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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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Contextual factors influencing CHW performance and programme functionality.
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Fig2: Contextual factors influencing CHW performance and programme functionality.

Mentions: Our findings indicate that contextual factors influence CHW performance at the CHW level (e.g., motivation or competencies), the end-user level (e.g., influencing health-seeking behaviour), or by influencing broader CHW programme performance (Figure 2). These factors relate to community (most prominently), economy, environment, and health system policy and practice and form a complex interactive web. They represent characteristics of settings in which a CHW programme operates and sometimes serve as preconditions for the performance of CHWs or CHW programmes. Factors that were found to be preconditions, such as the presence of well-functioning health services including logistics and supplies, were affecting CHWs’ ability to conduct their job. They were also related to CHW and end-user outcome levels, selected as outcome measures and comprising CHW performance in this review. For example, the absence of well-functioning health services influenced levels of motivation and job satisfaction (at the CHW outcome level) and utilization of services at the end-user outcome level. Policy makers and implementers of CHW interventions have to anticipate on and make use of the context particular to their setting to reach optimal performance.Figure 2


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)

Contextual factors influencing CHW performance and programme functionality.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Contextual factors influencing CHW performance and programme functionality.
Mentions: Our findings indicate that contextual factors influence CHW performance at the CHW level (e.g., motivation or competencies), the end-user level (e.g., influencing health-seeking behaviour), or by influencing broader CHW programme performance (Figure 2). These factors relate to community (most prominently), economy, environment, and health system policy and practice and form a complex interactive web. They represent characteristics of settings in which a CHW programme operates and sometimes serve as preconditions for the performance of CHWs or CHW programmes. Factors that were found to be preconditions, such as the presence of well-functioning health services including logistics and supplies, were affecting CHWs’ ability to conduct their job. They were also related to CHW and end-user outcome levels, selected as outcome measures and comprising CHW performance in this review. For example, the absence of well-functioning health services influenced levels of motivation and job satisfaction (at the CHW outcome level) and utilization of services at the end-user outcome level. Policy makers and implementers of CHW interventions have to anticipate on and make use of the context particular to their setting to reach optimal performance.Figure 2

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