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Outcome Effectiveness of Community Health Workers an Integrative Literature Review

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What do we know almost community-based health worker programs? A systematic review of existing reviews on customs health workers

  • S. West. Beckham2,
  • Margaret Grossthree,
  • George Pariyo1,
  • Krishna D Rao1,
  • Giorgio Cometto4 &
  • Henry B. Perry1

Human Resource for Health volume 16, Article number:39 (2018) Cite this article

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Abstruse

Objective

To synthesize electric current understanding of how community-based health worker (CHW) programs can best exist designed and operated in health systems.

Methods

We searched 11 databases for review articles published between 1 Jan 2005 and xv June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of grooming, were included. Nosotros assessed the methodological quality of the reviews according to AMSTAR criteria, and we written report our findings based on PRISMA standards.

Findings

We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Lxxx-three of the included reviews were from low- and eye-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous teaching, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster programme sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and college-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to grooming and supervision, on CHWs every bit community alter agents, and on the influence of health organization decentralization, social accountability, and governance.

Conclusion

Evidence concerning CHW program effectiveness tin can aid policymakers identify a range of options to consider. However, this evidence needs to exist contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements volition be vital to helping these programs achieve their full potential.

Peer Review reports

Background

Customs-based health worker (CHW) programs are undergoing a resurgence, as these wellness workers are envisioned to be culturally skillful members of comprehensive and people-centered master health care teams that will enable universal health care [1]. The last decade has seen both the introduction as well as the re-invigoration of national CHW programs in many low- and centre-income countries (LMICs) [ii, three]. These programs involve the commitment of customs-based health services by paid or volunteer health workers with fewer than 2 years training. There is a rapid growth of bear witness on the effectiveness of community-based interventions [4, 5], positive experiences with reinvigorated national CHW programs [2], and renewed interest in stronger national CHW programs [half dozen]. Wellness systems in LMICs and high-income countries (HICs) are expanding their utilization of CHWs in order to run into population health needs, better admission to services, address health inequities, and meliorate health organisation performance and efficiency [7]. Policymakers need evidence-based guidance to further develop this core of the health workforce. As a showtime footstep in developing policy guidance on health policy and systems support to optimize CHW programs, the World Health Organization (WHO) commissioned a systematic review of bachelor reviews related to CHWs.

This systematic review synthesizes existing reviews on CHWs in order to map what is known about these programs. Nosotros present bear witness on the roles and capacities of CHWs every bit well as the health arrangement enablers that can support their functionality. We reviewed heterogeneous evidence to identify the types of interventions that CHWs provide, equally well equally optimal approaches to training, back up, supervision, and remuneration, and health arrangement integration (i.e., recognition in national health care planning, regulation, and implementation) [eight].

Methods

Search strategy

We searched for articles published between 1 Jan 2005 and 15 June 2017 in 11 electronic databases: PubMed, Embase, PASCAL Biomed, the Cochrane Library, Ovid's Global Health, WHO Global Wellness Regional Libraries, the Database of Abstracts of Reviews of Effects (Cartel), Epistemonikos, Health Systems Show, PROSPERO, and the National Guideline Clearinghouse of the United states of america Department of Health and Homo Services. Searches were developed and conducted by an bookish librarian (co-author MG) and peer reviewed by a 2nd librarian prior to implementation.

The systematic literature search used a combination of controlled vocabulary and keywords for 2 concepts: (1) reviews and (2) community-based health workers (e.g., "community wellness worker", "lay health worker", "close-to-community provider"). We used the validated systematic review filter for PubMed [9] and expanded information technology to catch thirty primal articles. Similarly for Embase, nosotros used the validated Wilcynski and Haynes, "small drop in specificity, substantive gain in sensitivity" systematic review query [x] and expanded it with additional terms (metanalysis; review:ti), to include, for example, all titles with the give-and-take "review" in them. In the other nine databases, we did non employ pre-developed review filters merely instead used simpler search strings for the concept "review." We did non limit to language. All titles and abstracts relevant to our study were retrieved and searched for total text. Run into Additional file 1 for the full PubMed search strategy.

