Abstract
BackgroundThere has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period.MethodsA scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped.FindingsSix hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions.ConclusionsThe growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-016-0163-2) contains supplementary material, which is available to authorized users.
Highlights
There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years
As has been noted by many, the Millennium Development Goal (MDG) era saw a global resurgence of interest in the role of community health workers (CHWs) in health systems, an interest that is set to continue in new global health agendas [1]
CHWs and CHW programmes are a broad umbrella concept and practice under which a diverse array of programmatic priorities, roles and forms of community involvement in health and health care delivery exist. How are this diversity and the global pendulum swing towards CHWs reflected in the research on CHWs and CHW programmes? We report on a scoping review of trends, geographical distribution and programmatic orientations in the indexed literature on CHWs in low- and middle-income countries over a 10-year period (2005– 2014)
Summary
There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. As has been noted by many, the Millennium Development Goal (MDG) era saw a global resurgence of interest in the role of community health workers (CHWs) in health systems, an interest that is set to continue in new global health agendas [1]. Through the popularization of the concept of “task shifting”, the involvement of lay and community health workers has emerged as a rational strategy for addressing the vast shortfall in human resources impeding the roll-out of programmes in many countries. A number of significant international consensus statements have recommended that CHW programmes be integrated into health systems, increasingly linking these to the concept of universal health coverage (UHC) [7,8,9]
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