Tanzania is on target to achieve the Millennium Development Goal (MDG) of reducing childhood mortality by two thirds by 2015. The country’s remarkable success in this area followed improvements in its health system, including innovations such as the Tanzania Essential Health Interventions Project (TEHIP). By giving local districts the tools to make evidence-based decisions about the allocation of healthcare resources, TEHIP enabled districts to provide services that met their burden of disease patterns. These efforts led to dramatic declines in child mortality in two rural districts and TEHIP was later scaled up to 120 districts. Tanzania also introduced Integrated Management of Childhood Illness (IMCI) which was shown to have reduced child mortality by 13% and has been scaled up nationwide.
Despite these successes, the health system remains fragile and there has been little progress is reducing newborn and maternal mortality – a risk to the achievement of MDG4 and making achievement of MDG5 by 2015 in doubt. Access, quality, and cost of primary healthcare remain a challenge. In Tanzania the provision of community-based healthcare has been significantly hindered by the lack of a trained healthcare workforce and other capabilities that forge critical connections between local providers and the populations they serve. Despite the fact that the majority of Tanzanians live within five kilometers of a health facility, access remains a problem and outreach to communities and households is limited.
The research aims to therefore test a community health worker model for providing community-based health services and emergency referral to strengthen these connections between communities and health facilities and determine impact on child mortality, particularly newborn mortality. While it is expected to also have impact on maternal mortality, due to the size of the population under study and the duration of the project, it is not likely that the effect size will be significant. The study will also assist the Tanzanian Ministry of Health and Social Welfare (MOHSW) in testing and costing a model for recruitment, training and deployment of Community Health Agents (CHAs) as envisioned in the Primary Health Service Development Program (PHSDP). This intervention, to be conducted in three rural districts where community-based healthcare and outreach services have not been developed and health and demographic surveillance systems will also allow evaluation of impact on mortality, will be known as CONNECT. A two celled trial will test the proposition that introducing a community health worker cadre and providing them with the necessary health system supports will accelerate MDG4 and MDG5.