Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing.
This review presents evidence on CHW programmes’ integration into National Health Systems for improved health outcomes in SSA.
Sub-Saharan Africa.
Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form.
A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region.
Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region.
The study presents synthesized evidence on CHW programmes integration into national health systems in SSA.
Mortality among children under 5 years of age has long been a major public health problem.
The World Health Organization (WHO) has expressed concern that more than half of the deaths in children under 5 years of age are attributed to preventable and treatable diseases or conditions,
The WHO defined CHWs as:
[
The prospective to effectively render ‘cost-effective, high-quality and culturally competent health services within team-based care models’
There have been calls for this health workforce cadre to be integrated into National Health Systems.
Although recent literature has defined context, mechanisms and guidelines for integrating CHW programmes into mainstream health systems,
Policy processes are commonly depicted as linearly cyclic,
In line with Mary Dixon-Woods’ suggestions,
The evidence of integration sought for included government and/or Ministry of Health (MOH) standardised documented polices, plans and guidelines
World Health Organization building blocks and corresponding community health worker programme components.
Conceptual framework used in this study shows WHO building blocks
We conducted a systematic scoping review to provide evidence synthesis on how CHW programmes focusing on child health in SSA are integrated into National Health Systems. A scoping review or scoping study is:
[
The review was guided by Arksey and O’Malley’s scoping review framework.
Selection and classification of articles was informed by prior consultation with subject experts in the field of CHW programmes in SSA. This consultation resulted in the identification of candidate CHW programmes that are being operated as comprehensive programmes across several SSA countries. For the purposes of restricting our study to those CHW programmes that are known to be active and operated by respective central governments, a decision was then taken to (1) further consult documentary materials evidencing identified CHW programmes’ integration and (2) purposively sample identified CHW programmes to represent different SSA regions.
Health extension workers (HEWs) in Ethiopia.
Community health officers (CHOs) in Ghana.
Health surveillance assistants (HSAs) in Malawi.
Junior community health extension workers (JCHEWs), community health extension workers (CHEWs) and community officers (CHOs) in Nigeria.
Agents de santé maternelle (ASM) and binomes in Rwanda.
Community health assistants (CHAs) in Zambia.
It may appear that the use of purposive sampling in this study makes it difficult to demonstrate that the sample is representative of the wider population of interest. However, because the findings of a research based on purposive sampling can only be generalised to the subpopulation from which the sample is obtained and not to the entire population,
Having selected the CHW programmes therefore, the following eligibility criteria guided further selection and classification of articles that were to be admitted into the study:
Studies whose specific focus was on CHW programmes in any of the six selected SSA countries (as listed earlier).
Studies that described the design and governance of the CHW programmes including government policy documents, CHW country profiles and Community Health Systems Catalogue (an online CHW resource pool that contains information on community health programmes, CHWs, and CHW interventions containing summaries of country-specific CHW programmes policies, strategies, guidelines, plans and reports based on the WHO health system framework)
The studies had to be in English.
The studies should have been published between January 2010 and December 2018.
Guided by the aforementioned criteria on how to admit eligible papers, we searched databases and grey literature repositories for works that evidenced how the selected CHW programmes are integrated into National Health Systems. Using specific CHW programme names as they were specifically referred to in the selected countries, we designed the search terms to include terms as follows:
Health Extension Workers (HEWs) in Ethiopia,
Community Health Officers (CHOs) in Ghana,
Health Surveillance Assistants (HSAs) in Malawi,
Junior Community Health Extension Workers (JCHEWs), Community Health Extension Workers (CHEWs) and Community Officers (CHOs) in Nigeria,
Agents de santé maternelle (ASM) and Binomes in Rwanda, or Community Health Assistants (CHAs) in Zambia.
Databases that were searched include Ebscohost (MEDLINE, PsycINFO PsycARTICLES, and Academic Search Complete CINAHL with Full Text). Grey literature repositories were also explored in order to find any non-indexed literature of significance to the scoping review. These included CHW Central; USAID; WHO; One Million Community Health Workers Campaign; Global Health Workforce Alliance (GHWA); and Advancing Partners & Communities (APC). Literature searches were done between January and April 2018.
