Research Philosophy

Muso conducts rigorous research because our patients deserve the truth. Good intentions are not enough. Our patients deserve health care systems that work, that are evidence-based. That is why we test everything we do.

Our studies don’t set out to prove the validity of our model, but to help us learn, to help us improve, to provide us with evidence to better serve the communities where we work. And our mission doesn’t end at the borders of the communities we serve. Every person has the right to healthcare. No person should die because they can't access care.

That is why Muso is testing global solutions to these global injustices—to identify what strategies work, what strategies do harm, and what strategies can accelerate the global effort for universal health care and child survival.
TESTING PROACTIVE CARE IN BANKASS



3 YEARS (2016-2019)


7 SITES


137 VILLAGE AND HAMLET CLUSTERS


98,000 PEOPLE

A 2013 Harvard/UCSF study brought global attention to Muso’s Proactive Care health system as a global model for child survival. But it is important to note that the study had significant limitations. It was not designed to produce causal conclusions on the role of active case finding. That is why UCSF, the Malian Ministry of Health and Muso are together launching a large randomized controlled trial. The RCT will build from the first study's findings by testing the impact of one of the model’s core components, CHW active case finding.

About the RCT

Covers 98,000 people in 137 clusters in rural Mali. Villages will be assigned to either proactive care (with an active case finding CHW) or passive care (with a stationary CHW).

Participants

17,000 participants (8,500 in each arm) across 137 clusters will detect a 0.75% absolute difference in under-five mortality (a 25% relative difference) with 90% power.

Hypothesis

The study tests whether CHWs who proactively search for patients will increase early access to treatment and decrease child mortality compared to passive CHWs, which is Mali’s current model.

Outcomes

Primary Outcome: U5 mortality

Secondary Outcome: % of children aged 0-59 months receiving effective treatment for malaria, diarrhea, or respiratory illness within 24 hours of their first symptom.
CHW DASHBOARD RCT

Our CHWs are the vanguard of Muso's model. Can supervision with mobile health tools help CHWs continuously improve the quality, speed, and quantity of services they provide?

Muso has partnered with Medic Mobile, a leading nonprofit health technology company, to prototype, test and deploy a cutting-edge CHW Dashboard. An internet-based data analytics platform will analyze the patient care data that CHWs record as they provide care, and create an easy-to-read CHW Dashboard for each CHW. Supervisors will use these dashboards to provide each CHW with individualized feedback on how to improve their performance, and ultimately save more lives.

A compelling idea—but does it work? Many similarly good ideas have failed in the past, or even done harm. To test the CHW Dashboard, we have launched a randomized controlled trial.

Half of Muso's CHWs will receive a supervision package that includes CHW Dashboard feedback, while the remaining CHWs will continue using current supervision systems.

CHILD MORTALITY STUDY


Following the findings of our three-year study that documented a 10x difference in child mortality in the areas of Yirimadjo, Mali, Muso is conducting a six-year follow-up study to determine whether this difference has been sustained over time.
PRENATAL CARE STUDY


Through Muso’s new Proactive Reproductive Health initiative, CHWs provide home pregnancy testing, proactively, door to door. New research efforts are being developed to test whether this approach enables CHWs to find more pregnant patients, earlier, so they can be protected and healthy during their pregnancy.
FAMILY PLANNING STUDY


A new study in development will assess whether communities receiving proactive care increase their access to family planning. Mali's baseline utilization rate of family planning measures is just 10%.