In:
PLOS Global Public Health, Public Library of Science (PLoS), Vol. 3, No. 1 ( 2023-1-24), p. e0001512-
Abstract:
Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers to achieving universal health coverage. Gaps remain, however, in understanding whether evidence-based interventions delivered by CHWs, closely aligned with WHO recommendations, are effective in Nepal’s context. We conducted a type II hybrid effectiveness-implementation, mixed-methods study in two rural districts in Nepal to evaluate the effectiveness and the implementation of an evidence-based integrated maternal and child health intervention delivered by CHWs, using a mobile application. The intervention was implemented stepwise over four years (2014–2018), with 65 CHWs enrolling 30,785 families. We performed a mixed-effects Poisson regression to assess institutional birth rate (IBR) pre-and post-intervention. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the implementation during and after the study completion. There was an average 30% increase in IBR post-intervention, adjusting for confounding variables (p 〈 0.0001). Study enrollment showed 35% of families identified as dalit , janjati , or other castes. About 78–89% of postpartum women received at least one CHW-counseled home visit within 60 days of childbirth. Ten (53% of planned) municipalities adopted the intervention during the study period. Implementation fidelity, measured by median counseled home visits, improved with intervention time. The intervention was institutionalized beyond the study period and expanded to four additional hubs, albeit with adjustments in management and supervision. Mechanisms of intervention impact include increased knowledge, timely referrals, and longitudinal CHW interaction. Full-time, supervised, and trained CHWs delivering evidence-based integrated care appears to be effective in improving maternal healthcare in rural Nepal. This study contributes to the growing body of evidence on the role of community health workers in achieving universal health coverage.
Type of Medium:
Online Resource
ISSN:
2767-3375
DOI:
10.1371/journal.pgph.0001512
DOI:
10.1371/journal.pgph.0001512.g001
DOI:
10.1371/journal.pgph.0001512.g002
DOI:
10.1371/journal.pgph.0001512.g003
DOI:
10.1371/journal.pgph.0001512.g004
DOI:
10.1371/journal.pgph.0001512.g005
DOI:
10.1371/journal.pgph.0001512.t001
DOI:
10.1371/journal.pgph.0001512.t002
DOI:
10.1371/journal.pgph.0001512.t003
DOI:
10.1371/journal.pgph.0001512.t004
DOI:
10.1371/journal.pgph.0001512.t005
DOI:
10.1371/journal.pgph.0001512.s001
DOI:
10.1371/journal.pgph.0001512.s002
DOI:
10.1371/journal.pgph.0001512.s003
DOI:
10.1371/journal.pgph.0001512.r001
DOI:
10.1371/journal.pgph.0001512.r002
DOI:
10.1371/journal.pgph.0001512.r003
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
3101394-6
