Identifying Programmatic Factors that Increase Likelihood of Health Facility Delivery: Results from a Community Health Worker Program in Zanzibar

Matern Child Health J. 2022 Sep;26(9):1840-1853. doi: 10.1007/s10995-022-03432-3. Epub 2022 Apr 6.


Introduction: Community health worker (CHW) interventions have been utilized to address barriers that prevent pregnant women from delivering in health facilities in low- and middle-income countries (LMICs). The objective of this research was to assess the programmatic factors that increase the likelihood of health facility delivery within a large digital health-supported CHW program in Zanzibar, Tanzania.

Methods: This study included 36,693 women who were enrolled in the Safer Deliveries program with a live birth between January 1, 2017 and July 31, 2019. We assessed whether long-term enrollment, recency of CHW pregnancy visit prior to delivery, and number of routine home pregnancy visits were associated with an increased likelihood of health facility delivery compared to home delivery. We used Chi-squared tests to assess bivariate relationships and performed logistic regression analyses to assess the association between each programmatic variable and health facility delivery, adjusting for relevant confounders.

Results: We found that long-term enrollment was significantly associated with increased likelihood of health facility delivery, with the strongest relationship among women with a previous home delivery (OR = 1.4, 95%CI [1.0,1.7]). Among first-time mothers, two or more pregnancy visits by a CHW was positively associated with health facility delivery (OR = 1.8, 95%CI [1.2, 2.7]). Recent pregnancy visit by a CHW was positively associated with health facility delivery, but was not significant at the α = 0.05 level.

Discussion: In this program, we found evidence that at least two routine home pregnancy visits, longer length of enrollment in the program, and recency of home visit to the delivery date were strategies to increase health facility delivery rates among enrolled mothers. Maternal and child health programs should undertake similar evaluations to improve program delivery.

Keywords: Behavior change; Community health worker; Digital health; Health facility delivery; Maternal health; Zanzibar.

MeSH terms

  • Child
  • Community Health Workers*
  • Female
  • Health Facilities
  • Home Childbirth*
  • Humans
  • Pregnancy
  • Pregnant Women
  • Tanzania