TY - JOUR
T1 - The Tanzania Connect Project
T2 - A cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system
AU - Ramsey, Kate
AU - Hingora, Ahmed
AU - Kante, Malick
AU - Jackson, Elizabeth
AU - Exavery, Amon
AU - Pemba, Senga
AU - Manzi, Fatuma
AU - Baynes, Colin
AU - Helleringer, Stephane
AU - Phillips, James F.
N1 - Funding Information:
This work was supported by the African Health Initiative of the Doris Duke Charitable Foundation. Comic Relief UK also supports Connect interventions and research. Additional support was provided by the Bill and Melinda Gates Foundation for the formative research on emergency referral and the Maternal Health Task Force to initiate the mobile phone component of the project. We would like to acknowledge the contribution of Connect team members at Ifakara Health Institute to the development and execution of the project intervention and research program including: Dominic Mboya, Hildegalda P Mushi, Gloria Sikustahili, Kassimu Tani, John Noronha, Idda Kinyonge, Samuel Likasi, Doroth Maganga and Harun Machibya. The authors would also like to acknowledge the following who contributed to early conceptual development of the study: Godfrey Mbaruku, Selemani Mbuyita, Honorathi Masanja, Salim Abdulla, Lynn Freedman, Don de Savigny, Joanna Schellenberg, and Hassan Mshinda.
PY - 2013
Y1 - 2013
N2 - Background: Tanzania has been a pioneer in establishing community-level services, yet challenges remain in sustaining these systems and ensuring adequate human resource strategies. In particular, the added value of a cadre of professional community health workers is under debate. While Tanzania has the highest density of primary health care facilities in Africa, equitable access and quality of care remain a challenge. Utilization for many services proven to reduce child and maternal mortality is unacceptably low. Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers, but the Ministry of Health and Social Welfare (MoHSW) lacks evidence that this merits national implementation. The Tanzania Connect Project is a randomized cluster trial located in three rural districts with a population of roughly 360,000 (Kilombero, Rufiji, and Ulanga). Description of intervention. Connect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilization, and alter reproductive, maternal, newborn and child health seeking behavior; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre - Community Health Agents (CHA) - who were recruited from and work in their communities. To support the CHA, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. In addition, Connect's district-wide emergency referral strengthening intervention includes clinical and operational improvements. Evaluation design. Designed as a community-based cluster-randomized trial, CHA were randomly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System (HDSS) in the three study districts. To garner detailed information on household characteristics, behaviors, and service exposure, a random sub-sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline. The referral system intervention will use baseline, midline, and endline facility-based data to assess systemic changes. Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system. Discussion. Global commitment to launching community-based primary health care has accelerated in recent years, with much of the implementation focused on Africa. Despite extensive investment, no program has been guided by a truly experimental study. Connect will not only address Tanzania's need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities. Trial registration: ISRCTN96819844.
AB - Background: Tanzania has been a pioneer in establishing community-level services, yet challenges remain in sustaining these systems and ensuring adequate human resource strategies. In particular, the added value of a cadre of professional community health workers is under debate. While Tanzania has the highest density of primary health care facilities in Africa, equitable access and quality of care remain a challenge. Utilization for many services proven to reduce child and maternal mortality is unacceptably low. Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers, but the Ministry of Health and Social Welfare (MoHSW) lacks evidence that this merits national implementation. The Tanzania Connect Project is a randomized cluster trial located in three rural districts with a population of roughly 360,000 (Kilombero, Rufiji, and Ulanga). Description of intervention. Connect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilization, and alter reproductive, maternal, newborn and child health seeking behavior; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre - Community Health Agents (CHA) - who were recruited from and work in their communities. To support the CHA, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. In addition, Connect's district-wide emergency referral strengthening intervention includes clinical and operational improvements. Evaluation design. Designed as a community-based cluster-randomized trial, CHA were randomly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System (HDSS) in the three study districts. To garner detailed information on household characteristics, behaviors, and service exposure, a random sub-sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline. The referral system intervention will use baseline, midline, and endline facility-based data to assess systemic changes. Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system. Discussion. Global commitment to launching community-based primary health care has accelerated in recent years, with much of the implementation focused on Africa. Despite extensive investment, no program has been guided by a truly experimental study. Connect will not only address Tanzania's need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities. Trial registration: ISRCTN96819844.
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U2 - 10.1186/1472-6963-13-S2-S6
DO - 10.1186/1472-6963-13-S2-S6
M3 - Article
C2 - 23819587
AN - SCOPUS:84878577973
SN - 1472-6963
VL - 13
JO - BMC health services research
JF - BMC health services research
IS - SUPPL.2
M1 - S6
ER -