TY - JOUR
T1 - What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers
AU - Scott, Kerry
AU - Beckham, S. W.
AU - Gross, Margaret
AU - Pariyo, George
AU - Rao, Krishna D.
AU - Cometto, Giorgio
AU - Perry, Henry B.
N1 - Funding Information:
This study was funded by the Norwegian Agency for Development Cooperation (NORAD), through grants managed by the Alliance for Health Policy and Systems Research and the Global Health Workforce Alliance, partnerships hosted and administered by the World Health Organization. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/8/16
Y1 - 2018/8/16
N2 - Objective: To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. Methods: We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. Findings: We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. Conclusion: Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential.
AB - Objective: To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. Methods: We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. Findings: We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. Conclusion: Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential.
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U2 - 10.1186/s12960-018-0304-x
DO - 10.1186/s12960-018-0304-x
M3 - Review article
C2 - 30115074
AN - SCOPUS:85051998269
SN - 1478-4491
VL - 16
JO - Human Resources for Health
JF - Human Resources for Health
IS - 1
M1 - 39
ER -