina, {F}. and {A}ndriamiandra, {I}. {J}. and {M}ayfield, {A}. and {P}alazuelos, {D}. and {C}owley, {G}. and {R}amarson, {A}. and {I}hantamalala, {F}. and {R}akotonanahary, {R}. {J}. {L}. and {M}iller, {A}. {C}. and {G}architorena, {A}ndres and {M}c{C}arty, {M}. {G}. and {B}onds, {M}. {H}. and {F}innegan, {K}. {E}.},
  editor = {},
  language = {{ENG}},
  abstract = {{D}espite 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 ({CHW}s) may be the only available providers. {T}he nongovernmental health organization {P}ivot partnered with the {M}inistry of {P}ublic {H}ealth ({M}o{PH}) to pilot a new enhanced community health ({ECH}) model in rural {M}adagascar, where one {CHW} provided care at a stationary {CH} site while additional {CHW}s provided care via proactive household visits. {T}he program included professionalization of the {CHW} workforce (i.e., targeted recruitment, extended training, financial compensation) and twice monthly supervision of {CHW}s. {F}or the first eighteen months of implementation ({O}ctober 2019-{M}arch 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. {T}his allowed for a quasi-experimental study design of the impact of {ECH} on health outcomes using routinely collected programmatic data. {D}espite the substantial support provided to other {CHW}s, the results show statistically significant improvements in nearly every indicator. {S}ick child visits increased by more than 269.0% in the intervention following {ECH} implementation. {A}verage per capita monthly under-five visits were 0.25 in the intervention commune and 0.19 in the comparison communes (p<0.01). {I}n the intervention commune, 40.3% of visits were completed at the household via proactive care. {CHW}s completed all steps of the i{CCM} protocol in 85.4% of observed visits in the intervention commune (vs 57.7% in the comparison communes, p-value<0.01). {T}his evaluation demonstrates that {ECH} can improve care access and the quality of service delivery in a rural health district. {F}urther research is needed to assess the generalizability of results and the feasibility of national scale-up as the {M}o{PH} continues to define the national community health program.},
  keywords = {{MADAGASCAR}},
  booktitle = {},
  journal = {{PL}o{S} {G}lobal {P}ublic {H}ealth},
  volume = {4},
  numero = {3},
  pages = {e0002888 [12 p.]},
  year = {2024},
  DOI = {10.1371/journal.pgph.0002888},
  URL = {https://www.documentation.ird.fr/hor/fdi:010092774},
}