This community innovation has been accepted at the 2026 DHIS2 Annual Conference and will be in abstract track/lightning talk.
Healthcare impact of the Survive to Thrive program
BACKGROUND: Healthcare facility attendance for maternal and child health may be influenced by community mobilization, outreach, and the quality of water, sanitation, and hygiene (WASH) services in healthcare facilities. In collaboration with the Government of Zambia, World Vision implemented the “Survive to Thrive” program from 2019 to 2022 to promote healthcare attendance through Safe Motherhood Action Groups, community health worker education, and upgrades to healthcare facility WASH infrastructure in Luwingu District, Northern Province, Zambia. This study aimed evaluate program impacts for antenatal care and outpatient care utilization.
METHODS: We obtained monthly time-series data from DHIS2 for healthcare facilities in Luwingu District and all other non-program districts in Northern Province. Using a controlled interrupted time-series Poisson regression analysis, we assessed changes in monthly rates of maternal heath outcomes (first and follow-up antenatal visits, institutional deliveries) and child health outcomes (diarrhea diagnoses, respiratory infection diagnoses, and BCG immunization) across 11 program facilities and 122 population size-matched comparator facilities from 2017 to 2025.
RESULTS: Relative to non-program facilities, Survive to Thrive program facilities experienced a post-implementation increase in the average level of follow-up antenatal visits (incidence rate ratio: 2.95, 95% confidence interval: [1.80-4.86]). We did not observe significant differences in the post-intervention level or trend for other outcomes.
CONCLUSIONS: Healthcare facility WASH improvements and community-level support for maternal health are effective in motivating antenatal care attendance. Further research can explore factors that affect healthcare utilization. This research demonstrates the utility of DHIS2 for program evaluation. Researchers can collaborate with DHIS2 implementers to strengthen health information system reporting and develop retrospective and prospective evaluations.
Authors: Lucy Tantum, Miles Kirby, Kalaluka Kalaluka, Kingsley Kapemfu, Megan McNerney, Wanty Maposa Mweetwa, Darcy Anderson, Ryan Cronk
Keywords:
WASH; maternal health; healthcare utilization; program evaluation; time-series
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