I was interested to see this paper in the current issue of the WHO Bulletin (February 2017). The full text is freely available here:


The paper describes itself as ‘implementation research’. However, my understanding of implementation research (from the discussion we held on HIFA last year) is that implementation research starts by identifying and then exploring one or more research questions that relate to *how* better to implement a proven policy or practice. The current paper is perhaps better described as a health systems intervention (without explicit research question) with before-and-after measurement of health outcomes. Despite several weeks of discussion in 2016 of what is and what isn’t Implementation Research, I am not sure I am yet clear. As we discussed last year, all of us – and especially funders and policymakers – need to be crystal-clear what implementation research is if we are to expect it to be properly supported.

I hope perhaps one of the authors, or IR experts on HIFA, can clarify.

CITATION: Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

Peter W Luckow, Avi Kenny, Emily White, Madeleine Ballard, Lorenzo Dorr, Kirby Erlandson, Benjamin Grant, Alice Johnson, Breanna Lorenzen, Subarna Mukherjee, E John Ly, Abigail McDaniel, Netus Nowine, Vidiya Sathananthan, Gerald A Sechler, John D Kraemer, Mark J Siedner & Rajesh Panjabi

Bulletin of the World Health Organization 2017;95:113-120. doi: http://dx.doi.org/10.2471/BLT.16.175513


Objective: To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.

Methods: The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.

Findings: Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.

Conclusion: We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

Best wishes, Neil

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