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Impact of the Liberian National Community Health Assistant Program on childhood illness care in Grand Bassa County, Liberia

Author

Listed:
  • Emily White
  • Savior Mendin
  • Featha R Kolubah
  • Robert Karlay
  • Ben Grant
  • George P Jacobs
  • Marion Subah
  • Mark J Siedner
  • John D Kraemer
  • Lisa R Hirschhorn

Abstract

Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys that included information on 1291 illness episodes. We measured before-to-after changes in care for childhood illness by qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented. We also assessed changes in whether children received oral rehydration therapy for diarrhea and malaria rapid diagnostic tests if they had a fever by a qualified provider (facility based or CHW). For these analyses, we used a difference-in-differences approach and adjusted for potential confounding using inverse probability of treatment weighting. We also assessed changes in the source from which care was received and examined changes by key dimensions of equity (distance from health facilities, maternal education, and household wealth). We found that care of childhood illness by a qualified provider increased by 60.3 percentage points (95%CI 44.7–76.0) more in intervention than comparison areas. Difference-in-differences for oral rehydration therapy and malaria rapid diagnostic tests were 37.6 (95%CI 19.5–55.8) and 38.5 (95%CI 19.9–57.0) percentage points, respectively. In intervention areas, care by a CHW increased from 0 to 81.6% and care from unqualified providers dropped. Increases in care by a qualified provider did not vary significantly by household wealth, remoteness, or maternal education. This evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective care in rural Grand Bassa County. Improvements were approximately equal across three measured dimensions of marginalization.

Suggested Citation

  • Emily White & Savior Mendin & Featha R Kolubah & Robert Karlay & Ben Grant & George P Jacobs & Marion Subah & Mark J Siedner & John D Kraemer & Lisa R Hirschhorn, 2022. "Impact of the Liberian National Community Health Assistant Program on childhood illness care in Grand Bassa County, Liberia," PLOS Global Public Health, Public Library of Science, vol. 2(6), pages 1-15, June.
    • Handle: RePEc:plo:pgph00:0000668
    DOI: 10.1371/journal.pgph.0000668
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    References listed on IDEAS

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    1. repec:plo:pmed00:1002096 is not listed on IDEAS
    2. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    3. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    4. repec:plo:pone00:0065160 is not listed on IDEAS
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