Abstract
BackgroundThere is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs.MethodsFour databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.ResultsKey programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements.ConclusionThis review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.
Highlights
There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs)
Since the aim of the review was to obtain a better understanding of the factors that influence the performance of CHVs in urban informal settlements, studies were not excluded based on quality [16, 30]
This section begins by presenting an overview of the screening results followed by a description of the findings of the systematic review organized into broad thematic areas
Summary
There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs) This is despite such settings accounting for a high burden of disease. To increase healthcare access to such underserved populations and with renewed calls for universal health coverage (UHC), governments have rolled out various community health programmes using Community Health Volunteers (CHVs) as a link between the formal healthcare system and the community [7] This cadre of workers are referred to using differing terms depending on context such as Community Health Workers (CHWs), Accredited Social Health Activists (ASHAs), CHVs, lay health workers, etc., but for this paper we will be using the term CHV to broadly refer to them. Studies show that the success of such programmes depends on programme design factors (features of the programme or intervention such as renumeration, recruitment, supervision, workload); health system factors (such as health system financing and governance) and broad contextual factors (for instance gender roles, norms, cultural practices and legislation) surrounding the workings of such programmes [10–12]
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