Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 11th floor, Boston, MA, 02115, United States of America.
Management and Development for Health, Dar es Salaam, Tanzania.
Hum Resour Health. 2019 Mar 29;17(1):23. doi: 10.1186/s12960-019-0355-7.
There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered.
From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women's satisfaction with the CHW program and with the public-sector health system in Dar es Salaam.
In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27).
A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction.
ClinicalTrials.gov, EJF22802.
关于不同医疗服务提供方式对卫生系统满意度的因果效应，相关证据十分匮乏。在向社区卫生工作者（CHW）转移任务的背景下，深入了解公众对卫生系统的满意度尤为重要。本文旨在确定以孕产妇保健服务为重点的 CHW 项目对坦桑尼亚达累斯萨拉姆市处于孕期或产后不久的妇女对卫生系统满意度的影响。
2013 年 1 月至 2014 年 4 月，我们开展了一项 CHW 项目的卫生系统实施试验，采用整群随机对照设计。坦桑尼亚达累斯萨拉姆市的 60 个区被随机分配到孕产妇保健 CHW 项目（36 个区）或标准护理区（24 个区）。2014 年 5 月至 8 月，我们对随机抽取的正处于孕期或产后不久的妇女进行了调查。我们采用五级李克特量表评估了妇女对 CHW 项目和达累斯萨拉姆公共部门卫生系统的满意度。
共有 2329 名妇女参与了调查（应答率 90.2%）。干预区的家庭接受过 CHW 家访的可能性是对照组家庭的 2.3 倍（95% CI 1.8, 3.0）。该干预措施使表示对 CHW 项目满意或非常满意的妇女比例增加了 16 个百分点（95% CI 3, 30），对公共部门卫生系统满意的比例增加了 15 个百分点（95% CI 3, 27）。
坦桑尼亚的一项孕产妇和儿童保健 CHW 项目实现了比标准 CHW 项目更高的公众满意度。参与 CHW 项目设计和组织的政策制定者和实施者应考虑该项目对公众满意度的潜在积极影响。
ClinicalTrials.gov，EJF22802。
