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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 67

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          Achieving child survival goals: potential contribution of community health workers.

          There is renewed interest in the potential contribution of community health workers to child survival. Community health workers can undertake various tasks, including case management of childhood illnesses (eg, pneumonia, malaria, and neonatal sepsis) and delivery of preventive interventions such as immunisation, promotion of healthy behaviour, and mobilisation of communities. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers are not a panacea for weak health systems and will need focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. The introduction of large-scale programmes for community health workers requires evaluation to document the impact on child survival and cost effectiveness and to elucidate factors associated with success and sustainability.
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            1 million community health workers in sub-Saharan Africa by 2015.

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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.

              Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the roles of CHWs to enable them to become collaborative leaders in dramatically changing health care from "sickness care" systems to systems that provide comprehensive care for individuals and families and supports community and tribal wellness. We recommend drawing on the full spectrum of CHWs' roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness. We also urge that CHWs be integrated into "community health teams" as part of "medical homes" and that evaluation frameworks be improved to better measure community wellness and systems change.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                January 2016
                February 2016
                : 4
                : 1
                : 37-45
                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
                Article
                FMCH.2016.0102
                10.15212/FMCH.2016.0102
                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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