Conclusion
GEHIP’s community-based healthcare program was found to significantly reduce adverse pregnancy outcomes but no effect on relative equity was established. There was however a general reduction in adverse pregnancy outcomes in both arms of the study owing to the expansion of access to community-based primary healthcare services across the region which mitigates the effects of household remoteness on basic preventive and curative public health care. The results of this study are challenged by limitations in the experimental designs but can be explained by the inverse equity hypothesis.
Globally, improving maternal and child health in line with the United Nations Sustainable Development Goal targets is constrained by socio-economic inequalities in access to and use of essential healthcare services. Community-based healthcare services as low-cost strategies have an important role to play in improving services to remote communities in culturally appropriate ways. However, program planners and implementers should keep an eye to ensure that interventions do not widen equity gaps.