Procedures
malaria, diarrhoea, pneumonia
MALARIA, MAY, PNEUMONIA, MALNUTRITION
In each cluster, community leaders nominated individuals aged 18 to 45 years who could read and write in French to be trained, selected, and deployed as CHWs. Nominees were divided by study arm and trained separately over six weeks, with annual one-week refresher training, based on the same clinical protocols (that covered preventive and curative primary care for reproductive, maternal, newborn, and child health, including iCCM for diarrhoea, pneumonia, malaria, acute malnutrition, and newborn illnesses) and the delivery approach to which their clusters were allocated. CHWs were ultimately selected based on a post-training evaluation and deployed to serve approximately 700 people, in line with Mali’s 2016-2020 national community health strategy [CHWs in the intervention arm were instructed to conduct door-to-door proactive case-finding home visits for at least two hours per day, six days per week, with the goal of visiting every household at least twice per month. In the control arm, CHWs were instructed to station themselves at community health sites for four hours per day, six days per week, to provide the same package of services to care-seeking patients. CHWs in both arms were expected to be available on-call to provide care as needed, at all times.CHWs in both arms received the same systems support, in accordance with WHO guidelines [We assessed the outcomes at baseline (December 2016 to January 2017) and approximately 12 (February to March 2018), 24 (March to May 2019), and 36 months (January to April 2020) via surveys administered at respondents’ homes by female surveyors who were neither community residents nor involved in health care delivery. We adapted the household and women’s surveys from Mali’s Demographic and Health Survey (DHS) and programmed in Open Data Kit. They included a household roster (census) and modules on migration, mortality, and socio-economic characteristics. The women’s survey included socio-demographic characteristics, current contraceptive use, most recent pregnancy and childbirth, lifetime birth history, and symptoms and service utilisation in the two weeks preceding the survey for all the woman’s co-residing children under five years of age.