Evidence on the Impact of Community Health Workers on Health Indicators in Congo: A Quasi-Experimental Temporal Study

Introduction: Community Health Workers (CHWs) is considered a key strategy to improve access to primary health care in resource-limited countries. This study aimed to assess the impact of CHWs on district health indicators in Congo. Methods: Study used a pre-post design. Health indicators from six rural health districts were compared for the periods of 24 months before and 24 months after introduction of CHWs. Data were extracted from the national District Health Information System (DIHS2) platform. Indicator values were compared in terms of absolute differences, expressed in percentage points, using repeated measures analysis of variance (ANOVA). Mixed linear regression was used to assess the relationships between CHWs and health indicators. Statistical analyses were performed using R software (lme4 package). Results: CHWs led to a significant improvement for following indicators ( percentage points: pp, p-value): CPN1 (+12.6 pp, p Conclusion: Study shows a positive impact of CHWs on several health indicators in health districts. Results are in favor of strengthening community health programs as levers to strengthen health indicators in health districts with a low ratio of health workers, to increase the chances of moving towards achieving the objectives of universal health coverage. In this regard, challenges related to governance and financing of national community health programs, as well as the training and motivation of CHWs, must be addressed in order to stimulate and maintain the benefits of care in local communities.