Title screening of candidate papers was done by one reviewer (LMM). The accepted articles were imported into EndNote library reference management software. Duplicates were removed. The library was then shared between two reviewers for abstract screening. The abstract screening tool was initially piloted on a sample of 10 academic citations to attain reviewer interrater agreement. A kappa interrater agreement was computed to determine the agreement level. Upon establishment of agreement levels, abstracts were screened for eligibility by two reviewers, using the criteria that were determined beforehand, as advised by the pilot test. Consensus was used to iron out disagreements.
According to Cochrane Collaboration,
Sifting and sorting of accepted study components of interest was done using all-inclusive and uniform data extraction forms. Admitted literature were examined for which CHW programmes’ integration aspects they addressed, what conclusions were drawn with respect to the six integration variables, and how the relevant evidence is clarified. These were noted, reviewed and classified across all studies.
The modified version of PRISMA
Applying the conceptual framework as presented in
A total of 1789 articles were extracted from search databases. Furthermore, 99 additional articles were identified from references to the articles initially found. A total of 786 articles were screened after a total of 158 articles were excluded during full article screening for the reasons indicated in the PRISMA diagram (
Preferred reporting items for systematic reviews and meta-analyses flow diagram.
This section presents the results of evidence of the integration of CHW programmes into National Health Systems in SSA. The results are divided into three sections: characteristics of reviewed papers, characteristics of the included CHW programmes, and evidence of integration.
Peer-reviewed journals and grey literature repositories that were searched yielded a total of 42 peer-reviewed journal articles and policy documents that were admitted for the final review. Out of these, six were Community Health Systems Catalogues, six were Community Health Programmes Country Profiles, three were Book chapters with case studies, five were National Community Health Strategic Plans, 10 were qualitative studies, eight were quantitative studies and four used mixed methodologies.
Characteristics of studies included in the study.
This section gives an overview of the six national CHW programmes admitted into the study. Ethiopia’s HEWs work under the National Health Extension Programme
Mapping the selected community health worker programmes.
This section presents key findings of the integration of various CHW programmes in their respective countries, as found in the accepted literature. Based on the evidence, the integration variables or themes of CHW programmes for assessing evidence of the integration of CHW programmes into health systems have been developed inductively. They were then paired with critical functions based on their perceived suitability to strengthen the respective WHO health system building blocks. For each building block of the health system, the review examined whether the integration process was in place, as evidenced by the existence of broader government and/or MOH policies that refer to the merger and inclusion of CHWs in the health system.
Community health worker programmes’ components in National Health Systems critical functions.
Region | Country | CHW typology and brief history | Linkage to health system | CHW recruitment, education and certification (human resources for health) | CHW roles and responsibility (service delivery) | CHW remuneration (health financing) | CHW supervision (governance and leadership) | CHW information management (health information) | CHW equipment and supplies (medical products and technologies) |
---|---|---|---|---|---|---|---|---|---|
East Africa | Ethiopia |
Ethiopia Health Extension Program; HEWs; established by the government of Ethiopia; launched in 2003; over 38 000 HEWs. | Health extension workers are employed by the Ethiopian government and are connected to government health posts. |
Community health workers’ recruitment selection criteria: age, female gender preference, educational level, local residence. |
Roles and responsibilities include health promotion, disease prevention, and treatment of uncomplicated and non-severe illnesses such as malaria, pneumonia, diarrhoea and malnutrition. |
Paid by the government of Ethiopia Per diems and salaries Formal social recognition, opportunities for career advancement, and benefits such as annual leave. In some areas, community members and local government residences. |
Health extension workers are supervised by the medical professionals at the health centres on a weekly basis. |
Health extension workers are the first tier of the NHMIS. |
Health extension workers distribute including natural family planning, condoms, oral pills, implants and oral rehydration salts. |
Rwanda |
Community Health Program; ASM, binomes; number of CHWs is 45 011 (14 873 ASMs and 29 746 binomes); the programme began in 1995. | The Community Health Program in Rwanda is led by MOH and supported by various NGOs. |
