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. 2020 May;5(5):e002368.
doi: 10.1136/bmjgh-2020-002368.

Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature

MacKenzie Clark MacRae  1 , Owais Fazal  2 , James O'Donovan  3
Affiliations

Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature

MacKenzie Clark MacRae et al. BMJ Glob Health. 2020 May.

Abstract

Background: Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach.

Methods: We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature.

Findings: 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care.

Conclusion: Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.

Keywords: health education and promotion; prevention strategies; public health; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA diagram. The PRISMA diagram details the search and selection process applied during the scoping review.
Figure 2
Figure 2
Choropleth map of study locations. A Choropleth Map highlighting the country of origin for each study included in this scoping review.
Figure 3
Figure 3
Suggested roles for CHWs in the delivery of palliative care services.
See this image and copyright information in PMC

References

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