Project – Assessing the Role of Community Health Workers in Reducing Maternal and Child Mortality in Ogene Zaria

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Maternal and child mortality remain major public health concerns in many low‑ and middle‑income countries, including Nigeria. Globally, about 295,000 women died from pregnancy‑related causes in 2017, with Sub‑Saharan Africa accounting for approximately two‑thirds of these deaths (World Health Organization [WHO], 2019). Child mortality remains equally troubling; in 2020, an estimated 5 million children under age five died, with preventable causes such as pneumonia, malaria, and complications of preterm birth leading the trends (UNICEF, 2021). In Nigeria, maternal mortality ratios and under‑five mortality rates are among the highest in the world, reflecting systemic gaps in access to quality healthcare, skilled birth attendance, and effective community outreach (National Population Commission & ICF, 2019).

Community Health Workers (CHWs) have emerged as vital frontline agents in bridging healthcare access gaps, especially in underserved communities. CHWs are typically community‑based volunteers or paraprofessionals trained to deliver basic health services, track pregnancies, educate families on preventive health practices, and link individuals with formal health systems (Lehmann & Sanders, 2007). Many studies show that CHWs contribute significantly to improvements in maternal and child health outcomes by promoting antenatal care attendance, facilitating facility‑based deliveries, identifying and referring complications early, ensuring immunization uptake, and encouraging appropriate neonatal care practices (Haines et al., 2007; Perry et al., 2016).

In Ogene Zaria, a peri‑urban and rural area in Kaduna State, maternal and child health indicators have historically lagged behind national targets. Limited infrastructure, socioeconomic inequalities, cultural barriers, and shortages of skilled health professionals have constrained healthcare delivery. In response, the State Ministry of Health, in collaboration with local government authorities and non‑governmental organizations (NGOs), has deployed CHWs as part of community‑oriented primary care strategies. These CHWs conduct home visits, facilitate health education sessions, provide basic interventions such as distributing insecticide‑treated nets, and encourage utilization of antenatal and postnatal services.

Despite these interventions, maternal and child mortality rates in Ogene Zaria remain higher than desired, raising questions about the effectiveness, coverage, and sustainability of CHW initiatives. Research suggests that the impact of CHWs can be influenced by factors such as training quality, supervision, community acceptance, supply of essential tools and commodities, and integration with existing health systems (Bhutta et al., 2010). However, there is limited empirical evidence detailing how CHWs operating in Ogene Zaria specifically affect maternal and child mortality outcomes, and what barriers or facilitators shape their contribution.

Assessing the role of CHWs in this context is necessary to understand not only whether these workers are achieving intended health outcomes but also how gaps can be addressed to accelerate progress toward national and global mortality reduction goals (SDG 3). This study seeks to fill that gap by evaluating the role and effectiveness of CHWs in reducing maternal and child mortality in Ogene Zaria, offering insights for policymakers, health system planners, and community stakeholders.

1.2 Statement of the Problem

Despite significant investments in community health strategies across Nigeria, maternal and child mortality remain stubbornly high in many localities, including Ogene Zaria. According to local health records and community health reports, maternal deaths due to complications such as hemorrhage, hypertensive disorders, and sepsis continue to occur, while preventable child deaths from pneumonia, malaria, and diarrheal diseases persist. These outcomes suggest that existing health services may not be fully responsive to the needs of women and children in this community.

Community Health Workers were introduced to complement formal healthcare providers and extend essential services into households and remote areas. While CHWs have been associated with positive health outcomes in several settings, their role in Ogene Zaria has not been comprehensively evaluated. Questions remain about how CHWs influence key health indicators such as antenatal care attendance, skilled birth delivery rates, immunization coverage, and timely referrals of pregnancy‑related complications. Furthermore, it is unclear whether challenges such as inadequate training, supervision deficits, lack of supplies, community mistrust, and limited incentives compromise their effectiveness in reducing maternal and child mortality.

Without rigorous assessment, health authorities cannot determine whether CHW programs are truly impactful or if structural and operational barriers diminish potential benefits. There is also limited understanding of community perceptions regarding the value of CHWs and whether these perceptions influence utilization of CHW‑related services. Consequently, there may be missed opportunities to strengthen community health strategies, allocate resources more efficiently, and improve overall health outcomes for mothers and children in Ogene Zaria.

Therefore, this study aims to evaluate the role of Community Health Workers in reducing maternal and child mortality in Ogene Zaria, identify key enablers and barriers affecting their performance, and provide evidence‑based recommendations to inform programmatic decisions and policy formulations.

1.3 Research Objectives

The broad objective of this study is to assess the role of Community Health Workers in reducing maternal and child mortality in Ogene Zaria.

Specific objectives include:

1. To examine the contribution of CHWs to antenatal care utilization among pregnant women in Ogene Zaria.
2. To evaluate the influence of CHWs on uptake of skilled birth attendance and facility deliveries.
3. To assess the role of CHWs in promoting immunization and preventive child health practices.
4. To identify facilitators and barriers affecting the effectiveness of CHWs in this community.

1.4 Research Question

This study will be guided by the following research questions:

1. What is the contribution of CHWs to antenatal care attendance in Ogene Zaria?
2. To what extent do CHWs influence the utilization of skilled birth and delivery services?
3. What role do CHWs play in promoting immunization and child health practices?
4. What challenges and facilitators impact the effectiveness of CHWs in Ogene Zaria?

1.5 Hypothesis of the Study

H₀: Community Health Worker interventions do not have a statistically significant effect on reducing maternal and child mortality in Ogene Zaria.

H₁: Community Health Worker interventions have a statistically significant effect on reducing maternal and child mortality in Ogene Zaria.

1.6 Significance of the Study

This study will contribute valuable insights to public health professionals, policymakers, and program managers by identifying how CHWs impact maternal and child health outcomes within Ogene Zaria—a setting with limited empirical evidence. The findings will assist health planners in refining community health strategies, strengthening CHW support systems, and improving integration with formal health services. Additionally, the research will be useful for NGOs, donor agencies, and stakeholders engaged in maternal and child health programs to tailor interventions that enhance effectiveness and sustainability. Finally, the study will add to academic literature on community health systems in Nigeria.

1.7 Scope of the Study

The study focuses on CHWs deployed in Ogene Zaria and their activities related to maternal and child health. It covers services such as antenatal care promotion, delivery support, child immunization promotion, household visits, referrals, and health education over the last three years. The study includes perspectives from CHWs, mothers of children under five, pregnant women, and health facility supervisors.

1.8 Operational Definition of Terms

• Community Health Workers (CHWs): Trained lay health workers who provide basic health promotion, preventive services, and referrals at the community level.
• Maternal Mortality: The death of a woman while pregnant or within 42 days of termination of pregnancy from causes related to pregnancy or its management.
• Child Mortality: The death of a child before reaching age five.
• Antenatal Care: Routine health service visits during pregnancy to monitor and improve maternal and fetal health.

Project – Assessing the Role of Community Health Workers in Reducing Maternal and Child Mortality in Ogene Zaria