Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST)

Abstract

Background: Evidence has been accumulating that community health workers (CHWs) providing evidence-based interventions as part of community-based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale-up CHW programs still remain modest.

Methods: We used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence-based interventions that CHWs can deliver in these high-burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country-level results by region and by all 73 high-burden countries combined. We also estimated which specific interventions would save the most lives.

Findings: LiST estimates that a total of 3.0 (sensitivity bounds 1.8-4.0), 4.9 (3.1-6.3) and 6.9 (3.7-8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia.

Conclusions: Scaling up CHW programming to increase population-level coverage of life-saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could be achieved by expanding coverage of evidence-based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded.

Figure 1

Evidence–based interventions that can be provided by community health workers that have been included in the Lives Saved Tool calculations.

Figure 2

Under–five mortality rate for 73 Countdown countries (weighted by number of births in each country) with intervention scale–up by community health workers to reach population coverage levels of 50%, 70%, or 90%.

Figure 3

Overall mortality impact (lives saved and stillbirths prevented) by WHO region for 2015–2020 with intervention scale–up by CHWs to reach population coverage of 50%, 70%, and 90%.

Figure 4

Lives saved and stillbirths prevented by community–based interventions provided by CHWs to reach population coverage of 90% by 2020. The number of maternal lives saved is not shown because the scale of the number is too small to be displayed on the same graph.