A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation

Am J Public Health. 2018 Sep;108(9):1252-1259. doi: 10.2105/AJPH.2018.304555. Epub 2018 Jul 19.


Objectives: To assess a community health worker (CHW) program's impact on childhood illness treatment in rural Liberia.

Methods: We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March-April 2015) and follow-up (April-June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider.

Results: We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI] = 36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI = 42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI = -0.7, 45.5).

Conclusions: Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia's new National Community Health Assistant Program.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Health*
  • Child, Preschool
  • Community Health Services
  • Community Health Workers*
  • Diarrhea / therapy
  • Female
  • Fever / therapy
  • Health Care Surveys
  • Health Services Accessibility*
  • Humans
  • Infant
  • Liberia
  • Professional Role*
  • Program Evaluation
  • Respiratory Tract Infections
  • Rural Population*