Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”

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Abstract

Background

This is the concluding paper of our 11-paper supplement, “Community health workers at the dawn of a new era”.

Methods

We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes.

Results

CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness.

Conclusion

A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.

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Most cited references 82

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Global trends in emerging infectious diseases

Kate E. Jones, Nikkita G Patel, Marc A. Levy … (2008)

The next new disease Emerging infectious diseases are a major threat to health: AIDS, SARS, drug-resistant bacteria and Ebola virus are among the more recent examples. By identifying emerging disease 'hotspots', the thinking goes, it should be possible to spot health risks at an early stage and prepare containment strategies. An analysis of over 300 examples of disease emerging between 1940 and 2004 suggests that these hotspots can be accurately mapped based on socio-economic, environmental and ecological factors. The data show that the surveillance effort, and much current research spending, is concentrated in developed economies, yet the risk maps point to developing countries as the more likely source of new diseases. Supplementary information The online version of this article (doi:10.1038/nature06536) contains supplementary material, which is available to authorized users.

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Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness.

Henry Perry, Rose Zulliger, Michael M Rogers (2014)

Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.

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Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis

Audrey Prost, Tim Colbourn, Nadine Seward … (2013)

Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Seven trials (119,428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I(2)=58.8%, p=0.024) and neonatal results (I(2)=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283,000 newborn infants and 41,100 mothers per year if implemented in rural areas of 74 Countdown countries. With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country programme. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Henry B. Perry:

ORCID: http://orcid.org/0000-0003-0561-0492

hperry2@jhu.edu

Journal

Journal ID (nlm-ta): Health Res Policy Syst

Journal ID (iso-abbrev): Health Res Policy Syst

Title: Health Research Policy and Systems

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4505

Publication date (Electronic): 12 October 2021

Publication date PMC-release: 12 October 2021

Publication date Collection: 2021

Volume: 19

Issue : Suppl 3 Issue sponsor : Publication costs were covered by the Bill & Melinda Gates Foundation. Supplement Editors were not involved in the peer review for any article that they co-authored. The articles have undergone the journal's standard peer review process for supplements. The Supplement Editors declare that they have no other competing interests.

Electronic Location Identifier: 111

Affiliations

[1 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of International Health, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA

[2 ]GRID grid.52681.38, ISNI 0000 0001 0746 8691, BRAC University, ; Dhaka, Bangladesh

[3 ]UZIMA Foundation, Nairobi, Kenya

[4 ]Independent Consultant, Washington, DC USA

[5 ]Crigler Consulting, LLC, Hillsborough, NC USA

[6 ]GRID grid.415021.3, ISNI 0000 0000 9155 0024, Norwegian Institute of Public Health, Oslo, Norway and Health Systems Research Unit, , South African Medical Research Council, ; Cape Town, South Africa

[7 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, , Makerere University, ; Kampala, Uganda

[8 ]GRID grid.11503.36, ISNI 0000 0001 2181 1687, Department of Global Health, , KIT Royal Tropical Institute, ; Amsterdam, The Netherlands

[9 ]Independent Consultant, Toronto, Canada

[10 ]Community Health Impact Coalition, New York, NY USA

[11 ]GRID grid.59734.3c, ISNI 0000 0001 0670 2351, Department of Health System Design and Global Health, , Icahn School of Medicine at Mount Sinai, ; New York City, NY USA

[12 ]GRID grid.17089.37, School of Public Health, , University of Alberta, ; Edmonton, AB Canada

Author information

Henry B. Perry http://orcid.org/0000-0003-0561-0492

Simon Lewin http://orcid.org/0000-0001-7521-9515

Maryse Kok http://orcid.org/0000-0003-0889-8663

Kerry Scott http://orcid.org/0000-0003-3597-9637

Madeleine Ballard http://orcid.org/0000-0003-0107-4047

Steve Hodgins http://orcid.org/0000-0001-8365-3311

Article

Publisher ID: 755

DOI: 10.1186/s12961-021-00755-5

PMC ID: 8506098

PubMed ID: 34641891

SO-VID: 3842f5d0-b5f0-4d5c-9c6d-c953bbd3e628

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 16 June 2021

Date accepted : 17 June 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: ID OPP 1197181

Award Recipient : Henry B. Perry

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: community health workers,community health worker programmes,lay health workers,community-based primary healthcare,primary healthcare,sustainable development goals,ending preventable child and maternal deaths,universal health coverage

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: community health workers, community health worker programmes, lay health workers, community-based primary healthcare, primary healthcare, sustainable development goals, ending preventable child and maternal deaths, universal health coverage

Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”

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Abstract

Background

Methods

Results

Conclusion

Related collections

UN Sustainable Development Goals

Most cited references 82

Global trends in emerging infectious diseases

Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness.

Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis

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