Topical Area: Global Nutrition
Frontline health workers (FLW) are needed for delivering interventions at scale to reduce maternal and child undernutrition, but low- and middle-income countries often face inadequate FLW performance. This study aimed to test whether and how intervention design elements such as training, supervision, and mass media improved FLW performance in delivering nutrition services.
Methods : Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh and Vietnam. FLWs in A&T intensive (A&T-I) areas received specialized IYCF training, job aids, and regular supportive supervision. Those in A&T non-intensive (A&T-NI) areas received standard government training and supervision; there was mass media exposure in both areas. Multiple regression was used to test differences in exposure to intervention design elements and performance outcomes between the two intervention areas. Structural equation modeling was conducted to examine the paths from exposure to performance outcomes measured at the FLW and end-user levels.
Results : Compared to FLWs in A&T-NI areas, those in A&T-I areas had higher scores in training (by 1.3-3.6 out of 10 points), supportive supervision (by 0.3-3.5 points), and mass media exposure (by 0.3-3.5 points). These intervention design elements were significantly associated with FLW knowledge and motivation, which in turn improved service delivery. FLW-level performance outcomes contributed to improving end-user-level outcomes such as higher service utilization (β= 0.12-1.04 in Bangladesh and 0.11-0.96 in Vietnam) and maternal knowledge (β= 0.12- 0.17 in Bangladesh and 0.04-0.21 in Vietnam).
Conclusions : Training, supervision, and mass media exposure can contribute to improved FLW service delivery by enhancing knowledge and motivation, which in turn positively influence mother’s service utilization and IYCF knowledge. These elements and mechanisms should be considered by policy makers and program implementers when designing interventions or reinforcing the work context of FLWs.
Funding Sources : Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.