Abstract
Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.
Highlights
In low- and middle-income countries (LMICs), millions of children under 5 years old do not reach their full potential for physical and cognitive development [1,2]
community health workers (CHWs) faced during training and delivery of the RINEW intervention
CHWs mentioned that the quality of the training sessions, and quick and easy communication with their supervisors gave them confidence to carry out their job responsibilities
Summary
In low- and middle-income countries (LMICs), millions of children under 5 years old do not reach their full potential for physical and cognitive development [1,2]. Interventions that focus on increasing responsive stimulation in young children under two years of age improve child development outcomes immediately following intervention completion [3]. Two key questions for policymakers and program managers regarding child stimulation interventions are: (1) (2) Can they be implemented by community health workers (CHWs) at a large scale? According to the 2015 National Health Policy of Bangladesh, CHWs are mainly female, and work for both government and non-government organizations. They are mandated to provide a variety of domiciliary and community-based services, including prevention, education, and screening, as well as essential care and commodities and data gathering [6]
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