Thank you for sharing this important paper. I think we missed it on CHIFA at the time (2017) but would like to open discussion on some of the issues raised. Below are the citation, abstract and comments/questions from me.
CITATION: Expanding the population coverage of evidence–based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST)
Victoria B Chou, Ingrid K Friberg, Mervyn Christian, Neff Walker, Henry B Perry
Journal of Global Health 2017
Background Evidence has been accumulating that community health workers (CHWs) providing evidence–based interventions as part of community–based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale–up CHW programs still remain modest.
Methods We used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence–based interventions that CHWs can deliver in these high–burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country–level results by region and by all high–burden countries combined. We also estimated which specific interventions would save the most lives.
Findings LiST estimates that a total of 3.0 (sensitivity bounds 1.8–4.0), 4.9 (3.1–6.3) and 6.9 (3.7–8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia.
Conclusions Scaling up CHW programming to increase population–level coverage of life–saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could
be achieved by expanding coverage of evidence–based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded.
1. The full text concludes: 'If near–universal (90%) coverage of evidence–based interventions for mothers and children were achieved in 73 Countdown countries, 6.9 million lives would be saved during the period from 2016 to 2020, and the overall number of death would be reduced by 41% compared to baseline levels.'
2. This would be achieved by expansion of CHWs to provide 90% coverage of timely interventions. Examples of countries that have strong CHW programmes include Ethiopia, Rwanda, Brazil, Bangladesh, Nepal and it is pointed out that these 'have all made major progress in reducing maternal and child mortality'
3. You make the important point that the necessary human resources are already available in communities to expand the coverage of community–based MNCH interventions. 'Experience teaches that people with limited education can learn the skills needed to provide these interventions, and there are adequate numbers of people who are eager and willing to serve their community for the purpose of saving lives. The needed trainers and supervisors can be acquired if the financial investment is adequate.'
4. Since this paper has been published, the case for CHW programmes is ever stronger, and experience is shared internationally through a global CHW Symposium.
5. I would be interested to hear your experience (and the experience of others) about the uptake of your paper by policymakers. What has been their reaction to the accumulating evidence? Are they aware of the evidence, are they persuaded by it, have they integrated it into policy?
All best wishes, Neil
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CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org