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

作者：Kerry Scott, Sam Wilson Beckham, Margaret Gross, George William Pariyo, Krishna Dipankar Rao, Giorgio Cometto, Henry B. Perry · 发表于：Human Resources for Health · 年份：2018 · DOI：10.1186/s12960-018-0304-x · 被引用次数：765 · 研究领域：Global Maternal and Child Health、Interprofessional Education and Collaboration、Nursing education and management

OBJECTIVE: To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. METHODS: We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we 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). Eighty-three of the included reviews were from low- and middle-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 education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in th...