Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 16;4(3):e001308.
doi: 10.1136/bmjgh-2018-001308. eCollection 2019.

Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

Andrea Katryn Blanchard  1 , Audrey Prost  1 , Tanja A J Houweling  2
Affiliations

Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

Andrea Katryn Blanchard et al. BMJ Glob Health. .

Abstract

Introduction: Community health worker (CHW) interventions are promoted to improve maternal and newborn health in low-income and middle-income countries. We reviewed the evidence on their effectiveness in reducing socioeconomic inequities in maternal and newborn health outcomes, how they achieve these effects, and contextual processes that shape these effects.

Methods: We conducted a mixed-methods systematic review of quantitative and qualitative studies published between 1996 and 2017 in Medline, Embase, Web of Science and Scopus databases. We included studies examining the effects of CHW interventions in low-income and middle-income countries on maternal and newborn health outcomes across socioeconomic groups (wealth, occupation, education, class, caste or tribe and religion). We then conducted a narrative synthesis of evidence.

Results: We identified 1919 articles, of which 22 met the inclusion criteria. CHWs facilitated four types of interventions: home visits, community-based groups, cash transfers or combinations of these. Four studies found that CHWs providing home visits or facilitating women's groups had equitable coverage. Four others found that home visits and cash transfer interventions had inequitable coverage. Five studies reported equitable effects of CHW interventions on antenatal care, skilled birth attendance and/or essential newborn care. One study found that a CHW home visit intervention did not reduce wealth inequities in skilled birth attendance. A study of women's groups reported greater reductions in neonatal mortality among lower compared with higher socioeconomic groups. Equity was most improved when CHWs had relevant support for assisting women to improve health practices and access health care within community contexts.

Conclusion: While current evidence remains limited, particularly for mortality, existing studies suggest that CHW interventions involving home visits, cash transfers, participatory women's groups or multiple components can improve equity in maternal and newborn health. Future mixed-methods research should explore intervention strategies and contextual processes shaping such effects on equity to optimise these efforts.

Keywords: child health; health education and promotion; health systems; maternal health; systematic review.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart depicting the selection of studies.
Figure 2
Figure 2
Number of articles reporting on each type of CHW intervention by region. CHW, community health worker.
Figure 3
Figure 3
Number of studies reporting equity effects for different types of community interventions and outcomes. CHW, community health worker.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. United Nations Sustainable development goal 3: ensure healthy lives and promote well-being for all at all ages. Secondary sustainable development goal 3: ensure healthy lives and promote well-being for all at all ages, 2018. Available: https://sustainabledevelopment.un.org/sdg3
    1. Lawn JE, Blencowe H, Oza S, et al. . Every newborn: progress, priorities, and potential beyond survival. Lancet 2014;384:189–205. 10.1016/S0140-6736(14)60496-7 - DOI - PubMed
    1. UNICEF Maternal and Newborn Health Disparities - India. Geneva: UNICEF; 2016: 1–6.
    1. Tulenko K, Møgedal S, Afzal MM, et al. . Community health workers for universal health-care coverage: from fragmentation to synergy. Bull World Health Organ 2013;91:847–52. 10.2471/BLT.13.118745 - DOI - PMC - PubMed
    1. United Nations Sustainable Development Goals. Secondary sustainable development goals, 2018. Available: https://www.un.org/sustainabledevelopment/health/

Publication types

LinkOut - more resources