Health services and especially community-based health services in Africa are characterized by inefficiency, limited capacity, and poorly-trained personnel. The quality of care in these systems is dependent most heavily on personnel: training, monitoring, and ongoing quality of the implementation.

South Africa is deploying 65,000 community health workers (CHW), however, there are almost no systems currently, nor are the systems yet planned for how to train, monitor, and ensure quality care is delivered by these CHW. Building on the results of a successful effectiveness study in the townships of Cape Town, South Africa, we aim to show that training, monitoring, and data-informed supervision will result in CHW having significant benefits in maternal and child health (MCH) over the first two years of life, particularly mothers living with HIV, depressed mothers, and teenage mothers. With support from the provincial government, Philani’s innovative training and monitoring strategies aim to demonstrate that we can decrease the gap between what we know (based on science) and what we do to improve health in rural communities that currently lack accountability and efficiency. UCLA, Stellenbosch University, Zithulele Hospital, and the Philani Maternal, Child Health and Nutrition Trust will collaborate on this second effectiveness RCT of home visiting delivered by government-funded CHW.