ArticlePLOS global public health2024
Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar.
Article in PLOS global public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Community health worker involvement across domains and national infectious disease programmes in rural Madagascar: evidence of fragmentation and determinants of engagement.BMJ global health · 2026Article
- Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis.SSM - health systems · 2025Review
- Public health surveillance of tropical diseases in Madagascar: a scoping review of population burden, intervention strategies, and health system responses.BMC public health · 2025Article
- Increasing the resolution of malaria early warning systems for use by local health actors.Malaria journal · 2025Article
- Designing and Evaluating a Health System Resilient to Extreme Weather Events in Rural Madagascar.Annals of global health · 2025Article
- Combining OpenStreetMap mapping and route optimization algorithms to inform the delivery of community health interventions at the last mile.PLOS digital health · 2024Article
- Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar.PLOS global public health · 2022Article
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Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite 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 (CHWs) may be the only available providers. The nongovernmental health organization Pivot partnered with the Ministry of Public Health (MoPH) to pilot a new enhanced community health (ECH) model in rural Madagascar, where one CHW provided care at a stationary CH site while additional CHWs provided care via proactive household visits. The program included professionalization of the CHW workforce (i.e., targeted recruitment, extended training, financial compensation) and twice monthly supervision of CHWs. For the first eighteen months of implementation (October 2019-March 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. This allowed for a quasi-experimental study design of the impact of ECH on health outcomes using routinely collected programmatic data. Despite the substantial support provided to other CHWs, the results show statistically significant improvements in nearly every indicator. Sick child visits increased by more than 269.0% in the intervention following ECH implementation. Average per capita monthly under-five visits were 0.25 in the intervention commune and 0.19 in the comparison communes (p<0.01). In the intervention commune, 40.3% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 85.4% of observed visits in the intervention commune (vs 57.7% in the comparison communes, p-value<0.01). This evaluation demonstrates that ECH can improve care access and the quality of service delivery in a rural health district. Further research is needed to assess the generalizability of results and the feasibility of national scale-up as the MoPH continues to define the national community health program.
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