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. 2013 Jul;103(7):e74-82.
doi: 10.2105/AJPH.2012.301102. Epub 2013 May 16.

Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

Sarah Wood Pallas  1 , Dilpreet Minhas, Rafael Pérez-Escamilla, Lauren Taylor, Leslie Curry, Elizabeth H Bradley
Affiliations

Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

Sarah Wood Pallas et al. Am J Public Health. 2013 Jul.

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.

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Figures

FIGURE 1—
FIGURE 1—
Steps followed in the systematic literature review on scale-up or sustainability of community health worker programs in low- and middle-income countries. Note. CHW = community health worker.
See this image and copyright information in PMC

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