Babies and mothers in rural Zambia fare well when they receive health care from a team of community health workers and traditional birth attendants.
Notably, these teams have high mutual trust, cohesion, comprehension of goals and objectives, and communication. Further, team members that live within one hour’s walking distance of each other were more likely to work well together.
Zambia has a strained health care system with limited facilities and resources. This increases the reliance on community-based providers who offer basic health services, especially in rural areas, to confront a high under-5 mortality rate.
Two common volunteer cadres are community health workers (CHWs) and trained traditional birth attendants (TBAs). CHWs have been trained to provide a wide range of services, including preventive interventions, health education, and treatment of common childhood illnesses, while TBAs have been trained to provide maternal and newborn interventions.
For a new study, Save the Children deployed teams of the workers, who were tracked over two years to gauge how well they provided care for children under 5, including newborns. The study was conducted in the Lufwanyama District in the Copperbelt Province of Zambia.
About two-thirds of the active teams were categorized as “high performing,” according to the study, that is published in the journal BMC Health Services Research.
Team scores on communication were high and improved over time. Especially encouraging was that TBAs and CHWs made home visits jointly to mothers and newborns at 6-8 weeks of age, improving the usual handover of care from the birth attendants to community health workers.
“The joint home visits for handing over care of the young infant has the potential to . . . improve the use of facility-based postnatal services (where needed) and enhance the continuum of care,” the researchers write.
One area of concern was low scores for “performance monitoring,” indicating that team members need help in identifying their partners’ lapses in care. Also of concern was a high attrition rate among the workers—about 30 percent over two years. Attrition is largely due to low pay and the movement of workers to higher positions in the health system or other fields.
“If teaming is to be implemented, approaches to motivate and retain CHWs need to be adopted,” the study reports.
“These results look very promising,” says Davidson Hamer, coauthor and professor of global health at Boston University School of Public Health.
A USAID Child Survival and Health Grants Program Cooperative Agreement funded the project, with additional support from the ELMA Foundation, the Crown Family Philanthropies, and other private donors.
Source: Boston University