Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?
Top Cited Papers
- 1 July 2013
- journal article
- research article
- Published by American Public Health Association in American Journal of Public Health
- Vol. 103 (7), e74-e82
- https://doi.org/10.2105/ajph.2012.301102
Abstract
Objectives. We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs). Methods. We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization. Results. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment. Conclusions. Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.Keywords
This publication has 36 references indexed in Scilit:
- Culture, status and context in community health worker pay: Pitfalls and opportunities for policy research. A commentary on Glenton et al. (2010)Social Science & Medicine (1982), 2010
- The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysisSocial Science & Medicine (1982), 2010
- Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trialThe Lancet, 2009
- An integrated approach of community health worker support for HIV/AIDS and TB care in Angónia district, MozambiqueBMC International Health and Human Rights, 2009
- Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunitiesHuman Resources for Health, 2009
- Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trialThe Lancet, 2008
- Adherence Support Workers: A Way to Address Human Resource Constraints in Antiretroviral Treatment Programs in the Public Health Setting in ZambiaPLOS ONE, 2008
- Community health workers and the response to HIV/AIDS in South Africa: tensions and prospectsHealth Policy and Planning, 2008
- Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003)Journal of Perinatology, 2005