Prevention of social exclusion and role of antenatal care by BRAC community health workers in improving safe motherhood and neonatal care in urban slums of Bangladesh

Abstract This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.

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Community Health Workers to Improve Antenatal Care and PMTCT Uptake in Dar es Salaam, Tanzania

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000371 ◽

2014 ◽

Vol 67 ◽

pp. S195-S201 ◽

Cited By ~ 13

Author(s):

Irene A. Lema ◽

David Sando ◽

Lucy Magesa ◽

Lameck Machumi ◽

Esther Mungure ◽

...

Keyword(s):

Antenatal Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Dar Es Salaam

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What are the roles of community health workers? Looking back at the philosophies of primary health care

Global Health Promotion ◽

10.1177/1757975918811087 ◽

2019 ◽

Vol 27 (2) ◽

pp. 117-120

Author(s):

Marietou Niang

Keyword(s):

Health Care ◽

Primary Health Care ◽

Community Development ◽

Health System ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Primary Health ◽

Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

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