Eligibility criteria, screening, and article selection

Articles were included if they were (a) reviews and (b) focused on CHWs. We included systematic reviews too equally non-systematic reviews (such as realist, narrative, scoping, and literature reviews), considering many non-systematic reviews provided insight into CHW program design and health system integration. Our inclusive approach brought together reviews on CHWs that used a wide range of synthesis methods to comment on many features of CHW programs, going across the effectiveness focus of systematic meta-analysis. We divers CHWs as health workers based in communities (i.e., conducting outreach from their homes and beyond main health care facilities or based at peripheral health posts that are not staffed by doctors or nurses), who are either paid or volunteer, who are not professionals, and who have fewer than ii years training but at least some training, if only for a few hours. Adhering closely to this definition led us to include some programs, such as those for peer supporters and traditional birth attendants with some training, that reverberate divergent and context-specific understandings of the term "CHW." Nosotros excluded articles that did not directly mention CHWs or mentioned them only in passing without information on their role. Commodity titles and abstracts were divided and assigned for independent review to 2 authors from among KS, HBP, SWB, KDR, and GP, with a third author from among the same group selected on a revolving ground to resolve disputes. Full texts of retained articles underwent a final screening for eligibility.

Data extraction and quality cess

Included manufactures were divided among KS, HBP, SWB, KDR, and GP for detailed data extraction. Data extractors used a pilot-tested framework (in Excel) that synthesized content on the following topics, adapted from the 2006 Globe Health Report's framework on the working life of health care providers [eleven]: CHW roles and capacities, training, deployment, performance measurement, remuneration and incentives, support and supervision, cost effectiveness, customs embeddedness, logistical support and supplies, and integration into wellness systems. KS spot-checked the information extraction past often returning to original articles for verification.

Two authors (SWB and MG) assessed the methodological quality of the systematic reviews using the 11-item validated Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria [12]. They began by both rating the aforementioned x systematic reviews so compared and discussed their ratings to obtain consensus on how to proceed. They and then divided the remaining systematic reviews between them and rated a random sample of 10% in duplicate to bank check agreement. Disagreements were limited and resolved through discussion. For two AMSTAR items, we assessed the manufactures according to the original (strict) AMSTAR criteria and also for adjusted (relaxed) criteria that we developed to more than appropriately appraise the quality of included systematic reviews. See Boosted file 2 for an caption of the ratings. The non-systematic reviews used a various range of non-systematic approaches to show synthesis across a broad array of enquiry questions, making the application of a standardized quality criteria inappropriate.

Throughout this study, we use the term CHW although many review manufactures and individual studies used different terms such equally shut-to-community provider or trained traditional nascence attendant.

Results

From four 139 unique references identified in our search, 122 reviews met our inclusion criteria (Fig. 1). Boosted file iii provides an overview of the included reviews, which can exist searched and filtered for regional focus, review type (non-systematic, systematic, meta-analysis), population focus, wellness event, nature of the intervention, findings on CHW capacities and/or intervention outcomes, and AMSTAR rating. Additional file 4 presents a summary of the main findings of all included manufactures. Additional file 5 presents complete references of included and excluded manufactures.

Fig. 1
figure 1

Diagram of review choice process

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Of the 122 included reviews, 75 were systematic (including 34 meta-analyses) and were assessed using the AMSTAR quality criteria (Additional files 2 and 3). Seven of the 11 AMSTAR indicators of quality were met by the vast majority of the systematic reviews included in our written report, while the remaining four AMSTAR quality indicators (duplicate information screening and information extraction, grey literature searched, publication bias discussed; and included and excluded studies listed) were less normally met.

Most of the reviews focused on LMICs (n = 83) and a range of primary health intendance (north = fourteen), child wellness (north = 13), and maternal and kid health (n = fourteen) interventions. High-income land reviews (n = 29) tended to focus on non-communicable diseases (due north = 12) and reaching specific underserved groups (n = 7) (Tabular array 1).

Tabular array i Health topics discussed in the included reviews

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Nosotros now present findings from the reviews on considerations for CHW programmatic design and operation in health systems. We outset nowadays evidence on CHW functions and their contributions to improving health outcomes. We then written report on health system enablers that can support CHW functionality, including optimal approaches to grooming, support, supervision, remuneration, and health system integration.

CHW roles and capacities

CHWs perform a diverseness of wellness system functions, which can exist amassed into half dozen general categories (Table 2).

