Community Health Workers

Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking. [from abstract]

Volunteer community health workers (VCHW) are health care providers who are trained but do not
have any professional certification. They are intended to fill the gap for unmet curative, preventative, and health promotion health needs of communities. This study aims to investigate the non-financial incentives for VCHWs and factors affecting their motivation. [from abstract]

Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. [from introduction]

Community-based monitoring and planning (CBMP) of health services in Maharashtra state, India represents an innovative participatory approach to improving accountability and healthcare delivery. This paper examines the successes and challenges of this process, discussing lessons learned and the potential for generalizing such initiatives to other sectors and regions. Maharashtra’s experiment could inform ‘communitization’ of health services in diverse contexts, as an alternative to
privatization and as a means to enhancing the ‘publicness’ of health services. [from summary]

Female Community Health Volunteers (FCHVs) are considered service providers for major health problems at the community level in Nepal. However, few studies have been conducted about the roles of FCHVs from the users’perspective. This study sought to examine the current status of FCHV service utilization and identify the determinants of caregivers’utilization of FCHVs’health services in the mid-western region of Nepal. [from abstract]

Health facilities in rural, resource limited settings face multiple challenges responding to a growing demand for HIV treatment, including lack of adequate numbers of trained health workers. Many programs have used community health support workers (CHSWs) to provide specific services related to HIV care, and to complement facility-based treatment. [from abstract]

Indonesia is striving to achieve the Millennium Development Goal 4 target of less than 23 infant deaths per 1000 live births by 2015. In order to reach this target, a community case management (CCM) model, was introduced by the American funded Maternal and Child Health Integrated Program (MCHIP) and the Indonesian Ministry of Health (MoH) in 2011. Little is known about how CCM has been delivered and there is no research that examines the factors that contribute to the successful implementation of CCM in Indonesia.

This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes.

Behavior is crucial throughout global health interventions. The discipline of behavior change offers distinct expertise needed across 6 different domains of behavior. Such expertise is in short supply, however. We will not have effective and sustainable health systems, nor achieve our ambitious global health goals, without seriously addressing behavior change. [from abstract]

During national scale up of Integrated Community Case Management (iCCM) in Rwanda, greater improvements in care-seeking were found in the districts where Kabeho Mwana implemented its model than in the rest of the country. Success was attributed to an emphasis on routine data review, intensive monitoring, collaborative supervision, community mobilization, and, in particular, CHW peer support groups. [from introduction]

In countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers’ satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics.

Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. [from abstract]

The 4-year (2007–2011) Revitalizing Health for All international research program supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Three different reviewers synthesized each final project report through qualitative analysis to gauge equity in access, community empowerment and participation, social and environmental health determinants. {adapted from abstract]

One challenge that community health workers face when they provide hormonal contraceptives to new clients is ruling out pregnancy. A randomized controlled trial in Madagascar found that offering the health workers pregnancy tests to distribute for free increases their number of new contraceptive clients. [from introduction]

In 2012, Pathfinder conducted a study to explore whether CHWs who are intended to promote family planning as part of an integrated package of services do communicate with beneficiaries about family planning, and what actions women take based on these messages. The study also explored whether CHWs are reaching the poor, marginalized and vulnerable, and examined the costs of implementing the CHW component of the SCIP project. [from executive summary]

The Ugandan Government has an ambitious goal to reduce unmet need for family planning (FP) from its current 34% to 10% over the next 10 years. This brief shares experiences and lessons from capacity building for Family Planning at the national and district levels in Uganda.[adapted from introduction]

Family planning (FP) services have been available in Nepal for over 50 years, most extensively from the public sector health system, with nongovernmental agencies involved from the very beginning. These services are largely delivered by
facility-based service providers, except for the distribution of condoms and pills and, occasionally,
injectables. Community workers such as VHWs and MCHWs could potentially fill the gap if they were given the necessary knowledge and skills. [adapted from resource]

For decades, family planning programs and other public health programs have utilized community health workers (CHWs) as a way to reach and serve disadvantaged populations, often immigrants leery of government sponsored programs.Despite decades of experience, however, and a substantial body of evidence documenting their effectiveness and cost-effectiveness, these efforts continue to be hampered by the lack of a dedicated funding stream—a problem now being addressed by individual states and potentially by a little-noticed provision in the federal health care reform legislation that could provi

The Reference Guide has many practical examples from CHW programs around the world. The contents are in four sections and contain a total of 16 chapters covering such topics as a history of CHW programs, planning, governance and financing, national coordination and partnerships, roles and tasks, recruitment, training, supervision, motivation and incentives, relations with the community and health systems, scaling up, and measurement and data use. [from introduction]

See resource on Recruitment of Community Health Workers

This item is chapter eight in the book Developing and Strengthening Community Health Worker Programs at Scale. This chapter will help readers to consider key questions, recommendations, and challenges for CHW [Community Health Worker] recruitment planning and implementation, including selection, resource availability, and addressing CHW retention. [adapted from introduction]

This research tried to reveal the current situation and to track the future trends of the rural health workforce. By
stratified multistage cluster sampling processes, the baseline data of nationwide longitudinal survey were gathered
from China.

Children from traditionally underserved and marginalized communities have more health problems and less accessible, effective health care delivery than children generally. When children from underserved communities also have special health care needs, the problems they face are further compounded. The engagement of community health workers (CHWs) has emerged as a very promising strategy for addressing the persistent disparities in the delivery of health care and related service to Children with Special Health Care Needs. [from introduction]

In Taiwan, volunteers make a significant contribution to the health workforce. In this paper, we explain the volunteer’s role and describe both the benefits and barriers associated with volunteering as a health worker in Taiwan. We also outline the crucial function of volunteers in supporting community nursing work. [from abstract]

This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. [from abstract]

Volunteer community health workers (CHWs) are a key approach to improving community-based maternal and child health services in developing countries. A case–control study conducted in response to high dropout rates in the first year of the project showed that financial incentives, social prestige, community approval and household responsibilities were related to early retention in the project. In our present prospective cohort study, we aimed to better understand the factors associated with retention of volunteer CHWs once the project was more mature. [adapted from abstract]

To determine whether home visits for neonatal care by community health workers can reduce infant and neonatal deaths and stillbirths in resource-limited settings. [from abstract]

This report combines findings from a desk review,a mapping of [Close-to-Community] CTC providers and data collected during qualitative explorations carried out in two selected districts of Maputo Province as part of the context analysis. [from introduction]

Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south). [from abstract]

An outreach activity, which originally targeted health professionals and student nurses in rural Uganda, was extended to the community with a focus on addressing the most prevalent diseases/health problems reported by the Health Management Information System (HMIS) of the Uganda Ministry of Health.

In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.