Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna Institute of Demography / Austrian Academy of Sciences, Vienna, Austria.
J Glob Health. 2019 Jun;9(1):010435. doi: 10.7189/jogh.09.010435.
Community Health Workers (CHWs) are considered to be a cost-effective and inclusive solution to address the persistent health workforce shortage in many low and middle-income countries. In recent years, microfinance institutions (MFIs) got increasingly engaged in providing health services delivered by CHWs. Despite their growing importance, little is known about the impacts and implementation barriers of these mostly small-scale initiatives. This paper evaluates an MFI-led CHW program in the Philippines and studies the role of microfinance group networks in influencing program outreach and impact. The intervention aims at disseminating information in poor communities, improving health monitoring through increased check-ups and raising social support.
Clustered randomized controlled trial in 70 communities in the greater area of Metro Manila, the Philippines. The main data was collected in a baseline and follow-up survey and is complemented with extensive sociometric network and geographical data. The main outcome variable is a composite health index based on 10 indicators. The role of the health worker's embeddedness and connectedness in the community for program success is tested using tools of social network analysis.
The intervention led to a 3.8% (95% confidence interval (CI) = 1.3, 6.4) improvement in the composite health outcome. Effects across indicators are mixed and mainly driven by changes in immediate health monitoring behavior: The probability for routine examinations increased in the treatment group by 10.6% (95% CI = 3.2, 18.1), for regular blood pressure checks by 9.6% (95% CI = 3.3, 15.9), and for having access to a health care provider by 7.2% (95% CI = 0.93, 13.5). No statistical effects on general knowledge and social support are observable. Social networks are a key driver of program outreach and impact. Close friends and acquaintances of health workers used and benefited substantially more from the program than more distant ties.
Despite the promising immediate behavioral impacts, it remains questionable to what extent such small-scale MFI initiatives can bring transformative and sustainable changes without external support. Microfinance group networks played an important role for the success of the health intervention and further research is needed to better understand how these affect the health care utilization decisions of the clients.
社区卫生工作者（CHWs）被认为是解决许多低收入和中等收入国家持续存在的卫生人力短缺问题的一种具有成本效益和包容性的解决方案。近年来，小额信贷机构（MFIs）越来越多地参与提供 CHWs 提供的卫生服务。尽管它们越来越重要，但对于这些大多小规模举措的影响和实施障碍知之甚少。本文评估了菲律宾一个由小额信贷机构主导的 CHW 计划，并研究了小额信贷团体网络在影响计划推广和影响方面的作用。该干预旨在向贫困社区传播信息，通过增加检查来改善健康监测，并提高社会支持。
在菲律宾马尼拉大都会地区的 70 个社区进行了聚类随机对照试验。主要数据是在基线和随访调查中收集的，并辅以广泛的社会计量网络和地理数据。主要的结果变量是基于 10 项指标的综合健康指数。使用社会网络分析工具测试卫生工作者在社区中的嵌入和联系对计划成功的作用。
该干预措施导致综合健康结果改善了 3.8%（95%置信区间（CI）=1.3,6.4）。各指标的效果参差不齐，主要受即时健康监测行为变化的驱动：治疗组常规检查的概率增加了 10.6%（95%CI=3.2,18.1），定期血压检查增加了 9.6%（95%CI=3.3,15.9），获得医疗保健提供者的机会增加了 7.2%（95%CI=0.93,13.5）。没有观察到对一般知识和社会支持的统计学影响。社会网络是计划推广和影响的关键驱动因素。卫生工作者的亲密朋友和熟人比更远的关系更广泛地使用和受益于该计划。
尽管有希望的即时行为影响，但仍存在疑问的是，没有外部支持，此类小额信贷机构的小规模举措在多大程度上可以带来变革性和可持续的变化。小额信贷团体网络对健康干预的成功起到了重要作用，需要进一步研究以更好地了解这些网络如何影响客户的医疗保健利用决策。
