Liberia National Community Health Assistant (NCHA) Program and Under-five Mortality
- Conditions
- Malnutrition, ChildAcute Respiratory InfectionMalariaDiarrhea
- Interventions
- Behavioral: Liberia National Community Health Assistant Program
- Registration Number
- NCT05123378
- Lead Sponsor
- Last Mile Health
- Brief Summary
Last Mile Health (LMH) has partnered with the Liberian Ministry of Health (MOH) to support the design and implementation of the National Community Health Assistant Program (NCHAP). In collaboration with MOH, LMH is planning to conduct an impact evaluation in Grand Bassa to assess the effect of the National Community Health Assistant Program (NCHAP) on health outcomes, as well as to learn lessons around program operations and implementation. Our central hypothesis is that Community Health Assistants (CHAs) within the NCHAP will reduce under 5 mortality, as a result of expanding access to and uptake of health care utilization in remote communities. We will use a mixed effects discrete survival model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare the incidence of under-5 child mortality between the pre- and post-CHW program implementation periods.
- Detailed Description
Previous evaluations of the NCHAP in Rivercess and Grand Gedeh counties found significant increases in uptake of child and maternal health-care services from qualified providers. We will expand upon those studies to assess the impact of the CHA program after a phased implementation in an additional county.
The Liberian NCHAP is being rolled out staggered across the eight districts of Grand Bassa County by the government of Liberia. The practical program implementation is accompanied and supported by LMH. Starting with program implementation in March 2018, the last district will be covered by the NCHAP by January 2022. At baseline, midline, and endline LMH will conduct representative household surveys to assess the interventions uptake and effectiveness on population health. This programmatic strategy allows us to apply a effectiveness-implementation hybrid design, where we are using quasi experimental methods on the intervention's impact on relevant outcomes and program utilization and mixed methods to assess the implementation process.
The program implementation and data collection takes place in the Grand Bassa county of Liberia between 2018 and 2022. Measuring an area of 7,936 square kilometres and an overall population of 224,839 in 2008, the county is predominantly rural. For program roll out the five administrative districts were subdivided in eight study districts (see Figure 1). The target population of the NCHA are households in communities with a distance of more than 5 km from the nearest health facility. According to the 2018 LMH Grand Bassa household survey, 1,733 communities were identified as remote with 23,702 households.
The long-term objective of the NCHA program is to provide community-based health care that substantially improves population health and is desirable and respectful to the clients it serves. In pursuit of this objective, our specific research aims for the Grand Bassa causal impact evaluation is to assess the impact of the NCHA program on under-5 mortality.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 23702
- Communities >5 km from a health facility
- Within a household all women 18-49 were interviewed (if possible).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Phase 2 Implementation Liberia National Community Health Assistant Program District 3AB and District 2 begin NCHAP implementation in November 2018. Phase 1 Implementation Liberia National Community Health Assistant Program Campwood District and District 3C begin NCHAP implementation in May 2018. Phase 5 Implementation Liberia National Community Health Assistant Program District 1 begins NCHAP implementation in January 2022. Phase 3 Implementation Liberia National Community Health Assistant Program District 4 begins NCHAP implementation in September 2020. Phase 4 Implementation Liberia National Community Health Assistant Program Owensgrove District and Commonwealth District begin NCHAP implementation in April 2021.
- Primary Outcome Measures
Name Time Method Mortality in children under 5 Cross-sectional household surveys administered at endline in 2022 Assess the impact of the NCHA program on under-5 mortality
- Secondary Outcome Measures
Name Time Method Health care utilization Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022 Determine effects of the NCHA program on health care utilization
Child illness prevalence Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022 Determine effects of the NCHA program on child illness prevalence
Experiential quality and trust in the health care system Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022 Determine effects of the NCHA program on experiential quality and trust in the health care system
Trial Locations
- Locations (1)
Last Mile Health
🇱🇷Monrovia, Montserrado, Liberia