Village Health Workers Improve Child Health: The Jamkhed, India Experience

OBJECTIVE: To assess the effect of the three-decade old Comprehensive Rural Health Project (CRHP) on morbidity, mortality, immunization rates, and health care utilization among children under 5 years of age in Jamkhed, Central India. METHODS: We conducted a cross-sectional survey of a stratified, cluster sample of 879 children (under-fives) in 15 Jamkhed villages served by CRHP. CRHP has a three-tiered primary health care model that comprises a tertiary care facility, a mobile health program supporting 30 subcenters, and community-based health workers. FINDINGS: We found a prevalence of diarrhea [6.4%, 95% CI: 4.0%-8.8%], measles [2.3%, 95% CI: 0%-5.6%], tuberculosis [0.3%, 95% CI: 0%-0.8%], bronchopneumonia [0.1%, 95% CI: 0-0.3%], and no cases of poliomyelitis, pertussis, diphtheria, and tetanus among under-fives. Malnutrition (using WHO criteria) was less evident in infants [mean Z-score: -0.8] compared to children aged 1-5 years [mean Z-scores: -1.6 to -1.8]. The child International Journal of Global Health and Health Disparities 41 mortality rate of 4.6 deaths per 1,000 live births [95% CI: 0 to 9 deaths per 1,000] was 10-20 fold lower than corresponding state (58.1) and national (103.7) figures. The infant diarrhea prevalence rate of 6.4% [95% CI 4.0% to 8.8%] was also substantially lower than state (25.4%) and national data (19.6%). There was ≥ 99% immunization coverage for DPT3/OPV3 and measles after the child\u27s first year. CONCLUSION: These data document the effectiveness of village health workers in improving child health. If confirmed by other studies, these findings call for even greater allocation of primary health care resources to train, supervise and use community health workers