Recruitment and selection criteria: |
The ASM provides mostly MNCH-focused services and links pregnant women to the health centre for deliveries. |
The Government of Rwanda (GoR) uses a community performance-based financing system ASM and binomes both receive per diems and compensation through a community performance-based financing scheme for meeting predetermined service delivery goals. ASM and binomes receive a variety of nonfinancial incentives, including membership in the CHW cooperative; t-shirts; umbrellas; formal social recognition; mobile phones; boots; flashlights; identification badges and participation in study tours. |
Community-level service delivery in Rwanda is managed and coordinated across the national, district, sector, cell and village levels. |
Agents de santé maternelle and binomes collect data using home visit registers and stock cards. |
Community health workers are linked to the national supply chain, ensuring a reliable supply of community health commodities. |
|
Southern Africa | Malawi |
National HSA Program; HSAs; 10 451 HSAs as of 2013. | Employed by MOH and report to Health Facilities. |
Recruitment and selection criteria: Health surveillance assistants are trained for 12 weeks. Receive classroom and practical-based training Health surveillance agent training is done at PHC training centres and selected districts. Training guided by MOH training policies and curricula. |
Health surveillance assistants’ responsibilities include health promotion and delivery of services for family planning, HIV, TB, malaria prevention and nutrition. Health surveillance agents collect vital statistics and maintain village household registers. | The MOH and NGOs finance all incentives. Salaried as a civil servant Also receive per diems and salary top-ups. Bicycles. |
Zonal officers, national programme managers, DHOs, senior HSAs, environmental health officers, district programme coordinators and community health nurses supervise HSAs. |
-Health surveillance assistants collect data using specific forms including the Village Health Register, TBA Card, CBDA Card and VHC forms. |
Health surveillance assistants are provided with start-up kits including items for water treatment; test materials like sputum collection boxes; buckets; measuring tape; insecticides; job aids and counselling cards. |
Zambia |
National Community Health Worker Program; CHAs; first group of CHAs was trained in 2011 and deployed in 2012. | Community health assistants are employed by the government. |
Recruitment and selection criteria: Twelve months training comprised of theoretical-based and practical experiences at selected health facilities and communities. Training is guided by nationally accredited curriculum at existing MOH training institutions. |
Community health assistants are responsible for health promotion and disease prevention. |
The MOH/government is responsible for incentives of community health workers. Salary Bicycle, mobile phone, shoes, an umbrella, a backpack and a uniform. |
Community health assistants are supervised by the in-charge at the nearest health centre. |
Community health assistants submit community-level data supervisors at health posts and health centres using activity reports, stock sheets and registers of the number of clients. |
Community health assistants distribute condoms, oral contraceptives, emergency contraceptives, ORS, zinc, malaria treatment and antibiotics for respiratory infections. |
|
West Africa | Ghana |
National Community-based Health Planning and Services (CHPS); CHOs; piloted 1994–1999; rolled out to national implementation in 1999; number of CHNs 15 900. | Community health officers are salaried health workers based at CHPS compounds who deliver the CHPS service package. |
Community health workers’ recruitment and selection criteria: Age, education level, personal attributes |
Preventive health: |
Community health officers are salaried health workers. Salary and place to live within the CHPS compound. Bicycles, formal social recognition for their work. |
Community health officers are directly supervised by CHMCs and the officer in charge at health centres. | Community health officers should collect data using paper-based forms and submit them to the SDHMT, where they are compiled and passed to the DHMT. | Community health officers carry drugs such as paracetamol; ORS, multivitamin; first-line malaria drugs and contraceptives including injections, oral pills and condoms. |
Nigeria |
Primary health care system: |
Community health officers, CHEWs and JCHEWs are government employees, working and connected to government facilities. |
Recruitment and selection criteria: Age and education. JCHEWs and CHEWs receive training at state schools of health technology. One year of on-the-job training with mentorship and completing 2–3 years of formal training. Community health officers are trained at a teaching hospital for 2 year of formal training at a school of health technology. Training is guided by accredited curricula. They receive additional training as needed. |
