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Integration of community health workers into health systems in developing countries: Opportunities and challenges

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Abstract

Background: Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs). It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.

Objective: To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.

Methods: Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.

Results: CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload.

Conclusions: For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound governance of community resources, promotion of inclusiveness and cohesion, engagement in participatory decision making, and mobilization of local resources for community welfare.

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Most cited references 44

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Using framework-based synthesis for conducting reviews of qualitative studies

Framework analysis is a technique used for data analysis in primary qualitative research. Recent years have seen its being adapted to conduct syntheses of qualitative studies. Framework-based synthesis shows considerable promise in addressing applied policy questions. An innovation in the approach, known as 'best fit' framework synthesis, has been published in BMC Medical Research Methodology this month. It involves reviewers in choosing a conceptual model likely to be suitable for the question of the review, and using it as the basis of their initial coding framework. This framework is then modified in response to the evidence reported in the studies in the reviews, so that the final product is a revised framework that may include both modified factors and new factors that were not anticipated in the original model. 'Best fit' framework-based synthesis may be especially suitable in addressing urgent policy questions where the need for a more fully developed synthesis is balanced by the need for a quick answer. Please see related article: http://www.biomedcentral.com/1471-2288/11/29.
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Non-financial incentives for voluntary community health workers: a qualitative study

Y Amare (2009)
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Community health workers can be a public health force for change in the United States: three actions for a new paradigm

Author and article information

Affiliations
1School of Public Health, Capital Medical University, Beijing, China
2School of Health Sciences, Great Lakes University of Kisumu, Kenya
3Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
4Community Medicine Department, Faculty of Medicine and Health Sciences, University of Dongola, Sudan
5Systems and Intervention Research Centre for Health, School of Medical Sciences, Edith Cowan University, Perth, WA, Australia
Author notes
CORRESPONDING AUTHOR: Wei Wang, MD, PhD, FFPH Global Health and Genomics, School of Medical Sciences, Edith Cowan University, Joondalup WA 6027, Australia, Tel.: +61-8-63043717, Fax: +61-8-63042626, E-mail: wei.wang@123456ecu.edu.au
Journal
FMCH
Family Medicine and Community Health
FMCH
Family Medicine and Community Health & American Chinese Medical Education Association (USA)
2009-8774
2305-6983
January 2016
February 2016
: 4
: 1
: 37-45
Copyright © 2016 Family Medicine and Community Health

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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Self URI (journal page): http://fmch-journal.org/
Categories
Systematic Review

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