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.
