Community Health Promoters to Prevent Child Mortality in Uganda

Updated: Jul 22, 2020
Evidence Rating:
Near Top Tier

Highlights

  • Program:

    A program in rural Uganda that aims to improve maternal and child health by recruiting and training female community members as micro-entrepreneur Community Health Promoters (CHPs). CHPs provide households that have children under five years old with home visits, health education, and basic medical advice; and sell the households certain health products at a discount (e.g., insecticide-treated bednets to prevent malaria, and water purification tablets).  CHPs also receive small financial incentives to visit newborns within 48 hours of their birth. The study does not report the program’s cost per household.

  • Evaluation Methods:

    A well-conducted randomized controlled trial (RCT)[1] in which a sample of 214 rural villages in Uganda were assigned to either a treatment group served by a CHP or a control group that was not. The villages contained a total of 50,617 households at the study’s inception. Child mortality outcomes were collected via survey from a random subsample of 8,119 households three years after random assignment.

  • Key Findings:

    Over the three-year follow-up period, the program (i) reduced child mortality by 31% (for every 1,000 children under the age of five, 13.5 children died each year in the treatment villages compared to 19.4 children in the control villages[2]); and (ii) reduced infant mortality by 36% (for every 1,000 infants under the age of one, 33.8 infants died each year in the treatment villages compared to 52.7 infants in the control villages).[3] Both of these effects were statistically significant.

  • Other:

    The study was conducted in a single country – Uganda. As a next step in the research, a replication trial in another country would be desirable to hopefully confirm these results and establish that they generalize to other nations with similar rates of infant and child mortality.

Arnold Ventures’ Evidence-Based Policy team continuously monitors and reviews the evaluation literature in international development, as we do in domestic U.S. social policy, to identify programs with credible RCT evidence of important effects on people’s lives. However, given our organization’s focus on U.S. social policy, we only provide “highlights” of our evidence reviews for most international development programs (as shown above), without the accompanying detailed PDF summaries that we provide for U.S. programs.

References

[1] For example, the study had successful random assignment (as evidenced by highly similar treatment and control groups), minimal sample attrition, blinding of surveyors collecting outcome data as to whether households were in the treatment or control group, and an analysis that appropriately accounted for the fact that villages rather than individual households were randomly assigned.

[2]   These death rates were measured for children during the portion of their first five years of life that overlapped with the study’s three-year follow-up period. The study defines this period of time as the “exposure” period for children age 0-5. Thus, a precise description of the impact estimate is that the death rate was 13.5 deaths per 1000 years of exposure in the treatment group, versus 19.4 deaths per 1000 years of exposure in the control group.

[3] These death rates were measured for infants during the portion of their first year of life that overlapped with the study’s three-year follow-up period. The study defines this period of time as the “exposure” period for infants age 0-1. Thus, a precise description of the impact estimate is that the death rate was 33.8 infant deaths per 1000 years of exposure in the treatment group, versus 52.7 infant deaths per 1000 years of exposure in the control group.


Nyqvist, M.B., Guariso, A., Svensson, J., Yanagizawa-Drott, D. (2019). “Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda.” American Economic Journal: Applied Economics, 11(3): 155-192.

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