title: Evaluation of a volunteer community-based health worker program for providing contraceptive services in Madagascar.
abstract: BACKGROUND
  Madagascar recently scaled up their volunteer community health worker (CHW) program in maternal health and family planning to reach remote and underserved communities.
  
  
  METHODS
  We conducted a cross-sectional evaluation using a systematic sample of 100 CHWs trained to provide contraceptive counseling and short-acting contraceptive services at the community level. CHWs were interviewed on demographics, recruitment, training, supervision, commodity supply, and other measures of program functionality; tested on knowledge of injectable contraception; and observed by an expert while completing five simulated client encounters with uninstructed volunteers. We developed a CHW performance score (0-100%) based on the number of counseling activities adequately met during the client encounters and used multivariable linear regression to identify correlates of the score.
  
  
  RESULTS
  CHWs had a mean performance score of 73.9% (95% confidence interval [CI]: 70.3-77.6%). More education, more weekly volunteer hours, and receiving a refresher training correlated with a higher performance score. We found no other associations between measures of the components previously identified as essential for effective CHW programs and performance score.
  
  
  CONCLUSIONS
  Although areas of deficiency were identified, CHWs proved capable of providing high-quality contraception services.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: mgallo@cdc.gov.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.forename: Jenny
authors.initials: J
authors.lastname: Walldorf
authors.forename: Robert
authors.initials: R
authors.lastname: Kolesar
authors.forename: Aarti
authors.initials: A
authors.lastname: Agarwal
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Alyssa
authors.initials: A
authors.lastname: Finlay
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003150:Community Health Workers / Q000193:education; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004343:Drug Implants; D005193:Family Planning Services / Q000193:education; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007318:Inservice Training; D008270:Madagascar; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D011787:Quality of Health Care; D014838:Volunteers / Q000193:education; D000078329:Workforce; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: Community health workers; Contraception; Evaluation; Multivariable linear regression