CoChat
Sign Up
Cited by 44Global Maternal and Child HealthHealth Policy Implementation ScienceEvaluation and Performance Assessment

The DOI matches its Crossref record; 3 of the 3 references it cites were found in a registry or an index.

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

Open access
Mirzoev, Tolib, Etiaba, Enyi, Ebenso, Bassey, Uzochukwu, Benjamin, Manzano, Ana, Onwujekwe, Obinna, Huss, Reinhard, Ezumah, Nkoli, Hicks, Joseph P., Newell, James, Ensor, Timothy·2015·Implementation Science
DOI 10.1186/s13012-016-0443-1PMC PMC4896007
Open this paper in CoChat — free accountOpen PDF

Abstract

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.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s13012-016-0443-1

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 43

  1. UNICEF, WHO. Countdown to 2015. Maternal, Newborn and Child Survival. Accountability for Maternal, Newborn and Child Survival: An Update on Progress in Priority Countries. Geneva: World Health Organization; 2012.
  2. FMoH. Country Implementation Plan for Prioritized Life-Saving Commodities for Women and Children. Abuja: Federal Ministry of Health; 2013.
  3. FMoH. Saving newborn lives in Nigeria: Newborn health in the context of the Integrated Maternal, Newborn and Child Health Strategy. 2nd ed. Abuja: Federal Ministry of Health; Save the Children, Jhpiego; 2011.
  4. Onwujekwe O, Uzochukwu B, Ojukwu J, Dike N, Shu E. Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: An analysis of activities, costs and outcomes. Acta Trop. 2007;101(2):95–105. · DOI
  5. Green A, Thomas C, Newell JN, Baral SC, Byanjankar L. The contribution of volunteers to a successful community-orientated tuberculosis treatment centre in an urban setting in Nepal: A qualitative assessment of volunteers' roles and motivations. J Health Organ Manag. 2007;21:554–72. · DOI
  6. Onwujekwe O, Dike N, Ojukwu J, Uzochukwu B, Ezumah N, Shu E, et al. Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria. Malar J. 2006;5(1):117. · DOI
  7. Frehywot S, Mullan F, Payne P, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bull World Health Organ. 2010;88:364–70. · DOI · Paper page
  8. Bhutta ZA, Memon ZA, Soofi S, Salat MS, Cousens S, Martines J. Implementing community-based perinatal care: results from a pilot study in rural Pakistan. Bull World Health Organ. 2008;86:452–9. · DOI
  9. Gopalan SS, Mohanty S, Das A. Assessing community health workers’ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ Open 2012, 2(5). · DOI
  10. Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: WHO; 2007.
  11. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M et al: Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases (Review). Cochrane Database of Systematic Reviews 2010 2010(Issue 3). · DOI
  12. Jokhio AH, Winter HR, Cheng KK. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. N Engl J Med. 2005;352(20):2091–9. · DOI
  13. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13(1):847. · DOI
  14. Uzochukwu B, Obikeze E, Onwujekwe O, Onoka C, Griffiths U. Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT. Malar J. 2009;8(1):265. · DOI
  15. Lehmann U, Gilson L. Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes. Health Policy Plan. 2013;28(4):358–66. · DOI
  16. Gopalan SS, Mutasa R, Friedman J, Das A. Health sector demand-side financial incentives in low- and middle-income countries: A systematic review on demand- and supply-side effects. Soc Sci Med. 2014;100:72–83. · DOI
  17. Stame N. Theory-Based Evaluation and Types of Complexity. Evaluation. 2004;10(1):58–76. · DOI
  18. Pawson R, Tilley N. Realistic Evaluation. London: SAGE Publications; 1997.
  19. MRC. Developing and Evaluating Complex Interventions. London: Medical Research Council; 2008.
  20. Maluka S, Kamuzora P, SanSebastian M, Byskov J, Ndawi B, Olsen O, et al. Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation. Implement Sci. 2011;6(1):11. · DOI
  21. Prashanth NS, Marchal B, Hoeree T, Devadasan N, Macq J, Kegels G, Criel B. How does capacity building of health managers work? A realist evaluation study protocol. BMJ Open 2012, 2(2). · DOI
  22. Robert E, Ridde V, Marchal B, Fournier P. Protocol: a realist review of user fee exemption policies for health services in Africa. BMJ Open 2012, 2(1). · DOI
  23. Pawson R, Tilley N. Realist Evaluation. London: Sage Publications Limited; 1997.
  24. Wolff N. Randomised trials of socially complex interventions: promise or peril? J Health Serv Res Policy. 2001;6(2):123–6. · DOI
