title: Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania.
abstract: BACKGROUND
  Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health community health worker (MNCH CHW) focused on preventive and promotive services during the antenatal and postpartum periods in Morogoro Region, Tanzania. Study findings review the effect of several critical design elements on knowledge, time allocation, service delivery, satisfaction, and motivation.
  
  
  METHODS
  A quantitative survey on service delivery and knowledge was administered to 228 (of 238 trained) MNCH CHWs. Results are compared against surveys administered to (1) providers in nine health centers (n = 88) and (2) CHWs (n = 53) identified in the same districts prior to the program's start. Service delivery outputs were measured by register data and through a time motion study conducted among a sub-sample of 33 randomly selected MNCH CHWs.
  
  
  RESULTS
  Ninety-seven percent of MNCH CHWs (n = 228) were interviewed: 55% male, 58% married, and 52% with secondary school education or higher. MNCH CHWs when compared to earlier CHWs were more likely to be unmarried, younger, and more educated. Mean MNCH CHW knowledge scores were <50% for 8 of 10 MNCH domains assessed and comparable to those observed for health center providers but lower than those for earlier CHWs. MNCH CHWs reported covering a mean of 186 households and were observed to provide MNCH services for 5 h weekly. Attendance of monthly facility-based supervision meetings was nearly universal and focused largely on registers, yet data quality assessments highlighted inconsistencies. Despite program plans to provide financial incentives and bicycles for transport, only 56% of CHWs had received financial incentives and none received bicycles.
  
  
  CONCLUSIONS
  Initial rollout of MNCH CHWs yields important insights into addressing program challenges. The social profile of CHWs was not significantly associated with knowledge or service delivery, suggesting a broader range of community members could be recruited as CHWs. MNCH CHW time spent on service delivery was limited but comparable to the financial incentives received. Service delivery registers need to be simplified to reduce inconsistencies and yet expanded to include indicators on the timing of antenatal and postpartum visits.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. aelefevre@gmail.com.
authors.forename: Amnesty E
authors.initials: AE
authors.lastname: LeFevre
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. rcmpembeni@yahoo.com.
authors.forename: Rose
authors.initials: R
authors.lastname: Mpembeni
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. dereck.chitama@gmail.com.
authors.forename: Dereck
authors.initials: D
authors.lastname: Chitama
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ageorg22@jhu.edu.
authors.forename: Asha S
authors.initials: AS
authors.lastname: George
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. dr.dmohan79@gmail.com.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Mohan
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. durassa2@yahoo.co.uk.
authors.forename: David P
authors.initials: DP
authors.lastname: Urassa
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sgupta23@jhu.edu.
authors.forename: Shivam
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ifeldha1@jhu.edu.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Feldhaus
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. apereir9@jhu.edu.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pereira
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. Kilewo1950@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Kilewo
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. joychebbet@gmail.com.
authors.forename: Joy J
authors.initials: JJ
authors.lastname: Chebet
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA. Chelsea.Cooper@jhpiego.org.
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Cooper
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA. giuliabesana@gmail.com.
authors.forename: Giulia
authors.initials: G
authors.lastname: Besana
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. lutale88harrie@yahoo.com.
authors.forename: Harriet
authors.initials: H
authors.lastname: Lutale
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA. Dunstan.Bishanga@jhpiego.org.
authors.forename: Dunstan
authors.initials: D
authors.lastname: Bishanga
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA. Emmanuel.Mtete@jhpiego.org.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mtete
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. hi.semu@gmail.com.
authors.forename: Helen
authors.initials: H
authors.lastname: Semu
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. abaqui@jhu.edu.|International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. abaqui@jhu.edu.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. jkillewo@yahoo.co.uk.
authors.forename: Japhet
authors.initials: J
authors.lastname: Killewo
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. pwinch@jhu.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D000328:Adult; D002662:Child Health Services; D002675:Child, Preschool; D003150:Community Health Workers / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services; D011247:Pregnancy; D011314:Preventive Health Services; D013636:Tanzania; D014937:Work / Q000706:statistics & numerical data