Community health extension workers and JCHEWs provide general preventative, curative and prereferral care to the population as the entry point of the health care system at the community level. |
Community health extension workers, JCHEWs and CHOs paid employees of the government of Nigeria. Salaries Not specify in policy |
Community health officers are the highest-level cadre at the community level. |
Community health officers, CHEWs and JCHEWs use health maps, house numbering systems, home-based records contraceptive pills (child health cards, personal cards), a facility-based family card, wall charts, health facility district referral forms, health facility registers and other tools to collect and record data. |
Community health officers, CHEWs and JCHEWs provide condoms, oral pills, contraceptives and UIDs for family planning. In addition, CHOs distribute zinc, ORS, malaria treatment, immunisations, vitamins and minerals for childhood illness and infectious diseases. |
HEWs, Health Extension Workers; NGO, Non Governmental Organization; ASM, Animatrice de Santé Maternelle; MNCH, Maternal, Newborn and Child Health; FP, Family Planning; HMIS, Health Management Information System; HSA, Health Surveillance Agent; HSAs, Health Surveillance Assistants; DHOs, District Health Officers; HIV, Human Immunodeficiency Virus; TBA Card, Traditional Birth Attendant Card; CBDA card, Community-based Distribution Agents Card; VHC, Village Health Committee; PHC, Primary Health Care; ORS, Oral Rehydration Salts; CDAs, Clinical Document Architectures; MCDMCH, The Ministry of Community Development, Mother and Child Health; PMO, Principal Medical Officer; DMO, Designated Medical Officer; CHAs, Community Health Assistants; MOH, Ministry Of Health; CHOs, Community Health Officers; CHW, Community Health Workers; CHMCs, Community Health Management Committees; SDHMT, Sub-District Health Management Team; DHMT, District Health Management Team; CHN, Community Health Nurse; CHPS, Community-based Health Planning and Services; PHC, Primary Health Care; CHEWs, Community health extension workers; JCHEWs, Junior Community Health Extension Workers; IEC, Information, Education and communication; LGA NHMIS, Local Government Area National Health Management Information System National Health Management Information System; HMIS, Health Management Information System.
Countries integrate different components of CHW programmes into health systems in various ways. The first point of integration that runs across all countries reviewed is the linkage of CHW programmes to respective health systems. This is evidenced by the fact that all CHWs in the respective programmes implement community health initiatives of the respective governments and are all remunerated by governments in different ways.
With regard to CHW recruitment, education and certification, countries’ integration practices differ. The standardisation of recruitment criteria and the selection process vary from country to country. For example, age and education or literacy requirements are set out in policy documents of all countries. Membership in the community is ascribed for all countries except Ghana and Nigeria, female gender preference is expressed for Ethiopia and Zambia, while personal attributes are prescribed for Rwanda, Malawi and Ghana. Policy guidelines for preservice training of CHWs apply to all countries, although modalities such as duration, curricula development, accreditation, and certification differ.
With regard to service delivery, all reviewed countries have policy guidelines on the scope of the CHW’s work, roles and responsibilities. Although CHWs in different countries provide different services depending on different epidemiological trends and public health needs, health promotion and disease prevention services were common in all countries. The remuneration of CHWs is another component of the CHW programme integrated into the health financing building block in the reviewed programmes. All countries have different financial incentives for CHWs, such as salaries and per diems paid by the respective governments. All countries have policy guidelines on nonfinancial incentives, except for Nigeria. Nonfinancial incentives included work aids such as bicycles and mobile phones, work uniforms such as boots and backpacks, preferential access to healthcare, government residences, social recognition by community members and other healthcare providers, to name a few.
Community health worker supervision is a component of the CHW programme, whose integration into the health system is sporadic across the countries reviewed. For example, all countries provide policy guidelines on who CHW supervisors are, depending on the structures of the respective health systems. However, in some countries, modalities, strategies, procedures and supervision processes such as the use of standardised supervision checklists, the frequency of supervision and CHW-supervisor ratios are not integrated into policy guiding documents. Policy documents from Ethiopia, Malawi and Zambia describe the use of a checklist for the exercise.
