title: Implementation research on community health workers' provision of maternal and child health services in rural Liberia.
abstract: OBJECTIVE
  To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.
  
  
  METHODS
  The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.
  
  
  RESULTS
  Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.
  
  
  CONCLUSIONS
  We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.
authors.affiliation: Geisel School of Medicine at Dartmouth College, Hanover, United States of America (USA).
authors.forename: Peter W
authors.initials: PW
authors.lastname: Luckow
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Avi
authors.initials: A
authors.lastname: Kenny
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Emily
authors.initials: E
authors.lastname: White
authors.affiliation: Department of Social Policy and Intervention, University of Oxford, Oxford, England .
authors.forename: Madeleine
authors.initials: M
authors.lastname: Ballard
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dorr
authors.affiliation: Harvard Medical School, Boston, USA .
authors.forename: Kirby
authors.initials: K
authors.lastname: Erlandson
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Benjamin
authors.initials: B
authors.lastname: Grant
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Alice
authors.initials: A
authors.lastname: Johnson
authors.affiliation: University of Minnesota Medical School, Minneapolis, USA .
authors.forename: Breanna
authors.initials: B
authors.lastname: Lorenzen
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Subarna
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: E John
authors.initials: EJ
authors.lastname: Ly
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Abigail
authors.initials: A
authors.lastname: McDaniel
authors.affiliation: Grand Gedeh County Health Team, Ministry of Health, Monrovia, Liberia .
authors.forename: Netus
authors.initials: N
authors.lastname: Nowine
authors.affiliation: Last Mile Health, Monrovia, Liberia .
authors.forename: Vidiya
authors.initials: V
authors.lastname: Sathananthan
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA .
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Sechler
authors.affiliation: Department of Health Systems Administration, Georgetown School of Nursing and Health Studies, Washington, USA .
authors.forename: John D
authors.initials: JD
authors.lastname: Kraemer
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, USA .
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA .
authors.forename: Rajesh
authors.initials: R
authors.lastname: Panjabi
mesh_terms: D000328:Adult; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D000068101:Maternal-Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012141:Respiratory Tract Infections / Q000453:epidemiology; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*