Abstract
BackgroundCommunity health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs.MethodsWe conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings.ResultsHealth system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment.ConclusionsThe functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system.
Highlights
Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs)
Existing work has highlighted decentralization as the backdrop of CHW programs, little research has explored the ways in which a decentralized health system directly impacts the governance of CHW programs and the experiences of CHWs within decentralized health systems. In this context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore the experiences of CHWs and how the governance and administration of CHW programs shaped these experiences across different settings
Governance challenges of administering CHW programs in a decentralized health system Based on the experiences of CHWs and program administrators, we found that the decentralization of the health system contributed to a number of administrative challenges in the governance of the CHW program
Summary
Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). Sustainable Development Goal (SDG) 3 commits to promoting wellbeing “for all, at all ages” by the year 2030, with SDG 3.8 committing to universal health coverage (UHC) [1] This emphasis on universal health coverage has strengthened national and international commitments to the equitable delivery of primary health care services, especially in low-resource settings, and has renewed interest in community health worker programs as a means of implementing UHC [2]. In low- and middleincome countries (LMICs) where governments are increasingly adopting decentralized health care policies, CHWs are often the first point of contact with health systems for many individuals [6, 7] These programs serve as an intermediary between health systems and communities, with the intention of extending the reach of health care providers, enhancing access and equity of health services, and improving individual and community level health outcomes (e.g., [4, 6, 8,9,10,11,12])
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