Table 2 Health organization functions of CHWs

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The number, complexity, and range of functions CHWs perform vary substantially among programs according to context-specific needs and opportunities; functions also evolve over time [13]. While in that location is no optimal set of tasks or workload level that maximizes CHW productivity, one review [14] cited studies that found that as well many responsibilities reduce CHW productivity and service quality, and CHWs in these situations are forced to choose which tasks to perform based on factors such as feasibility, remuneration, or preference. The authors of this review conclude that CHWs are more likely to succeed when they accept a clear role and a limited number of tasks. In LMICs, CHWs commonly provide curative services, and there is some prove that being tasked with curative tasks equally opposed to solely providing health education or psychosocial back up may increase CHW motivation in LMIC settings [15].

Amongst the reviews that assessed CHW contributions to addressing specific health bug, almost found that CHWs can better health outcomes (Tabular array 3) just many noted concerns near the low quality of included studies and emphasized the importance of wellness systems enablers such equally training and support, discussed in later sections of this article. The reviews were heterogeneous, examining diverse CHW programs and analyzing effectiveness beyond a range of wellness event measures. Equally a result, a meta-synthesis across the reviews was unfeasible. Thus, while Table three summarizes show on CHW contributions to health outcomes, we encourage readers to refer to each private review in Additional file 3 and Boosted file 4 for details.

Table 3 CHW capacities for delivering specific health interventions

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As shown in Table 3, CHWs tin can make important contributions to improving health, especially in extending care to underserved groups, and can successfully handle complex health counseling and biomedical tasks. Nonetheless, CHWs can only run across their potential in performing these roles and improving health outcomes when supported by a range of health system enablers, discussed adjacent.

Training

The proper corporeality and blazon of training required by CHWs must be understood in relation to the health system context, the CHWs' pre-existing capacities, and the roles that CHWs are expected to play. Table 4 presents findings from the review literature on cadre considerations in CHW training domains.

Table 4 Summary of findings on CHW training

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Preparation should seek to impart both technical competency and socially oriented capacities such as skills in advice and counseling as well equally awareness of the importance of confidentiality [15,xvi,17]. Awareness of the social and political determinants of health [eighteen] and problem-solving skills were besides identified equally being of import [19]. 1 review noted that theoretical, classroom-based competency-oriented CHW grooming to promote immunization in India is an inappropriate approach [20]. Other reviews advise that some competencies such as record keeping or correctly interpreting malaria test results can exist introduced in the classroom but crave supportive supervision and hands-on practice to be implemented properly in the field [20, 21].

Training increases CHW knowledge and skills [22] and can positively influence CHW motivation, job satisfaction, and performance [23, 24]. Nonetheless, in that location was no direct evidence linking grooming to wellness outcomes in one review that looked for it [25], nor is there evidence that different aspects of training or different training approaches affect CHW performance [24]. One pathway through which training can contribute to CHW motivation is by increasing community confidence in their CHWs and ultimately increasing CHWs' confidence in their capacity to perform their duties [20, 24]. Relatedly, short and insufficient training erodes CHW confidence and reduces customs trust and uptake of their CHW'southward services [26].

Supervision

Supervision was often mentioned as disquisitional for the effectiveness of CHWs, and in that location is some evidence regarding the benefits of supervision on CHW operation [fourteen, xv, 23, 27, 28]. However, few details of the supervisory structure (type of supervisor, frequency of supervision, and blazon of preparation and support provided to supervisors) contributing to success were mentioned [15], and few studies have tested which approaches work best or how they are best implemented [15, 29,30,31]. Poor-quality supervision and low recognition from the health system can undermine community embeddedness and reduce CHW motivation [32,33,34]. Negative interactions of CHWs with higher-level health system actors (such as punitive supervision styles) can discourage and demotivate CHWs [33]. Supervision is frequently one of the "weakest links" in a CHW programme, and CHW programs commonly give inadequate attending to ensuring high-quality supervision [fourteen, 35], with negative implications for CHW empowerment [36]. Table five summarizes findings from the review literature on support and supervision.

Table 5 Summary findings on supervision for CHWs

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Level of education prior to condign a CHW

At that place is some evidence that CHWs with higher levels of formal education prior to condign CHWs are more effective (for case, in tape-keeping, diagnosing childhood illness, and accordingly counseling clients), but more highly educated CHWs may as well be more likely to driblet out afterward deployment [24]. One review concluded that completion of primary school should be a minimum educational requirement for inbound CHW training to meet the needs of underserved communities far from wellness centers [35].

