From Community Health Workers to Community Health Systems: Time to Widen the Horizon?

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Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

Dilpreet Minhas, Leslie A Curry, Lauren Taylor … (2013)

We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs). We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment. Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.

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Identifying and Defining the Dimensions of Community Capacity to Provide a Basis for Measurement

R Goodman, M. Speers, K McLeroy … (1998)

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

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Community health workers in global health: scale and scalability.

Anne Liu, Sarah G Sullivan, Mohammed Afzal Khan … (2024)

Community health worker programs have emerged as one of the most effective strategies to address human resources for health shortages while improving access to and quality of primary healthcare. Many developing countries have succeeded in deploying community health worker programs in recognition of the potential of community health workers to identify, refer, and in many cases treat illnesses at the household level. However, challenges in program design and sustainability are expanded when such programs are expanded at scale, particularly with regard to systems management and integration with primary health facilities. Several nongovernmental organizations provide cases of innovation on management of community health worker programs that could support a sustainable system that is capable of being expanded without being stressed in its functionality nor effectiveness--therefore, providing for stronger scalability. This paper explores community health worker programs that have been deployed at national scale, as well as scalable innovations found in successful nongovernmental organization-run community health worker programs. In exploration of strategies to ensure sustainable community health worker programs at scale, we reconcile scaling constraints and scalable innovations by mapping strengths of nongovernmental organizations' community health worker programs to the challenges faced by programs currently deployed at national scale.

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Journal

Title: Health Systems & Reform

Abbreviated Title: Health Systems & Reform

Publisher: Informa UK Limited

ISSN (Print): 2328-8604

ISSN (Electronic): 2328-8620

Publication date Created: June 24 2016

Publication date (Print): June 24 2016

Volume: 2

Issue: 2

Pages: 112-118

Article

DOI: 10.1080/23288604.2016.1166307

PubMed ID: 31514640

SO-VID: f73a98b2-24c8-418e-9360-314464b68a22

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From Community Health Workers to Community Health Systems: Time to Widen the Horizon?

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Special series on Community Responses to Climate Change

Most cited references 24

Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?

Identifying and Defining the Dimensions of Community Capacity to Provide a Basis for Measurement

Community health workers in global health: scale and scalability.

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