Community health volunteer program functionality and performance in Madagascar : a synthesis of qualitative and quantitative assessments
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Community health volunteer program functionality and performance in Madagascar : a synthesis of qualitative and quantitative assessments

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      With approximately 3.5 million community health workers (CHWs) around the world, this cadre of frontline service providers represents an invaluable component of the health workforce, providing primary health care to their communities. The Madagascar Ministry of Public Health has scaled up to over 35,000 community health volunteers (CHVs) as of December 2012.

      For more than a decade, the U.S. Agency for International Development (USAID) Mission in Madagascar and other partners have invested in the development of a national CHV system to improve access to life-saving primary health care services for rural and remote populations. Presently, the USAID/Santénet2 Project (SN2) aims to increase access to and availability of community-based interventions in 800 communes concentrated in 16 regions of eastern and southern Madagascar. SN2 provides local capacity building, training, and supervision to mobilize over 12,000 CHVs to offer life- saving health services, including family planning counseling and short-acting contraceptives and maternal, newborn, and child health, including community case management for uncomplicated malaria, pneumonia, and diarrheal disease. In general, two CHVs have been elected by their communities from each of the 5,758 targeted villages located more than five kilometers from the nearest health center. MAHEFA, Santénet2’s sister project, is scaling up support for integrated community-based activities through an additional 3,500 CHVs in underserved western and northern Madagascar.

      USAID/Madagascar asked the USAID Health Care Improvement Project (HCI) and the Global Health Technical Assistance (GH Tech) Project, with technical assistance from the U.S. Centers for Disease Control and Prevention (CDC), to conduct qualitative and cross-sectional studies, respectively, of CHV program functionality and performance. The purpose of this report is to synthesize the findings from the two assessments. Complete findings are available in the respective assessment reports (Wiskow et al. 2013 and Agarwal et al. 2013).

      This synthesis report was prepared University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) and authored by Sarah Smith (EnCompass LLC), Aarti Agarwal (U.S. Centers for Disease Control and Prevention, CDC), Lauren Crigler (Independent Consultant (formerly Initiatives Inc.) Maria Gallo (CDC), Alyssa Finlay (CDC), Francis Antonio Homsi (John Snow Inc., formerly URC consultant), Emily Lanford (URC), Christiane Wiskow (Interational Labour Organisation, formerly URC consultant), and Tana Wuliji (URC). The development of the synthesis report was carried out under the USAID Health Care Improvement Project, which is managed by URC and made possible by the generous support of the American people through USAID.

      This evaluation was supported by the American people through the USAID Health Care Improvement Project (HCI), the President’s Malaria Initiative (PMI), and CDC. HCI is managed by University Research Co., LLC (URC) under the terms of Contract Number GHN-I-03-07-00003-00. URC’s subcontractors for HCI include EnCompass LLC, FHI 360, Health Research, Inc., Initiatives Inc., Institute for Healthcare Improvement, and Johns Hopkins University Center for Communication Programs. For more information on HCI’s work, please visit or write

      Recommended citation: Smith SC, Agarwal A, Crigler L, Gallo M, Finlay A, Homsi FA, Lanford E, Wiskow C, Wuliji T. 2013. Community health volunteer program functionality and performance in Madagascar: A synthesis of qualitative and quantitative assessments. Research and Evaluation Report. Published by the USAID Health Care Improvement Project. Chevy Chase, MD: University Research Co., LLC (URC).


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