A new evaluation of community-based malaria programs in Côte d’Ivoire shows that women’s groups conducting household visits have been an effective, low-cost way to change health behaviors during pregnancy.

The study, conducted in partnership with the Johns Hopkins Center for Communication Programs-led Breakthrough ACTION project and the Ivorian Ministry of Health, looked at whether women who were visited by members of community women’s groups adopted healthier practices compared to those who were not reached.

The findings were clear. These visits mattered.

“Across the board, we found that the women who had been visited had more positive attitudes, knowledge, and behaviors than the women who had not been visited,” said CCP’s Danielle Naugle, PhD, one of the study’s authors. “The bottom line is that these home visits from women in the community actually worked.”

The women’s groups, often originally formed for economic purposes such as savings clubs, were repurposed and trained to share key malaria prevention messages with pregnant women including advice to attend prenatal visits, sleep under insecticide-treated nets, and take preventive malaria medication.

“It was relatively low cost,” Naugle said. “They got a very small stipend—less than $100 a month—some training, and a flipbook. That was the main investment. But through this method, you could reach a lot of people and change behaviors that we traditionally think of as hard to change.”

The evaluation found that the effectiveness of the women’s groups varied by location. In areas where the groups were well-organized and supported by health centers, nearly all recently pregnant women surveyed reported receiving at least one home visit. In other areas, where groups struggled with leadership conflicts or lacked strong links to local health facilities, almost no women were reached.

“The quantitative and qualitative data really gave a whole picture,” Naugle said. “It wasn’t that the visits themselves weren’t effective, it was that the women’s groups weren’t being successfully mobilized to do the visits.”

Community buy-in also made a difference. In some districts, local authorities formally introduced the groups to the community, giving them legitimacy. “That kind of formal stamp of approval from local leaders seemed really powerful,” Naugle said.

In several cases, women group members went beyond simply sharing information. “There are stories of women’s group members who literally took pregnant women by the hand and brought them to the health center,” Naugle said. “That personal connection made women feel more comfortable seeking care.”

While other community activities, like cleanup days organized by broader community action groups, showed limited impact, the women’s groups stood out. “Having received a visit from a women’s group member made an impact,” Naugle said.

“It’s a low-cost, effective strategy for getting the community itself to improve its own health outcomes. It worked, and it would be worth replicating and scaling up.”