Study protocol: Realist evaluation of effectiveness and sustainability of a community health workers programme in improving maternal and child health in Nigeria

  • Implementation Science, Volume 11, No. 1, Year 2016

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Study Justification:
– Improved maternal and child health outcomes are a global priority, especially in sub-Saharan African countries like Nigeria.
– Evidence suggests that Community Health Workers (CHWs) can effectively improve access to health services and MCH outcomes.
– This study aims to evaluate the effectiveness and sustainability of a Nigerian CHW scheme.
Study Highlights:
– The study will use a realist evaluation approach, which considers the context, mechanisms, and outcomes of the intervention.
– It will be conducted in Anambra state, Nigeria, and will draw upon health economics, social sciences, and statistics.
– Data collection methods will include interviews, focus group discussions, document reviews, quantitative data analysis, and surveys.
– The impact of the CHW program on output and outcome indicators will be assessed using interrupted time-series analysis.
– Ethics approvals have been obtained from the University of Leeds and the University of Nigeria.
Study Recommendations:
– The study will provide valuable insights into health systems strengthening, specifically in Anambra state and potentially across Nigeria.
– Researchers can learn from the robust methodologies used in this study to assess complex health system interventions.
– Policymakers and practitioners can use the study findings to inform policies and practices related to CHW programs.
Key Role Players:
– Researchers from various disciplines (health economics, social sciences, statistics)
– Community Health Workers
– Managers of the CHW program
– Service providers
– Service users (mothers and children)
– University of Leeds and University of Nigeria (ethics approvals)
Cost Items for Planning Recommendations:
– Research staff salaries
– Travel and accommodation expenses for data collection
– Data analysis software and equipment
– Printing and dissemination of study findings
– Training and capacity building for CHWs and other stakeholders
– Administrative and logistical support

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study protocol outlines a comprehensive methodology for evaluating the effectiveness and sustainability of a community health workers programme in Nigeria. The use of a realist evaluation approach and the inclusion of multidisciplinary and mixed-method research methods are strengths. However, the abstract does not provide specific details about the sample size, data collection methods, or statistical analysis plan, which could be improved to enhance the strength of the evidence.

Background: Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority, particularly for sub-Saharan African countries such as Nigeria. Evidence suggests that the use of Community Health Workers (CHWs) can be effective in broadening access to, and coverage of, health services and improving MCH outcomes in such countries. Methods/design: In this paper, we report the methodology for a 5-year study which aims to evaluate the context, processes, outcomes and longer-term sustainability of a Nigerian CHW scheme. Evaluation of complex interventions requires a comprehensive understanding of intervention context, mechanisms and outcomes. The multidisciplinary and mixed-method realist approach will facilitate such evaluation. A favourable policy environment within which the study is conducted will ensure the successful uptake of results into policy and practice. A realist evaluation provides an overall methodological framework for this multidisciplinary and mixed methods research, which will be undertaken in Anambra state. The study will draw upon health economics, social sciences and statistics. The study comprises three steps: (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. Specific methods for data collection will include in-depth interviews and focus group discussions with purposefully identified key stakeholders (managers, service providers and service users), document reviews, analyses of quantitative data from the CHW programme and health information system, and a small-scale survey. The impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. Ethics approvals for this study were obtained from the University of Leeds and the University of Nigeria. Discussion: This study will provide a timely and important contribution to health systems strengthening specifically within Anambra state in southeast Nigeria but also more widely across Nigeria. This paper should be of interest to researchers who are interested in adapting and applying robust methodologies for assessing complex health system interventions. The paper will also be useful to policymakers and practitioners who are interested in commissioning and engaging in such complex evaluations to inform policies and practices.

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The study protocol mentioned aims to evaluate the effectiveness and sustainability of a Community Health Workers (CHWs) program in improving maternal and child health in Nigeria. The study will utilize a realist evaluation approach, which involves understanding the intervention context, mechanisms, and outcomes. The evaluation will be conducted in Anambra state and will involve data collection through in-depth interviews, focus group discussions, document reviews, analysis of quantitative data, and a small-scale survey. The impact of the program will be assessed through an interrupted time-series analysis. The study is expected to contribute to health systems strengthening in Anambra state and potentially across Nigeria. Researchers interested in assessing complex health system interventions and policymakers/practitioners interested in commissioning and engaging in such evaluations may find this study protocol useful.
AI Innovations Description
The recommendation to improve access to maternal health based on the study protocol is the implementation and evaluation of a Community Health Workers (CHWs) program in Nigeria. CHWs can play a crucial role in broadening access to health services and improving maternal and child health outcomes, particularly in sub-Saharan African countries like Nigeria.

The study protocol outlines a 5-year evaluation of a CHW scheme in Anambra state, Nigeria. The evaluation will assess the context, processes, outcomes, and long-term sustainability of the program. The evaluation will utilize a multidisciplinary and mixed-method realist approach, combining health economics, social sciences, and statistics.

Data collection methods will include in-depth interviews, focus group discussions, document reviews, analysis of quantitative data from the CHW program and health information system, and a small-scale survey. The impact of the program on key output and outcome indicators will be assessed through an interrupted time-series analysis.

The study aims to provide valuable insights into the effectiveness and sustainability of the CHW program in Anambra state and potentially inform health systems strengthening efforts across Nigeria. The findings will be relevant to researchers interested in assessing complex health system interventions and policymakers and practitioners involved in commissioning and engaging in such evaluations to inform policies and practices.
AI Innovations Methodology
Based on the provided description, the study protocol aims to evaluate the effectiveness and sustainability of a Community Health Workers (CHWs) program in improving maternal and child health in Nigeria. The methodology for this study follows a realist evaluation approach, which involves understanding the intervention context, mechanisms, and outcomes. Here is a brief description of the methodology:

1. Initial Theory Development: The study will begin by developing an initial theory that explains how and why the CHW program is expected to improve maternal and child health outcomes. This theory will be based on existing evidence, literature reviews, and consultations with key stakeholders.

2. Theory Validation: The initial theory will be validated through data collection methods such as in-depth interviews and focus group discussions with key stakeholders, including managers, service providers, and service users. These qualitative data will help identify the contextual factors and mechanisms that influence the program’s effectiveness.

3. Theory Refinement and Lessons Learned: Based on the findings from the validation phase, the initial theory will be refined and further developed. Lessons learned from the implementation of the CHW program will be identified to inform future improvements and adaptations.

Data Collection Methods:
– In-depth interviews and focus group discussions: These qualitative methods will provide insights into the perspectives and experiences of key stakeholders involved in the CHW program.
– Document reviews: Existing program documents, reports, and policies will be reviewed to understand the program’s context and implementation processes.
– Quantitative data analysis: Data from the CHW program and health information system will be analyzed to assess the impact of the program on key output and outcome indicators. An interrupted time-series analysis (ITS) will be conducted using monthly quantitative data.

Ethics Approvals:
Ethics approvals for this study have been obtained from the University of Leeds and the University of Nigeria, ensuring that the research is conducted ethically and with the necessary permissions.

Overall, this study aims to provide valuable insights into the effectiveness and sustainability of the CHW program in improving maternal and child health outcomes in Nigeria, specifically within Anambra state. The findings will contribute to health systems strengthening efforts and inform policies and practices in the field of maternal and child health.


Statistics:
Citations: 29
Identifiers:
DOI: 10.1186/S13012-016-0443-1
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Workforce
Study Countries:
Nigeria
Study Design:
Cross Sectional Study, Exploratory Study, Grounded Theory, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
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