Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria.
BACKGROUND
Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services.


METHODS
Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model.


RESULTS
Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years.


CONCLUSIONS
Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas.
Partnership for Reviving Routine Immunization in Northern Nigeria-Maternal Newborn and Child Health Initiative, Kano, Nigeria.
Charles A
CA
Uzondu
Partnership for Reviving Routine Immunization in Northern Nigeria-Maternal Newborn and Child Health Initiative, Kano, Nigeria Columbia University, Mailman School of Public Health, New York, NY, USA.
Henry V
HV
Doctor
Columbia University, Mailman School of Public Health, New York, NY, USA.
Sally E
SE
Findley
Partnership for Reviving Routine Immunization in Northern Nigeria-Maternal Newborn and Child Health Initiative, Kano, Nigeria.
Godwin Y
GY
Afenyadu
Columbia University, Mailman School of Public Health, New York, NY, USA aa2468@columbia.edu.
Alastair
A
Ager
D002648:Child; D002662:Child Health Services; D003150:Community Health Workers; D003695:Delivery of Health Care; D036861:Delivery, Obstetric; D005260:Female; D006297:Health Services Accessibility; D006792:House Calls; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services; D008880:Midwifery; D009549:Nigeria; D010865:Pilot Projects; D011247:Pregnancy; D011295:Prenatal Care; D012111:Residence Characteristics; D019035:Rural Health Services; D012424:Rural Population; D016387:Women's Health; D000078329:Workforce