Abstract
BackgroundCommunity Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.MethodsWe searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996–2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies.ResultsGuided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW’s perspectives, and technology support.ConclusionCHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.
Highlights
Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas
In the attempt to deal with this health workers crisis, many countries, especially low- and middleincome countries (LMICs) have widely used community health workers (CHWs) to support the underserved population in resource-limited settings and deliver key health care and health promotion interventions in their communities [4]
Involving CHWs in the delivery of public health programs has a long history in China
Summary
Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. The World Health Organization (WHO) has identified the global chronic shortage of skilled health workers in the World Health Report [1]. In the attempt to deal with this health workers crisis, many countries, especially low- and middleincome countries (LMICs) have widely used community health workers (CHWs) to support the underserved population in resource-limited settings and deliver key health care and health promotion interventions in their communities [4]. According to WHO, CHWs consist of different community health aides, but not trained health professionals, who are selected and trained to work in their own communities [1] They are usually trained to deliver various basic and health-related interventions and services within their own community. We will use the term “CHWs” to describe all these categories of healthcare workers in this paper, unless specified otherwise
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