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. 2016 Oct 26;14(1):65.
doi: 10.1186/s12960-016-0163-2.

The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

Helen Schneider  1 , Dickson Okello  2 , Uta Lehmann  3
Affiliations

The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

Helen Schneider et al. Hum Resour Health. .

Abstract

Background: There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period.

Methods: A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped.

Findings: Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions.

Conclusions: The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.

Keywords: Community health worker; Community health worker programmes; Integrated community case management; Lay health worker; Maternal-child health; Village health worker.

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Figures

Fig. 1
Fig. 1
Numbers of indexed publications on CHWs 2005–2014 (n = 678)
Fig. 2
Fig. 2
Publication numbers by programme area 2005–2009 and 2010–2014 (excluding “not specified”) (n = 660)
Fig. 3
Fig. 3
Regional profile of programmatic orientations (excluding the Middle East and “not specified”, n = 648)
Fig. 4
Fig. 4
Role orientations of CHWs in papers (n = 615). CCA care, counselling, adherence; Scr&Sur screening, surveillance, referral
See this image and copyright information in PMC

References

    1. Campbell J, Admasu K, Soucat A, Tlou S. Maximizing the impact of community-based practitioners in the quest for universal health coverage. Bull World Health Organ. 2015;93(9):590A. doi: 10.2471/BLT.15.162198. - DOI - PMC - PubMed
    1. Balabanova D, Mills A, Conteh L, Akkazieva B, Banteyerga H, Dash U, et al. Good health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet. 2013;381(9883):2118–2133. doi: 10.1016/S0140-6736(12)62000-5. - DOI - PubMed
    1. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases (Review). Cochrane Database Syst Rev. 2010;(3):CD004015. - PMC - PubMed
    1. Malarcher S, Meirik O, Lebetkin E, Shah I, Spieler J, Stanback J. Provision of DMPA by community health workers: what the evidence shows. Contraception. 2011;83(6):495–503. doi: 10.1016/j.contraception.2010.08.013. - DOI - PubMed
    1. Mutamba BB, van Ginneken N, Paintain LS, Wandiembe S, Schellenberg D. Roles and effectiveness of lay community health workers in the prevention of mental, neurological and substance use disorders in low and middle income countries: a systematic review. BMC Health Serv Res. 2013;13:412. doi: 10.1186/1472-6963-13-412. - DOI - PMC - PubMed

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