The Situation

Muso is a global health organization working with governments to design proactive health systems that save lives by reaching patients early, within hours of their first symptoms. The simple idea: speed saves lives. While traditional health systems are reactive, waiting for patients to seek out a nurse, doctor, or community health worker (CHW), Muso sends providers door-to-door to look for patients. While traditional health systems are facilities-based, most care in Muso’s system happens in the home, building upon the strong social networks that bind communities.

Muso has spent ten years in Mali working with the Ministry of Health (MOH) to provide universal health care and to solve the child mortality crisis, using a proactive model staffed in the field by CHWs. Muso will scale this model to eight new sites in the rural district of Bankass, Mali, including areas where nine out of ten residents did not see a health worker last year. While scaling the model, Muso will launch a three-year Randomized Controlled Trial (RCT) with research partners including the MOH. This RCT will test a key aspect of the model: the increased benefits of active versus passive CHW workflow.

Most health systems in the world are passive, but the key question of how CHWs should best spend their time – waiting for patients to come to them or proactively seeking them out – has never to Muso’s knowledge been tested in a randomized trial. The results of the study could lead to policy changes in international best practices for CHWs across the world, and improved care for hundreds of millions of people. The World Bank, the UN MDG Health Alliance, and USAID, all of which have featured Muso’s work as a global best practice, will be tracking the results. 

The Roadblock

In 2014, Muso built out a five-year plan to run a three-year RCT beginning in 2016. Preliminary power calculations from Muso’s research partners determined the size of the study: based on this input, Muso planned to enroll 5,800 women in the RCT.

However, in completing an in-depth power analysis in November 2015, the Muso team learned their earlier calculations, from which they had created the budget and strategic plan, would significantly under-power the study. New calculations required the enrollment of a total of 26,846 participants (4,000 for a pilot and 22,846 in the RCT itself) in order to ascertain with 90% probability, a 0.75% absolute difference in under-five mortality between the study arms. To include the additional study participants increased costs by $117,000.

Open Road's Response

A charitable grant from Open Road Alliance closed the financial gap and allowed the on-time launch of the RCT. The Malian MOH has committed to using the findings from the research to steer the Ministry’s national CHW scale-up plan, which will reach over three million of Mali’s poorest and most remote citizens.

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