Community health worker information management is another component that has evidently been integrated into the critical function of health information of the respective countries under investigation. Firstly and most importantly, CHWs’ generated information has been recognised as the first level of the National Health Management Information System (NHMIS) in all countries reviewed. Although each country uses different data collection tools, all countries have standardised data collection tools. In addition, all countries have policy guidelines for consolidating community and facility data before they are submitted to higher tiers of the health system. However, some countries have not provided guidance on the use of processed information for decision-making locally and on improving health outcomes at the community level.
Finally, the CHW equipment and supplies component of the CHW programmes was integrated into the medical products and technologies building block of the system. This was demonstrated by the fact that CHW supplies are linked to the national supply chain of the health system. Other logistics, such as access, restocking and quality audits, varied depending on the services provided. Another indicator of integration that was evident in all countries except Zambia was policy guidance on the safe disposal of medical waste generated by the CHW service. The rest of the results are summarised in
We examined what is published on the integration of CHW programmes into National Health Systems with reference to child health in SSA. The scoping review was structured around the six building blocks of WHO health systems and their corresponding components of CHW programmes. The entire discourse on whether CHW programmes are integrated into the National Health Systems was based on evidence of integration at the policy level, as identified in the reviewed literature. Therefore, the discussion revolves around the latest WHO guidelines for health policy and system support to optimise CHW programmes.
The CHW programme component that addresses the Human Resources for Health (HRH) function in this study is CHW recruitment, education and certification. Evidence of integration from the examined literature included government and/or MOH policies that articulate recruitment, training modalities and certification guidelines. Information on policy-based selection criteria and processes was found for all six countries reviewed, although with variations. Policy guidelines mentioned age, gender, minimum level of education, membership and acceptance by the target group, as well as personal attributes on the selection criteria of the CHWs. Contrary to WHO’s recommendation on selection criteria,
Another selection criterion reported in all countries was the level of education. Ethiopia reported 10th grade as a prerequisite
The WHO suggested the use of certain criteria to determine duration of preservice training. These include: scope of work, anticipated role and responsibilities, competences required for service delivery, prior knowledge and skills institutional capacity, and expected conditions of practice among many others.
The CHW programme component that has been identified to improve the service delivery in this study is CHW roles and responsibilities. Evidence of integration abstracted from surveyed literature included government and/or MOH policies articulating guidelines on CHW roles and responsibilities
In the study, evidence of integration for health financing was government/MOH guidelines, records on CHW remunerations and incentive payments.
Evidence of integration sought for under this integration variable include government/MOH standardised CHW supervision plans and guidelines, supervisor job descriptions and qualifications, supervision checklists or other tools, supervision reports and supervision training documents.
In this study the integration variable that resonates with the information health system function is the CHW documentation and information management. The evidence of integration sought for under this integration variable was that government through MOH and/or health system provides policy guidelines on CHW documentation and information management,
Evidence of integration for this variable included national government provision of requisite equipment and supplies to CHWs that are needed to deliver services as expected. Examples include: MOH guidelines for CHW stocks and supplies, supply ordering procedures and forms, inventory forms and procedures.
This study focused on CHW programmes run by respective governments. This has a limiting bearing on the kind of integration insights that might have been gained were it to also include CHWs not run by respective National Health Systems. The shortcomings of the health system building blocks framework have a limiting effect on the methods used as the study documents were selected based on the building blocks and the abstracted evidence of integration mapped on the same. The study design also limited the kind of recommendations that the study would have delivered. This is because the admitted papers focused on contextual issues surrounding CHW integration at the expense of theoretical explanations for the same. In addition, the study did not assess the feasibility of the policies to indicate if they are likely or unlikely to be put into practice. Lastly, we did not appraise the quality of papers admitted into the study and this could undermine the quality of the findings.
Globally, CHWs need to complement existing health services to meet unmet community health needs. This has made strengthening health systems to improve child health outcomes a contemporary discourse and priority for health systems today. Zambruni et al.
