Abstract
BackgroundThere is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered.MethodsFrom January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women’s satisfaction with the CHW program and with the public-sector health system in Dar es Salaam.ResultsIn total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27).ConclusionsA CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction.Trial registrationClinicalTrials.gov, EJF22802
Highlights
There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction
In the case of health programs for women of reproductive age, high satisfaction with the public-sector health system can contribute to ensuring good coverage of antenatal care, facility-based delivery, and postnatal care, as well as good adherence to nutrition recommendations provided by health workers
Of women living in intervention areas, 86% reported that their household had ever received a visit from a Community health worker (CHW), compared to 37% of women living in control areas
Summary
There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered. Public satisfaction with the health system is important for several reasons. It is a key goal of health systems in and of itself. In the case of health programs for women of reproductive age, high satisfaction with the public-sector health system can contribute to ensuring good coverage of antenatal care, facility-based delivery, and postnatal care, as well as good adherence to nutrition recommendations provided by health workers. Public satisfaction with the health system is a key metric to hold actors in the health system—policy-makers, planners, and providers—accountable for their decisions and actions [3]
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