  25. Lindsay B. Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? J Adv Nurs. 2004;45(1):84–94. · DOI
  26. The-Presidency. Subsidy Reinvestment and Empowerment Programme (SURE-P): 2012 Annual Report. Abuja, Nigeria: Subsidy Reinvestment and Empowerment Programme (SURE-P); 2013.
  27. Ebenso B, Manzano A, Uzochukwu B, Huss R, Etiaba E, Ensor T, et al. Research Methodology. REVAMP project: ‘Determinants of effectiveness and sustainability of a novel community health workers programme in improving mother and child health in Nigeria’. Leeds, UK: University of Leeds; 2015.
  28. Pawson R, Manzano-Santaella A. A realist diagnostic workshop. Evaluation. 2012;18(2):176–91. · DOI
  29. Karki D, Mirzoev T, Green A, Newell J, Baral S. Costs of a successful public-private partnership for TB control in an urban setting in Nepal. BMC Public Health. 2007;7(1):84. · DOI
  30. Mirzoev T, Baral S, Karki D, Green A, Newell J. Community-based DOTS and family member DOTS for TB control in Nepal: costs and cost-effectiveness. Cost Eff Resour Alloc. 2008;6(1):20. · DOI
  31. Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, et al. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. BMJ. 2005;331(7525):1107. · DOI
  32. Ozawa S, Pongpirul K. 10 best resources on … mixed methods research in health systems. Health Policy Plan. 2014;29(3):323–7. · DOI
  33. Pommier J, Guevel M-R, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. BMC Public Health. 2010;10(1):43. · DOI
  34. Ricketts JA. The making of Jamaica’s ‘National Policy for Persons with Disabilities 2000’: macro, meso and micro factors. Disabil Soc. 2010;25(5):551–64. · DOI
  35. Hudson J, Lowe S. Understanding the Policy Process: Analysing Welfare Policy and Practice. 2nd ed. Bristol: Policy Press; 2009.
  36. NPHCDA. Programme Implementation Manual. Subsidy Reinvestment and Empowerment (SURE) Programme. Abuja, Nigeria: National Primary Health Care Development Agency; 2012.
  37. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analyzing Qualitative Data. New York: Routledge; 1994.
  38. Ramsay CR, Matowe L, Grilli R, Grimshaw JM, Thomas RE. Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care. 2003;19(4):613–23. · DOI · Paper page
  39. Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26 suppl 2:ii84–91.
  40. Mirzoev T, Lê G, Green A, Orgill M, Komba A, Esena RK, et al. Assessment of capacity for Health Policy and Systems Research and Analysis in seven African universities: results from the CHEPSAA project. Health Policy Plan. 2013. doi: 10.1093/heapol/czt065 . · DOI
  41. Mirzoev T, Omar M, Green A, Bird P, Lund C, Ofori-Atta A, et al. Research-policy partnerships - experiences of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. Health Res Policy Syst. 2012;10(1):30. · DOI
  42. COMDIS-HSD. ‘How To’ Guide On Research & Development: The Embedded Approach. Leeds, U.K: COMDIS-Health Service Delivery; 2012.
  43. Knowlton LW, Phillips CC. The Logic Model Guidebook: Better Strategies for Great Results. 2nd ed. Los Angeles: SAGE Publications; 2012.

Metadata

Authors
Mirzoev, T., Etiaba, E., Ebenso, B., Uzochukwu, B., Manzano, A., Onwujekwe, O., Huss, R., Ezumah, N., Hicks, J. P., Newell, J., & Ensor, T.
Affiliations
  • University of Leeds (GB)
  • University of Nigeria (NG)
Corresponding author
Etiaba, Enyi
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
11
Issue
1
Pages
83-83
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-016-0443-1
PMC
PMC4896007
OpenAlex
W2417567978
Cited by
44
References
3
Citations by year
2026: 2 · 2024: 2 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 12 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 1
FWCI
2.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
  • Wellcome Trust
  • University of Leeds
  • Medical Research Council (MR/M01472X/1)
  • Economic and Social Research Council
  • Faculty of Medicine and Health, University of Sydney
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
Keywords
community health workers, maternal and child health, realist evaluation, complex interventions, intervention sustainability, health system strengthening, program effectiveness, Anambra State, Nigeria
MeSH terms
Child Health, Maternal Health, Adult, Child, Child Health Services, Child, Preschool, Community Health Workers, Female, Humans, Infant, Male, Maternal Health Services, Nigeria, Research Design, Program Evaluation, Interrupted Time Series Analysis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review