Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers.Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers.Design: A systematic review of peer-reviewed papers and grey literature.Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre...

https://tandfonline.com/doi/pdf/10.1080/16549716.2017.1272223

Who is a community health worker? – a systematic review of definitions

There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs’ intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work.

/pdf/sources-of-community-health-worker-motivation-a-qualitative-1hta4xm972.pdf

Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania

Background: Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. Methods: The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOHled Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson’s chi-squared test and difference-indifference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. Results: The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. Conclusions: The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to systematically document all inputs and monetary costs borne by the MOH to implement the model.

/pdf/shifting-management-of-a-community-volunteer-system-for-4lp33nxbrq.pdf

Shifting management of a community volunteer system for improved child health outcomes: results from an operations research study in Burundi

Introduction to a Special Supplement : Evidence for the Implementation, Effects, and Impact of the Integrated Community Case Management Strategy to Treat Childhood Infection

/pdf/introduction-to-a-special-supplement-evidence-for-the-54f2bpjmd7.pdf

BACKGROUND: Community case management (CCM) involves training supporting and supplying community health workers (CHWs) to assess classify and manage sick children with limited access to care at health facilities in their communities. This paper aims to provide an overview of the status in 2013 of CCM policy and implementation in sub-Saharan African countries. METHODS: We undertook a cross-sectional descriptive quantitative survey amongst technical officers in Ministries of Health and UNICEF offices in 2013. The survey aim was to describe CCM policy and implementation in 45 countries in sub-Saharan Africa focusing on: CHW profile CHW activities and financing. RESULTS: 42 countries responded. 35 countries in sub-Saharan Africa reported implementing CCM for diarrhoea 33 for malaria 28 for pneumonia 6 for neonatal sepsis 31 for malnutrition and 28 for integrated CCM (treatment of 3 conditions: diarrhoea malaria and pneumonia) - an increase since 2010. In 27 countries volunteers were providing CCM compared to 14 countries with paid CHWs. User fees persisted for CCM in 6 countries and mark-ups on commodities in 10 countries. Most countries had a national policy memo or written guidelines for CCM implementation for diarrhoea malaria and pneumonia with 20 countries having this for neonatal sepsis. Most countries plan gradual expansion of CCM but many countries plans were dependent on development partners. A large group of countries had no plans for CCM for neonatal sepsis. CONCLUSION: 28 countries in sub-Saharan Africa now report implementing CCM for pneumonia diarrhoea and malaria or "iCCM". Most countries have developed some sort of written basis for CCM activities yet the scale of implementation varies widely so a focus on implementation is now required including monitoring and evaluation of performance quality and impact. There is also scope for expansion for newborn care. Key issues include financing and sustainability (with development partners still providing most funding) gaps in data on CCM activities and the persistence of user fees and mark-ups in several countries. National health management information systems should also incorporate CCM activities.

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Community case management of childhood illness in sub-Saharan Africa - findings from a cross-sectional survey on policy and implementation.

We describe community health workers (CHWs) in government community case management (CCM) programs for child survival across sub-Saharan Africa. In sub-Saharan Africa, 91% of 44 United Nations Children's Fund (UNICEF) offices responded to a cross-sectional survey in 2010. Frequencies describe CHW profiles and activities in government CCM programs (N = 29). Although a few programs paid CHWs a salary or conversely, rewarded CHWs purely on a non-financial basis, most programs combined financial and non-financial incentives and had training for 1 week. Not all programs allowed CHWs to provide zinc, use timers, dispense antibiotics, or use rapid diagnostic tests. Many CHWs undertake health promotion, but fewer CHWs provide soap, water treatment products, indoor residual spraying, or ready-to-use therapeutic foods. For newborn care, very few promote kangaroo care, and they do not provide antibiotics or resuscitation. Even if CHWs are as varied as the health systems in which they work, more work must be done in terms of the design and implementation of the CHW programs for them to realize their potential.

Community health workers providing government community case management for child survival in sub-Saharan Africa: who are they and what are they expected to do?

Marika Yip Bannicq

Papers

Community health workers providing government community case management for child survival in sub-Saharan Africa: who are they and what are they expected to do?