Performance measurement

The reviews included in our study provided very little evidence linking routine supervisory performance appraisal to CHW performance equally measured by researchers [15]. However, formal supervisory checklists may increase the efficiency of identifying CHWs who are most in demand of further preparation or supervision [twenty].

Logistical back up and supplies

Regular provision of logistical support and supplies (such every bit drugs and educational materials) is essential to maintain CHW program effectiveness, productivity, and respect of CHWs by the community [26, 37]. Lack of supplies is demotivating for CHWs [14, 15, 35, 38]. Table 6 summarizes findings from the review literature on logistics and supplies.

Table vi Summary of findings on logistical support and supplies

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Remuneration and incentives

Monetary remuneration (such every bit salaries, financial incentives, or income from selling commodities) and not-monetary incentives (such every bit respect, trust, recognition, and opportunities for personal growth, learning, and career advancement) are important motivators for CHWs [15, xix, 23, 33, 39]. In Kok et al.'s [15] review on intervention design factors that influence CHW performance, 25 of the 81 studies with information on incentives reported that CHWs were dissatisfied with their incentives. Satisfaction (or dissatisfaction) with incentives was closely linked to CHW motivation and performance (or lack thereof). Improved financial remuneration tin reduce attrition amongst CHWs in LMICs [23, twoscore]. CHW rights and the need of CHWs for reliable financial remuneration were discussed in merely one review, which highlighted Indian CHWs' consistent (and unmet) need for salaried positions [41]. Tabular array 7 summarizes findings from the review literature on remuneration and incentives.

Tabular array 7 Summary findings on remuneration and incentives

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Deployment

There is no elementary formula for determining the optimal size of a CHW's catchment population. Instead, decisions about catchment area population should be based on a variety of context-specific considerations: frequency of contact required; nature of the services provided; expected weekly time delivery from the CHW; and local geography (including proximity of households), weather, and transport availability [fourteen, 15, 24]. One review [42] institute that for interventions consisting of home visits only, there was no consistent upshot of the size of the catchment population and neonatal mortality impact. Even so, when the interventions involved community mobilization as well, the reduction in neonatal mortality was greater when the catchment population for the CHW was smaller. Another related finding was that a high workload can lead to CHW demotivation [23].

Community embeddedness

14 reviews highlighted aspects of community embeddedness as important enablers of CHW programme success [14, 15, 19, 23, 34, 35, 37, 40, 43,44,45,46,47,48]. CHWs are embedded in communities when community members trust and respect them and feel a sense of ownership over the program, such equally can be achieved by giving communities a role in CHW choice and definition of CHW activities [xix]. The community'due south acceptance of CHWs and their sense that the CHW program is locally appropriate and "owned" is associated with CHW memory, motivation, performance, accountability, and support, and ultimately with the acceptability and uptake of CHWs' health-related piece of work [fourteen, 15, nineteen, 23, 38, 40, 47, 49]. Locally trusted CHWs can serve as an effective link between health facilities, health workers, and communities [50], and CHWs who are embedded in their communities tin can provide services to difficult-to-reach populations [20, 40]. However, CHW embeddedness tin can pb to CHWs being caught in tensions betwixt the community and the health organization as well equally betwixt social and biomedical issues [51]. Table viii summarizes findings from the review literature on community embeddedness.

Table 8 Summary findings on community embeddedness

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Cost-effectiveness

Inquiry from LMICs has constitute that shifting aspects of HIV care from college-level health workers to CHWs is price-effective [fifty, 52, 53]. There is some evidence of cost-effectiveness for community case direction of malaria past CHWs compared to standard malaria treatment at a health facility [21, 33], for the provision of mental health care past CHWs in LMICs [54], and for the delivery of multiple principal health care interventions [55]. However, 1 review noted that costing methods varied across studies, making it difficult to generate articulate conclusions. The same review besides noted that the opportunity costs borne by CHWs for volunteering their time were inadequately accounted for [33]. Table nine summarizes findings from the review literature on cost-effectiveness.

Tabular array 9 Summary findings on toll-effectiveness

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In HICs, interventions delivered by CHWs to reduce triggers for childhood asthma brought cost savings [56, 57]. Another HIC study reported price savings associated with peer support for breastfeeding [58]. Three reviews found inconclusive or no prove on cost-effectiveness: vaccination promotion in LMICs [59], control of vascular diseases in HICs [threescore], and outreach to underserved groups in the USA [25].

