Demand-Side Factors in Maternal Health Outcomes: Evidence from a Community Health Worker Programme in Uganda

Area of Science:

• Global Health
• Public Health Interventions
• Maternal Health

Background:

• Community health workers (CHWs) are vital in low-resource healthcare systems.
• Limited evidence exists on CHW health impacts and their underlying mechanisms.
• Maternal health outcomes are a critical area for intervention.

Purpose of the Study:

• To evaluate the impact of a CHW program on maternal health outcomes in southwestern Uganda.
• To investigate the mechanisms of CHW program effects, considering variations in exposure.
• To identify factors influencing the effectiveness of CHW interventions.

Main Methods:

• Employed a difference-in-differences design comparing treatment and control groups.
• Assessed health behaviors such as antenatal care attendance and skilled birth delivery.
• Analyzed treatment effect heterogeneity based on gestational age at first antenatal visit.

Main Results:

• Found minimal overall program effect on key maternal health behaviors.
• Suggestive evidence indicated treatment effects varied with gestational age at first antenatal visit.
• Observed significant improvements in healthcare-seeking behavior across both groups post-intervention.

Conclusions:

• Suboptimal CHW performance may explain the limited program effects, underscoring the need for monitoring and incentive schemes.
• Concurrent health facility improvements or CHW spillover effects may have driven broader healthcare-seeking behavior changes.
• Further research is needed to optimize CHW program delivery and impact.