Evaluations & Reviews

With the overall aim of identifying community health worker (CHW) programs with positive impact on Millennium Development Goals (MDGs) related to health or otherwise, this global systematic review was undertaken of such interventions, as well as eight in-depth country case studies in Sub-Saharan Africa (Ethiopia Mozambique and Uganda), South East Asia (Bangladesh, Pakistan and Thailand) and Latin America (Brazil and Haiti).

Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices, and contextual mediators on these effects. [from abstract]

The objective of this literature review is to assess the effectiveness of community-based intervention packages of improved maternal care during pregnancy, delivery and postpartum, as well as care of the newborn, in preventing maternal morbidity and mortality and improving neonatal outcomes. [adapted from summary]

This assessment evaluates a health service mangement systems project undertaken in the Aceh province after the 2004 earthquakea and tsunami. The project implemented information systems for hospitals and primary care, and this evaluation details the lessons learned and challenges from health workers as well as the short term impact the systems have had on health service delivery processes.

This study evaluates the health impacts of a volunteer intervention addressing health worker shortage in remote mountainous communities of Vietnam. [from abstract]

Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. [from summary]

This report presents the results and conclusions of a case study conducted within the broader context of assessing resource flows into the development of human resources for health (HRH). Using the example of Mozambique, it examines whether the emerging policy focus on aid effectiveness responds to the evident needs in scaling up HRH. [from publisher]

The purpose of the present paper is to shed light on the treatment of health workforce issues under health sector investments by the World Bank and its African country borrowers and their project agencies. [from introduction]

The objective of this paper is to assess the impact of Oportunidades (Human Development Program)on skilled attendance at delivery in rural areas through the application of a variety of evaluation techniques, taking advantage of the experimental design implemented for the evaluation of this program in rural areas. [from introduction]

This paper explores a long-standing strategy to attract and retain doctors in rural areas in Chile: the Rural Practitioner Programme. The objectives of the study are to describe this programme for rural doctors (médicos generales de zona), to characterize its multidimensional set of incentives and to carry out a preliminary evaluation of programme outcomes. [from introduction]

This study compiled information on the numbers and types of health worker compulsory service programs in WHO countries.

The objective of this study was to model the relative effectiveness of different policy interventions on the recruitment of nurses to rural areas in three different countries. [from introduction]

This paper examines the extent to which health workers differ in their willingness to work in rural areas and the reasons for these differences, based on the data collected in Rwanda analysed individually and in combination with data from Ethiopia. [from introduction]

Evidence indicates that lack of communication and collaboration between health providers can seriously harm patients. To solve these issues, we need to change how health services are delivered and how providers interact with each other. This project examined interprofessional interventions and how they impact the health workforce and workplace quality. [adapted from summary]

Increasing interest has been shown in the use of lay health workers (LHWs) for the delivery of a wide range of maternal and child health (MCH) services in low and middle income countries. However, robust evidence of the effects of LHW interventions in improving MCH delivery is limited. The objective of this document is to review evidence from randomized controlled trials on the effects of LHW interventions in improving MCH and addressing key high burden diseases. [adapted from abstract]

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. [from abstract]

This study uses data from the Demographic and Health Surveys and AIDS Indicators Surveys from 12 countries in Africa, Asia, and Latin America and the Caribbean to explore use of HIV testing and sexually transimitted infections care from the private for-profit sector, and its association with household wealth status. [adapted from abstract]

In 2008, Malawi piloted the distribution of depo-medroxy progesterone acetate (DMPA), an injectable contraceptive, to the community by Health Surveillance Assistants. This report presents lessons learned during the initial implementation, from gaining stakeholder buy-in to curriculum development, and the initial three months after the training and implementation roll-out. [from abstract]

This study focused on a trained health workforce in Northern Uganda. The retention of specifically-trained staff 12-15 months after attending training was examined, as was the relevance and usefulness of the training as perceived by the health workers. [from abstract]

The purpose of this study was to conduct a comparative evaluation of two internet-based continuing medical education delivery formats and the effect on satisfaction, knowledge and confidence outcomes. [from abstract]

This report documents the efficiency of the Learning for Performance approach in the implementation of new pre-service reproductive health/family planning and child health training modules aimed at local health technicians working in Northern Mali. [adapted from introduction]

The Capacity Project used the Learning for Performance (LFP) approach to develop the family planning (FP), HIV/AIDS and gender components included in the competency-based A1 nursing and midwifery pre-service curricula. LFP was also used to adapt the Rwanda national FP curriculum to an on-the-job training approach. This study documents the implementation of the and the lessons learned from its application in preservice education and in-service training in Rwanda. [from summary]

In direct response to the country’s human resources for health needs, the Capacity Project helped to develop the capacity of the district hospital clinical workforce to expand access to a full range of quality family planning methods through a pilot vasectomy in-service training program for physicians and nurses at two district hospitals. [adapted from introduction]

This evaluation presents the results of a Kenyan emergency hiring plan (EHP) to quickly hire, train and deploy workers to high-need areas. The report presents the tracked hiring, training and deployment of all new hires compared to identified gaps. It also contains facility statistics and new hire and coworker feedback in a sample of ten facilities at baseline and every six months for period of three years. [adapted from summary]

The Capacity Project worked to strengthen HRIS in several low-resource countries to assist decision-makers and human resources managers in identifying and responding to critical gaps in HRH. The findings and recommendations in this report cover the Capacity Project’s implementation of HRIS in Swaziland, Rwanda and Uganda. [from summary]

The objective of this document was to conduct a systematic review of the evidence on characteristics of community health workers (CHWs) and CHW interventions, outcomes of such interventions, costs and cost-effectiveness of CHW interventions, and characteristics of CHW training. [from abstract]

This report outlines a rapid descriptive assessment to gain an initial understanding of the management workforce for service delivery in Ethipia, Ghana and Tanzania and to test selected criteria for assessing managers as part of the health workforce. [adapted from summary]

This evaluation focused on the relevance of the health sector strategic and implementation plans to the achievement of the the MDGs in health; the extent of progress and achievements in the health sector reform process; achievements in improving acces, service quality and health outcomes; and changes in partnership activities. Section 8 examines how effectively the health sector has dealt with important issues in HRH during the evaluation period. [adapted from author]

The goal of this paper is twofold. It uses the recent experience of Brazil’s Family Health Program to assess the effectiveness of community based health interventions as instruments for improvements in health conditions in less developed areas. It also evaluates whether the health improvements associated with the program also brought about the changes in household behavior predicted by economic theory and noticed in other contexts. [adapted from author]

Because of increased demand for injectable contraception coupled with an overburdened clinical health system, countries, particularly in sub-Saharan Africa, have recently expanded the use of non-clinic based approaches in providing this method. In this first review of the available evidence of these efforts, this consultation concluded that there is sufficient evidence to support expansion of community-based health workers providing progestin-only injectable contraceptives, especially DMPA. [from author]