Can Training Home Visiting and Increasing Accountability of Government Workers Improve South African Maternal, Perinatal, and Infant Outcomes

Concurrent epidemics of HIV, depression, alcohol abuse, and partner violence threaten maternal and child health (MCH) in South Africa. Although home visiting has been repeatedly demonstrated efficacious in research evaluations, efficacy disappears when programs are scaled broadly. In this RCT we are examining whether the benefits of ongoing accountability and supervision within an existing government funded and implemented CHW home visiting program ensure the effectiveness of home visiting. In the deeply rural, Eastern Cape of South Africa, CHW are hired by the government and will be initially trained by the Philani Programme to conduct home visits with all pregnant mothers and their children until the children are two years old. Twenty-four of these CHW have been randomized to receive either: 1) the Accountable Condition (AC) in which additional monitoring and accountability systems that Philani routinely uses are implemented (n=540 women, 12 areas); or 2) a Control Condition (CC), of initial Philani training, but with supervision and monitoring being delivered by local government structures and systems (n=540 women, 12 areas). Assessments take place during pregnancy, within two weeks of post-birth, 6 months, 15 months, and 24 months later. Primary outcomes are a composite score of documenting maternal HIV/TB testing, linkage to care, treatment adherence and retention; and child physical growth, cognitive functioning, and child behavior and developmental milestones. In the symposium we will present baseline data from the RCT.