Abstract
BACKGROUND: Maternal health has made important gains globally over the past decades, but it remains a pressing health priority that is facing diminishing returns from conventional policy instruments. Community engagement approaches hold great promise through their focus on social and contextual determinants of maternal health. This study explores the short-term effects of a relational community engagement intervention which foregrounded trust and relationships between communities and local healthcare providers as important social determinants: the Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust (CONNECT) Initiative in Lao People's Democratic Republic (PDR). METHODS: We studied the short-term effects of the CONNECT Initiative on health-centre-provided maternal healthcare attitudes, practices, and experiences. An evaluative study using a quasi-experimental study without control design was implemented from 10/2022 to 12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of complete census surveys before and at least three months after village-based CONNECT activities (3,161 survey observations), 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews. RESULTS: Among others, attitudes among women to recommend health centres for ante-natal care and delivery were 7.3 and 14.6 percentage points higher at endline (p < 0.01), and practices of giving birth at their local health centre were 14.3 percentage points higher at endline (p = 0.095). No statistically significant effect for maternal healthcare experiences was detected. Compared to the changes across survey periods, changes were similarly pronounced at endline among women who were exposed to CONNECT relative to unexposed villagers. We also observed a proportionate counter-reaction of reduced indicators of attitudes and practices involving hospital-provided maternal healthcare services. CONCLUSIONS: CONNECT addressed communities' trust and relationships towards local healthcare providers. The Initiative responded effectively to social determinants of maternal health in Lao PDR, with the positive side-effect of strengthening the gatekeeping functions of primary care facilities in the broader health system. This provides strong support for further operational and evaluation research into the opportunities of relational community engagement activities to complement supply-sided interventions in the attainment of global maternal health goals and low- and middle-income country health services provision more broadly.