As evidenced by the results of this review, some SSA countries have heeded the CHW integration call, but there is still a need to further investigate the extent or degree of integration of CHW programmes into the broader health systems. In large part, this scoping review underscores the willingness of health systems in the region to integrate CHW at the policy level. Evidence of integration through policy-based guidelines for all selected integration variables runs across countries and shows the complexity of CHW integration. Most importantly, the next step, given the implementation guidelines, would be to measure the extent of integration at the implementation level. Rigorous assessments of validated integration measurement metrics are however required in future CHW integration research.
Given the importance of this link to the success of CHW programmes, these study findings could inform policy makers and CHW programme managers on how to strengthen health systems to improve child health outcomes. This could help to further reduce the burden of morbidity and mortality in SSA.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
All authors contributed equally to this work.
Ethical clearance to conduct this study was obtained from the Biomedical Research and Ethics Committee of the University of KwaZulu-Natal (No. BE066/17).
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data sharing does not apply to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors, and the publisher.
Characteristics of studies reviewed.
First author and year | Country | Aims of study |
---|---|---|
Devlin e t al. 2017 |
Ethiopia | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Ethiopia. |
Advancing Partners & Communities 2013 |
Ethiopia | To collect the most up-to-date information available on the community health system, CHWs and community health services in Ethiopia. |
Perry et al. 2017 |
Ethiopia | To provide an overview of large-scale CHW programmes in Ethiopia. |
MOH Ethiopia 2015 |
Ethiopia | To improve equity, coverage and utilisation of essential health services, improve quality of health care and enhance the implementation capacity of the health sector at all levels of the system. |
Kok et al. 2015 |
Ethiopia | To understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimising HEW performance in providing maternal health services. |
Lunsford et al. 2015 |
Ethiopia and Tanzania | To increase HIV testing among pregnant women and antenatal care service utilisation and improve sanitation. |
Medhanyie et al. 2012 |
Ethiopia | To investigate the knowledge and performance of HEWs on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care. |
Damtew et al. 2011 |
Ethiopia | To examine conditions that may affect the quality of HEWs training in Ethiopia. |
Egan et al. 2017 |
Ghana | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Ghana. |
Advancing Partners & Communities 2013 |
Ghana | To collect the most up-to-date information available on the community health system, CHWs and community health services in Ghana. |
Moh Ghana 2016 |
Ghana | To attain the goal of reaching every community with a basic package of essential health services towards attaining universal health coverage and bridging the access inequity gap by 2030. |
Sacks et al. 2015 |
Ghana | To examine domains of community health nurse satisfaction and motivation. |
Baatiema et al. 2016 |
Ghana | This analysis presents systematic and comprehensive evidence of CHWs’ contributions and health policy gaps in Ghana. |
Devlin et al. 2016 |
Malawi | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Malawi. |
Advancing Partners & Communities 2014 |
Malawi | To collect the most up-to-date information available on the community health system, CHWs and community health services in Malawi. |
MOH Malawi 2017 |
Malawi | To ensure quality, integrated community health services which are affordable, culturally acceptable, scientifically appropriate and accessible to every household through community participation. This strategy focuses on multiple areas such as integration of health services; community engagement; sufficient and equitable distribution of well-trained community health workforce; and sufficient supplies, transport and infrastructure. |
Gilroy et al. 2012 |
Malawi | To assess the quality of care provided by HSAs – a cadre of community-based health workers – as part of a national scale-up of CCM of childhood illness in Malawi. |
Callaghan-Koru et al. 2013 |
Malawi | To: (1) describe the types and levels of selected health system supports provided to HSAs performing CCM in Malawi and (2) identify factors that constrain and facilitate the delivery of health system supports. |
Lewycka et al. 2010 |
Malawi | To evaluate two community-based interventions aimed at reducing newborn and infant mortality rates through either mobilisation of women’s groups or home visits by village women volunteers focusing on maternal and infant care and feeding practices. |