Integration into wellness systems

The integration of CHW programs into the health arrangement is reported in many reviews to exist a key enabler [14, 15, 17, 19, 23, 24, 26, 32, 34, 35, 38, 61]. Pallas et al. [23] highlight that the integration of CHW programs into the agendas of the ministry of wellness, NGOs, and international donors can strengthen CHW programs and can also assistance eternalize programs in times of political upheaval, loss of external donor funding, and reduced prioritization by the ministry of health. Integration that fosters respectful collaboration and advice betwixt CHWs and college-level staff tin can enable the health organisation to benefit from the unique, applied noesis that CHWs accept and tin back up CHW memory; this integration can enhance the acceptability and brownie of CHW programs [14, 15, 19, 24, 38, 44]. Table x summarizes findings from the review literature on health system integration.

Table x Summary findings on health arrangement integration

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Discussion

CHWs perform many roles in high-, middle-, and depression-income land health systems and contribute to improving a range of health outcomes. However, their chapters is directly contingent on the support they receive from the health arrangement. This review of reviews identifies a number of broad wellness system supports that optimize CHW programs and can be considered in light of context-specific factors to back up wellness policy controlling. It finds that CHW tasks should exist clearly divers and should crave a time commitment appropriate to the incentives/remuneration and support provided. Training should seek to impart both technical competency and socially oriented skills such as communication and counseling, including on confidentiality. Preparation appears to exist more constructive in imparting competencies by integrating hands-on practical components rather than just providing classroom learning and should be closely linked to ongoing supportive (rather than castigating or bureaucratic) supervision. Regular provision of supplies, such as medicines, communication tools and pedagogy aids, and transportation support, is essential for maintaining CHW program effectiveness. The review finds strong support for ensuring community embeddedness, as this is associated with CHW retention, motivation, operation, accountability, and support -- and ultimately affects the acceptability and uptake of CHWs' health-related work. Linking CHWs to a supportive and functioning referral facility is often vital to CHW plan effectiveness. Furthermore, programs must develop appropriate financial and non-financial incentives that take into account a range of factors, including the wellness organisation's resources availability, CHW needs, rights, and expectations, and the tasks and time commitments required. The size of a CHW's catchment population should be adamant in response to the local reality, including population density, travel required, and workload.

As many countries are in the process of implementing new national CHW programs or strengthening electric current ones, the evidence synthesized in this review can assist optimize these efforts. Ultimately, CHW programs are highly context specific. There are no standard blueprints that tin can exist used to design and implement a CHW program. When developing programs, decisions must be made based on national, sub-national, district, and local realities.

This review also enabled the identification of several gaps in the review prove. Relatively more than (and higher quality) testify is available on the effectiveness of CHWs in delivering specific health interventions than on effective approaches and cross-cutting strategies to integrate and support CBPs in wellness systems and optimize their performance [62]. In that location is lilliputian discussion in the review literature on the rights and needs of CHWs (with notable exceptions [36, 41]), on constructive approaches to training and supervision, on CHWs every bit community change agents, as multisectorial actors, and on the influence of health system decentralization, social accountability, and governance.

Finer addressing population needs for Universal Wellness Coverage with realistically available resources requires harnessing opportunities from the education and deployment of CHWs as members of inter-professional person primary wellness care teams [ane]. Countries should develop policies and mechanisms to integrate CHWs with the health system so every bit to enable these cadres to benefit from health arrangement support and to enable the health system to achieve optimal benefit from CHWs [63]. Health system integration should foster respectful communication and collaboration between CHWs and other health system actors.

Integration of CHWs with health systems requires their inclusion into public policies, including those related to national human resources for health planning, governance, legal frameworks, and financing for wellness services. The requisite inputs of human being and financial resources should be factored in at planning and budgeting stages and should be reflected in national health workforce and health sector strategies.

Policy dialogue about creating a strong part for CHWs in health systems must also accost human and labor rights issues surrounding the CHW workforce [64], the favorable consequences of employment of large numbers of CHWs for economic growth and social development [64,65,66], equally well every bit for achieving the Sustainable Development Goals [67].

