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How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, Taegtmeyer M, Broerse JE, de Koning KA - Health Res Policy Syst (2015)

Bottom Line: Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance.Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context.Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place.

View Article: PubMed Central - PubMed

Affiliation: Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. maryse.kok@kit.nl.

ABSTRACT

Background: Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

Methods: We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized.

Results: Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes.

Conclusions: Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

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Related in: MedlinePlus

Flow chart search results.
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Related In: Results  -  Collection

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Fig1: Flow chart search results.

Mentions: The flow chart in FigureĀ 1 presents the search results. The list of 94 included papers and their basic characteristics can be found in Additional file 1. A total of 42 studies were qualitative, 28 studies used mixed methods, and 24 studies were quantitative. Fifty of the studies were conducted in Africa and 41 in Asia. One study was from Oceania and two included Latin America. Most of the studies and interventions took place in rural settings. The programmes were run by either non-governmental organizations (NGOs) or governments or a collaboration of these. In 66 of the studies, the CHWs delivered services to people in their homes and/or in the community (as opposed to facility-based CHW services). CHWs in the included studies had diverse promotional, preventive, and curative tasks. Seventy-two studies reported outcomes at the level of the CHW and 35 studies at the level of the end-user. Few studies had the influence of contextual factors on CHW performance as primary research focus. However, many discussed these factors and we categorized them as factors related to the community, economic context, environment, health system policy, and health system practice.Figure 1


How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, Taegtmeyer M, Broerse JE, de Koning KA - Health Res Policy Syst (2015)

Flow chart search results.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358881&req=5

Fig1: Flow chart search results.
Mentions: The flow chart in FigureĀ 1 presents the search results. The list of 94 included papers and their basic characteristics can be found in Additional file 1. A total of 42 studies were qualitative, 28 studies used mixed methods, and 24 studies were quantitative. Fifty of the studies were conducted in Africa and 41 in Asia. One study was from Oceania and two included Latin America. Most of the studies and interventions took place in rural settings. The programmes were run by either non-governmental organizations (NGOs) or governments or a collaboration of these. In 66 of the studies, the CHWs delivered services to people in their homes and/or in the community (as opposed to facility-based CHW services). CHWs in the included studies had diverse promotional, preventive, and curative tasks. Seventy-two studies reported outcomes at the level of the CHW and 35 studies at the level of the end-user. Few studies had the influence of contextual factors on CHW performance as primary research focus. However, many discussed these factors and we categorized them as factors related to the community, economic context, environment, health system policy, and health system practice.Figure 1

Bottom Line: Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance.Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context.Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place.

View Article: PubMed Central - PubMed

Affiliation: Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. maryse.kok@kit.nl.

ABSTRACT

Background: Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

Methods: We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized.

Results: Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes.

Conclusions: Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

Show MeSH
Related in: MedlinePlus