Contribution of Community Health Workers on Family Planning Uptake in Mozambique: A Provincial-Level Segmented Time-Series Analysis from 2013-2017

Thesis (Master's)--University of Washington, 2019University of Washington Abstract Contribution of Community Health Workers on Family Planning Uptake in Mozambique: A Provincial-Level Segmented Time-Series Analysis from 2013-2017 Aneth Antonio Dinis Chair of the Supervisory Committee: Kenny Sherr Global Health Department Background: One of the Sustainable Development Goals is to guarantee universal access to family planning services by 2030, and to integrate reproductive health services, including family planning, in national strategies. In 2016, family planning services were formally expanded and deivered at the community level by the Agentes Polivalentes Elementares (APEs ) – a cadre of formal community health workers from the Ministry of Health. We aim to evaluate the trend of the new users of these services between 2013-2017 and assess the effectiveness of the strategy of provision of family planning services by the APEs in 2017 at the provincial level in Mozambique. Methods: To examine the trend of new users of family planning, we conducted a quasi-experimental, provincial-level interrupted time series analysis of the monthly ratio of new users of FP to the population of women of fertile age between January 2013 and December 2017. The relative contribution of the APE program to FP services was assessed using a negative binomial generalized linear mixed model (GLMM) with province-level random-effects and random-slopes for time pre-intervention and time post-intervention. Results: Overall, the relative monthly increase of the ratio of new users of FP was 1% [1.01(1.01-1.02)] in the period pre-intervention versus 6% [1.06 (1.03-1.09)] in the period post-intervention. The immediate level change post-2016 was not statistically significant [0.91 (0.78-1.07)]. Five provinces had a positive trend of a 2% monthly increase in the ratio of new users of FP in the pre-intervention period and in the period post-intervention the slopes varied between 4% and 14% monthly increase. Conclusion: There was a positive trend in the monthly number of new users of FP services between 2013-2017 and this trend was larger in the period post-2016, suggesting that the services provided by the APEs had a positive influence on the overall number of new users of FP services across Mozambique