Virtual community health services - for equity and quality in health care in Mali

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DESCRIPTION (provided by applicant): Strengthening health programs at the community level can play a vital role in addressing reducing high levels of under-five and maternal mortality in rural Africa. Community-based approaches allow community health workers (CHWs) to reach people in need of care in their homes and to provide the support for behavior change that may be absent in clinic-based care. The critical barrier addressed is the limited utility and effectiveness of household visits by CHWs in routine programs. The barrier is addressed through implementation and evaluation of a Virtual Community Health Services (VCHS) intervention package. This package of interventions includes 1) virtual workday for strategic deployment of CHW and mobile technology inputs, 2) Immediate feedback to and from beneficiaries on quality, 3) Monthly CHW- led conference call, 4) Improved supervision processes, and 5) Mobile money incentives. Aims: 1) Develop an mHealth intervention package (VCHS) for CHWs that prioritizes key contacts for interpersonal communication by CHW, shifts much of the burden for provision of reminder messages to mobile phones, helps CHWs tailor the content of their counseling by stage of pregnancy, age of child, season; 2) Assess effectiveness of the intervention package in increasing coverage and quality of key IMCI services, through a quasi-experimental design Methods: The study will be carried out in the S�lingu� health district located 120 km south-west from Bamako. The district encompasses the catchment areas of 5 community health centers (CSCom), covering 5 health zones with a population of 83 318. In Year 1 of the project, we will 1) develop a measurement tool, informed by psychology and information theory, to assess the value assigned to interpersonal communication by CHWs during household visits; and 2) pretest and assess the reliability and validity of the measurement tools to assess intervention impact. In Year 2 of the project, we will implement the intervention package in two health zones (sub- districts) and assess its effectiveness on key outcomes, and conduct a process evaluation to understand strengths and weakness of the intervention package. Partnership: The study is a collaboration between the Johns Hopkins Bloomberg School of Public Health, Department of International Health, and the University of Bamako (USTTB), Department of Public Health. The study builds on existing collaborations in public health training and malaria and child health research. This study will be conducted over the course of two years and will conclude with a dissemination workshop in Bamako. Findings will be used for advocacy for more responsive and appropriate community health for this population.