Testing Community-Led Outreach Clinics to Improve Health in Rural Areas

The HAC program establishes one-day integrated care outreach clinics in remote communities (communities that are greater than 5 km from the nearest health facility) every 1-2 months. Government healthcare workers are transported from the health faciliy to target communities to provide a range of health services. Local Community Associations in remote communities are trained to lead the program in collaboration with the local health facility and are also supported in financing the costs of the outreach clinics.

2025-07-01

2027-08-18

Health Utilization, Health Outcomes, Schooling Outcomes, and Labor Market Outcomes

Health utilization is measured by whether an individual received any healthcare in the past 30 days for all age groups as well as separately for those aged 5–17 and 18–60.

Health outcomes are assessed by the number of days an individual was sick in the past 30 days, analyzed for all age groups as well as separately for those aged 5–17 and 18–60.

Schooling outcomes are measured by the number of school days missed in the past 30 days for individuals aged 5–17.

Labor market outcomes include the number of workdays missed due to usual work activities in the past 30 days for individuals across all age groups and whether individuals aged 18–60 are currently engaged in wage labor. These variables will be collected through multiple rounds of household surveys.

Health Facility Service Delivery

Service delivery is assessed at both the facility and individual levels to capture a comprehensive picture of the intervention's impact. At the individual level, it is measured through health utilization, health status, schooling, and labor market outcomes, focusing on villages located near health facilities that are not actively engaged in the HAC outreaches. At the facility level, service delivery is measured by key operational metrics, including the frequency of drug stockouts, adherence to facility operation schedules, and staffing levels among the participating health facilities.

This study is a two-armed randomized control trial that will be conducted among 64 health facilities, 128 corresponding communities / villages (2 villages per health facility) that are located within each health facility’s catchment area, and an estimated 3,200 eligible households (approximately 25 households per selected village). The study consists of a baseline survey with health facilities, villages, and households, followed by randomization of health facilities into the HAC intervention and control arms and the implementation of the two-year family planning intervention. Two follow-up surveys were conducted one and two years after the baseline survey, respectively.

We will select 64 HC-III or HC-IV health facilities (HFs), and we will identify 128 villages (2 villages per HF) that are located more than 5 km away from the 64 HFs. From each village, we will select 25 households with at least one school-aged child (aged 5-17) for baseline surveys.

Following a baseline survey with 3200 households and 64 HFs, we will randomize HFs, and their corresponding villages and houesholds, into a treatment group or a control group:
• 32 HFs will be randomly selected as the control group. These HFs, and their corresponding villages and households, will receive no interaction with the HAC intervention, and no HAC outreach services will take place.
• 32 HFs will be randomly selected as the treatment group. Staff at these HFs will partner with HAC and will provide outreach services to households in the corresponding villages that are part of the HF's service catchment area..

We will then conduct several rounds of follow-up over a two year period to: (i) measure impacts of the HAC intervention on short-term and long-term outcomes of interest, (ii) identify any effects of the HAC intervention on the service delivery at health facilities. After 1 year of implementation, we will survey an additional 1600 households outside the target villages in order to detect any unintended impacts of the HAC intervention on service utilization at HFs and the resulting spillover effects that these unintended effects may have had on non-target communities.

Not available

Randomization done in office by a computer.

Our study will employ a clustered randomization design, stratified by district. Health facilities will be randomly assigned to either the treatment or control group.

Yes

64 health facilities, with additional 6 facilities as backup in the baseline survey

64 health facilities (plus an additional 6 facilities in the baseline survey), 192 villages, and 4800 households.

Treatment group: 32 health facilities and their corresponding 64 villages and 1600 households within the catchment area.
Control group: 32 health facilities and their corresponding 64 villages and 1600 households within the catchment area.
Indirect analysis: 64 villages, and their corresponding 1600 households, that are located close to the health facilities.

We focus on the primary outcomes measured in year 2 of our intervention. For health utilization, the standardized MDE for receiving health care among all individuals is 0.15 standard deviation (SD), with a 94% power, corresponding to a 6.7 percentage point (pp) increase in health care receipt. For individuals aged 5–17 and 18–60, the MDEs are also 0.15 SD with power levels of 90% and 85%, respectively, corresponding to a 6.2 pp and 6.5 pp increase in health care receipt. Regarding health outcomes, the MDE for days sick across all individuals is 0.15 SD with 99% power, equating to a 0.74-day reduction in days sick. For school-aged children (5–17), the MDE is 0.15 SD with 95% power, corresponding to a 0.52-day reduction, while for individuals aged 18–60, it is 0.15 SD with 95% power, translating to a 0.75-day reduction. In terms of schooling outcomes, the MDE for days of school missed among children aged 5–17 is 0.11 SD with 83% power, representing a 0.22-day reduction in school absences. For labor market outcomes, the MDE for the likelihood of currently working for pay among individuals aged 18–60 is 0.14 with 81% power, corresponding to a 5.7 pp increase. Additionally, the MDE for days of usual work activity missed among all individuals is 0.07 SD with 87% power, reflecting a 0.24-day reduction. These results indicate the study's strong ability to detect meaningful changes across a range of outcomes, with standardized MDEs ranging from 0.07 to 0.15 SD and high statistical power (≥80%) across all measures. Throughout the power analysis, we assume 20% random attrition rates per year. We also include allowance for the increase in precision due to the inclusion of covariates as follows: 13% increase in R-2 from individual covariates; 8% increase in R-2 from village-level covariates; an increase in R-2 of 27% from HF covariates. These parameters are based upon regression estimates using covariates correlated with days sick and days of usual activity missed due to sickness. We use empirical ICCs at various levels taken from either the 2019-2020 UNPS or 2016 Uganda DHS.