Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review

Maryse C Kok, Marjolein Dieleman, Miriam Taegtmeyer, Jacqueline E W Broerse, Sumit Kane, Hermen Ormel, Mandy M Tijm, Korrie A M de Koning

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    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 influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.
    Original languageEnglish
    Pages (from-to)1207-27
    Number of pages21
    JournalHealth Policy and Planning
    Volume30
    Issue number9
    Early online date11 Dec 2014
    DOIs
    Publication statusPublished - Nov 2015

    Keywords

    • Clinical Competence
    • Community Health Workers
    • Cooperative Behavior
    • Delivery of Health Care
    • Developing Countries
    • Humans
    • Motivation
    • Journal Article
    • Research Support, Non-U.S. Gov't
    • Review

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