Blog

Dec 11, 2023

A repeated cross-sectional study of the association of community health worker intervention with the maternal continuum of care in rural Liberian communities

The maternal continuum of care (CoC) (antenatal care, facility-based delivery, postnatal care) is critical to maternal and neonatal health and reducing mortality, but completion in rural areas of low- and middle-income countries is often limited. We used repeated cross-sectional household surveys from a rural Liberian county to explore changes in rates of completion of all steps and no steps in the maternal CoC after implementation of the National Community Health Assistant Program (NCHAP), a community health worker (CHW) intervention designed to increase care uptake for families over five kilometers from a facility.

Jul 26, 2023

Relationship between household member vaccine acceptance and individual vaccine acceptance among women in rural Liberia

Despite the availability of COVID-19 vaccines, vaccination uptake remains low in Liberia. Social norms, and in particular an individual’s family preferences can have a strong normative influence on health behavior. However, few studies across the globe have explored how behavioral intent about COVID-19 vaccination among household members affects individual vaccination acceptance, particularly in rural, resource-limited settings. We respond to this gap in knowledge by analyzing data from a household survey of women in rural Liberia with the goal of understanding how household COVID-19 beliefs and vaccine behavioral intent correlated with those of individual household members.

Apr 26, 2023

Measuring Health System Responsiveness in a national community health worker primary care program in rural Liberia

As many low- and middle-income countries scale up community health worker (CHW) programs to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centered care, but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems quality of CHW-delivered care in two Liberian counties where the national CHW program for communities five kilometers or more from a health center has been implemented.

We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients’ experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to community health program design and delivery.