Despite improvements in under-five child mortality, an estimated 6.9 million children die from preventable diseases worldwide every year. A majority of these deaths occur in the poorest countries in the world, in areas within countries of underserved populations with inadequate access to basic health services. An increasingly common approach to reach these populations has been Community Health Worker (CHW) programs. However, a systematic review of the evidence indicates mixed results of this approach in reducing child mortality. Whether alternative, financially sustainable, delivery models where CHWs earn a margin on product sales and small performance-based incentives can provide a solution is an open question. In this project, we study a community health worker program in Uganda – the community health promoter (CHP) program – where, in contrast to traditional volunteer-based community health workers, community health promoters operate as micro-entrepreneurs earning an income on the sale of preventive and curative products to keep them motivated and active in the community.
External Link(s)
Citation
Björkman Nyqvist, Martina et al. 2014. "Entrepreneurial community health delivery in Uganda: a cluster-randomized controlled trial ." AEA RCT Registry. October 21. https://doi.org/10.1257/rct.530-1.0.
Primary study outcome is under-five child mortality rate. Secondary study outcomes include community-health worker visits, percentage of children sleeping under a treated mosquito bed net, percentage of households that treat water before drinking it, malaria and diarrhea morbidity among children under 5, malaria diarrhea cases promptly treated, percentage of children under 5 receiving Vitamin A supplementation, percentage of deliveries in health facilities, follow up visits after malaria or diarrhea cases, antenatal care visits, follow up visits and delivery, health knowledge.
Primary Outcomes (explanation)
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
A cluster-randomized controlled trial from 214 rural villages in 10 districts in Uganda. In treatment villages, Living Goods and BRAC Community Health Promoters conducted home visits, educated households on essential health behaviors and sold preventive and curative health products at 5-30% below prevailing retail prices over a three-year period (2011- 2013). On average, around 38 households were surveyed per village at the end of 2013, for a total sample size of roughly 8100 households.
Experimental Design Details
Randomization Method
Randomization done in office by computer
Randomization Unit
Community Health Worker potential catchment area (essentially village)
Was the treatment clustered?
Yes
Sample size: planned number of clusters
214 Community Health Worker (CHW) potential catchment areas (roughly villages)
Sample size: planned number of observations
8100
Sample size (or number of clusters) by treatment arms