This review faced some limitations. In including a range of study types—meta-analyses, systematic reviews, and non-systematic reviews (e.g., scoping, narrative, realist reviews)—and synthesizing findings across a broad range of bug and contexts, it was not possible to assess the overall take chances of bias in the findings or to systematically account for the variable quality of the included reviews. Furthermore, presenting findings synthesized from a range of reviews necessitated a high level of abstraction and limited our capacity to nowadays specific and important details and findings from private studies. We encourage readers to examine AMSTAR quality scores and strength of prove assessments in Additional file 3 for specific articles and to return to the source materials referenced for more information on topics of interest. Our definition of CHWs may non friction match definitions used by other teams, leading to inclusions and exclusions that may not fit the needs of all readers. In including research from high-, middle-, and depression-income countries, some findings from drastically dissimilar settings may exist hard to transfer and utilise. In improver, we focused only on bookish, peer-reviewed literature, likely missing out on important findings from the gray literature.

Conclusion

The findings from this review tin can be adapted to national contexts, where the available resources to support CHW programs are highly variable. Developing and strengthening CHW programs will involve taking into account existing prove of CHW program effectiveness, weighing options in light of a country'southward existing primary health intendance system and needs, making informed decisions involving all stakeholders, designing and implementing the all-time programme possible, and then adjusting course on the ground of feel, monitoring and evaluation, and findings from rigorous implementation enquiry. Future progress in improving CHW programs will depend not only on synthesizing existing evidence but also on supporting and funding research to continually accelerate the contextualized bear witness on how to design and implement CHW programs to maximize effectiveness [68]. CHWs tin play a fundamental function in strengthening health systems to provide universal, comprehensive, and people-centered intendance that is equitable, culturally advisable, and economically viable [ane].

Abbreviations

AMSTAR:

Assessing the Methodological Quality of Systematic Reviews

CHW:

Community-based health worker

HIC:

High-income country

HIV:

Human being immunodeficiency virus

LMIC:

Depression- and middle-income land

NCD:

Non-communicable illness

TBA:

Traditional birth attendant

WHO:

World Health Organisation

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Acknowledgements

Nosotros thank Dena Javadi (Alliance for Wellness Policy and Systems Enquiry, World Health System) and Elie Akl (American University in Beirut) for their helpful comments and inputs in the conceptualization and quality assurance of this assay. We thank Valerie Caldas for her help with Boosted file iii and the two bearding reviewers for their insightful comments.

Funding

This study was funded by the Norwegian Agency for Development Cooperation (NORAD), through grants managed past the Alliance for Health Policy and Systems Inquiry and the Global Health Workforce Alliance, partnerships hosted and administered past the World Wellness Organization. The funding body had no role in the pattern of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Availability of data and materials

All information generated or analyzed during this study are included in this published article and its supplementary information files.

Author data

Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205, Us

    Kerry Scott, George Pariyo, Krishna D Rao & Henry B. Perry

  2. Department of Health, Beliefs and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, United states of America

    South. W. Beckham

  3. Welch Medical Library, Johns Hopkins Medical Institutions, 1900 E Monument Street, Baltimore, 21205, Us of America

    Margaret Gross

  4. Health Workforce Department, Earth Health Organization, Avenue Appia xx, 1202, Geneva, Switzerland

    Giorgio Cometto

Contributions

GC and HBP conceptualized and designed the study. MG developed and conducted the database searches. KS, SWB, GP, KDR, and HBP screened the references identified through the database searches using the inclusion and exclusion criteria and extracted data from the included articles. MG and SWB applied the quality assessment tool (AMSTAR) criteria to all included systematic reviews. KS analyzed and synthesized data and drafted the manuscript, under HBP's guidance. HBP, GC, MG, KS, SWB, GP, and KDR provided disquisitional intellectual feedback and assisted in revising the manuscript. All authors read and approved the final manuscript.

Corresponding writer

Correspondence to Kerry Scott.

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Scott, K., Beckham, S.Westward., Gross, Thousand. et al. What do we know well-nigh community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 16, 39 (2018). https://doi.org/10.1186/s12960-018-0304-ten

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  • DOI : https://doi.org/ten.1186/s12960-018-0304-ten

Keywords

  • Customs-based Wellness Workers (CHW)
  • Assessing The Methodological Quality Of Systematic Reviews (AMSTAR)
  • Low- And Center-income Countries (LMICs)
  • Community Embeddedness
  • Community Modify Agents

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Source: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-018-0304-x

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