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The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project

Center for Health Policy, Health Inequalities Program, and Terry Sanford Institute of Public Policy, Duke University, Durham NC USA, bpence{at}aya.yale.edu

Philomena Nyarko

Population Council - Ghana Office, Accra, Ghana

James F. Phillips

Policy Research Division, Population Council, New York, NY, USA

Cornelius Debpuur

Navrongo Health Research Centre, Navrongo, Ghana

Background: Despite effective treatments and preventive measures for the major causes of child illness and death in less wealthy nations, child mortality remains high in resource-poor settings due in part to ineffective health service delivery models. Methods: The Navrongo Community Health and Family Planning Project is a longitudinal community trial of alternative organizational strategies for health service delivery in a rural, impoverished area of Ghana. In one area, nurses are placed in communities with doorstep visitation and service responsibilities. A second area includes training of a local health volunteer and community involvement in health delivery. A third area combines both strategies. Under-five mortality rates were calculated and Poisson regression was used to adjust for potential confounding characteristics. Results: In areas with village-based community nurse services, under-five child mortality fell by 14% during five years of program implementation compared with before the intervention, with reductions in infant (5%), early child (18%), and late child (39%) mortality. The volunteer intervention was associated with a 14% increase in mortality, primarily driven by a 135% increase in early child mortality. Areas with both nurses and volunteers saw an 8% increase, with small increases in all age groups. Mortality in a comparison area with standard Ministry of Health services fell by 4% during the same time period. Conclusions: These results suggest that convenient, accessible professional nursing care can reduce child mortality in impoverished African settings. However, they do not demonstrate a beneficial effect of community volunteers and suggest a possible negative impact on children's survival.

Key Words: Child mortality • Sub-Saharan Africa • Health service delivery • Community health volunteers • Field trials • Demographic surveillance • Bamako Initiative

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