Kok et al. 2016 |
Malawi | To obtain in-depth insight into the facilitators of and barriers to interpersonal relationships between HSAs and actors in the community and health sector in hard-to-reach settings in two districts in Malawi, in order to inform policy and practice on optimising HSA performance. |
Chikaphupha et al. 2016 |
Malawi | To explore factors that influence motivation of HSAs in Malawi, with the aim of identifying interventions that can be applied to enhance motivation and performance of HSAs. |
Egan 2017 |
Nigeria | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Nigeria. |
Advancing Partners & Communities 2014 |
Nigeria | To collect the most up-to-date information available on the community health system, CHWs and community health services in Nigeria. |
Findley et al. 2013 |
Nigeria | To describe early results of an integrated MNCH programme in Northern Nigeria where child mortality rates are two to three times higher than in the southern states. |
Ordinioha et al. 2010 |
Nigeria | This study was performed to report the experience of the use of CHEWs in the provision of primary care in a private rural health care facility in a community in Nigeria. |
Uzondu et al. 2015 |
Nigeria | To explore the feasibility of deploying resident female CHEWs to rural areas to provide essential MNCH services. |
Charyeva et al. 2015 |
Nigeria | To (1) assess the knowledge and skills of trained CHEWs in the provision of implants; (2) determine satisfaction of clients with services provided by CHEWs; (3) assess the extent to which the mechanisms support CHEWs’ provision of implants functioned as intended and (4) determine facilitators and challenges encountered by CHEWs in the provision of implants. |
Egan et al. 2017 |
Rwanda | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Rwanda. |
Advancing Partners & Communities 2013 |
Rwanda | To collect the most up-to-date information available on the community health system, CHWs and community health services in Rwanda. |
Perry et al. 2017 |
Rwanda | To provide an overview of large-scale CHW programmes in Rwanda. |
MOH 2018 |
Rwanda | To identify gaps and opportunities and lay out policy guidelines with an aim to contribute to the achievement of health targets as identified in the MDGs, Vision 2020 and EDPRS. To provide clear guidance for the provision of holistic and sustainable health care services to communities with their full participation. |
Condo et al. 2014 |
Rwanda | To assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme, as perceived by the CHWs and their beneficiaries. |
Drobac et al. 2013 |
Rwanda | To document the collaboration between the MOH and PIH, in HSS activities that focus on improving health care access, quality, delivery and health outcomes. |
Devlin et al. 2016 |
Zambia | To provide the most up-to-date information available on community health systems based on existing policies and related documentation in Zambia. |
Advancing Partners & Communities 2013 |
Zambia | To provide the most up-to-date information available on the community health system, CHWs and community health services in Zambia. |
Perry et al. 2017 |
Zambia | To provide an overview of large-scale CHW programmes in Zambia. |
MoH, Zambia, 2010 |
Zambia | A National Community Health Worker Strategy has been developed by the MOH with the aim of repositioning and expanding the currently available CHW cadre. |
Zulu et al. 2015 |
Zambia | To demonstrate whether implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level. |
Zulu et al. 2014 |
Zambia | To explore CHA experiences and how these affect their motivation to do a good job. |
Zulu et al. 2013 |
Zambia | To address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. |
Phiri et al. 2017 |
Zambia | To explore the facilitators and challenges in implementing the CHA programme, for strategic learning and programmatic improvement. |
Shelley et al. 2016 |
Zambia | The CHA scope of work includes preventive and curative services related to disease prevention and control, behavioural health, environmental health, reproductive health, child health, and medical and surgical conditions. |
CHA, community health assistant; CHW, community health worker; MOH, Ministry of Health; HSS, health system strengthening; MDG, Millennium Development Goals; CHEWs, community health extension workers; MNCH, maternal, newborn, and child health; HSAs, health surveillance assistants; HSA, health surveillance agent; CCM, community case management; HEWs, health extension PIH, Partners in Health; EDPRS, Economic Development and Poverty Reduction Strategy.
Note: Please see the full reference list of the article, Mupara LM, Mogaka JJO, Brieger WR, Tsoka-Gwegweni JM. Community Health Worker programmes’ integration into national health systems: Scoping review.