Abstract
BackgroundCommunity participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women’s Development Army (WDA), was added to extend Ethiopia’s Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA’s Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy.MethodsUsing data from cross-sectional surveys in 2010–11 and 2014–15 from 177 kebeles, we estimated self-reported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level random-effects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys.ResultsKebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth.ConclusionsThis study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.
Highlights
Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs
A community-based health information system is defined as community members actively collaborating with representatives from the health system to gather, analyze, interpret and use data to improve the efficiency of the delivery of health services to the community [9,10,11,12,13]
There are several examples of implementing health information systems for community-based programs to improve uptake of health services [8, 13,14,15,16,17,18,19,20,21,22,23,24]. These community-based information systems can be categorized into two types: (a) as a part of the health management information system of a national program, where salaried community health workers collect and use data to deliver and ensure quality of services, and the data are aggregated and used at higher levels of the health system for program monitoring and planning purposes; and (b) a strictly community-level health information system in which health workers in the formal health system facilitate community health volunteers and community representatives to collect data and use it to plan and improve uptake of health services
Summary
Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. For the community engagement and voluntary community health worker programs to achieve their objectives, community-led monitoring and evaluation of health service delivery, including a community-based health information system, are essential [9,10,11]. There are several examples of strictly community-based health information systems or community-based program monitoring and evaluation systems where the information systems are implemented and used within the local community to improve the uptake of health services [18, 23,24,25]. There is evidence that the strictly community-based health information systems in Honduras, Kenya, and Nigeria were effective in improving health care utilization [13, 18, 23], and that in Uganda, community-based monitoring and evaluation improved health outcomes [24], these community-based health information systems were pilot studies, or they were implemented on a small scale
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
