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

Author

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  • Pallas, S.W.
  • Minhas, D.
  • Pérez-Escamilla, R.
  • Taylor, L.
  • Curry, L.
  • Bradley, E.H.

Abstract

Objectives. 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). Methods. 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. Results. 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. Conclusions. 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. Copyright © 2012 by the American Public Health Association®.

Suggested Citation

  • Pallas, S.W. & Minhas, D. & Pérez-Escamilla, R. & Taylor, L. & Curry, L. & Bradley, E.H., 2013. "Community health workers in low- and middle-income countries: What do we know about scaling up and sustainability?," American Journal of Public Health, American Public Health Association, vol. 103(7), pages 74-82.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2012.301102_7
    DOI: 10.2105/AJPH.2012.301102
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    Cited by:

    1. Netsanet Fetene & Erika Linnander & Binyam Fekadu & Hibret Alemu & Halima Omer & Maureen Canavan & Janna Smith & Peter Berman & Elizabeth Bradley, 2016. "The Ethiopian Health Extension Program and Variation in Health Systems Performance: What Matters?," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-19, May.
    2. Mami Hitachi & Violet Wanjihia & Lilian Nyandieka & Chepkirui Francesca & Norah Wekesa & Juma Changoma & Erastus Muniu & Phillip Ndemwa & Sumihisa Honda & Kenji Hirayama & Mohammed Karama & Satoshi Ka, 2020. "Improvement of Dietary Diversity and Attitude toward Recommended Feeding through Novel Community Based Nutritional Education Program in Coastal Kenya—An Intervention Study," IJERPH, MDPI, vol. 17(19), pages 1-11, October.
    3. Donela Besada & Daygan Eagar & Russel Rensburg & Gugu Shabangu & Salamina Hlahane & Emmanuelle Daviaud, 2020. "Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-19, January.
    4. Estelle D. Watson & Shabir Moosa & Dina C. Janse Van Rensburg & Martin Schwellnus & Estelle V. Lambert & Mark Stoutenberg, 2023. "Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation?," IJERPH, MDPI, vol. 20(17), pages 1-13, August.
    5. Nichols, Carly, 2024. "Equity and empowerment effects: Multiple styles of ‘voluntarism’ in community-based health projects," World Development, Elsevier, vol. 174(C).
    6. Yemisrach B. Okwaraji & Zelee Hill & Atkure Defar & Della Berhanu & Desta Wolassa & Lars Åke Persson & Geremew Gonfa & Joanna A. Schellenberg, 2020. "Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods," IJERPH, MDPI, vol. 17(16), pages 1-20, August.
    7. Saran, Indrani & Winn, Laura & Kipkoech Kirui, Joseph & Menya, Diana & Prudhomme O'Meara, Wendy, 2020. "The relative importance of material and non-material incentives for community health workers: Evidence from a discrete choice experiment in Western Kenya," Social Science & Medicine, Elsevier, vol. 246(C).
    8. Najafizada, Said Ahmad Maisam & Labonté, Ronald & Bourgeault, Ivy Lynn, 2017. "Stakeholder’s perspective: Sustainability of a community health worker program in Afghanistan," Evaluation and Program Planning, Elsevier, vol. 60(C), pages 123-129.
    9. Edward, Anbrasi & Branchini, Casey & Aitken, Iain & Roach, Melissa & Osei-Bonsu, Kojo & Arwal, Said Habib, 2015. "Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system," Social Science & Medicine, Elsevier, vol. 145(C), pages 173-183.
    10. Hyejin Lee, 2017. "Sustainability in International Aid Programs; Identification of Working Concepts of Sustainability and Its Contributing Factors," International Journal of Social Science Studies, Redfame publishing, vol. 5(1), pages 7-19, January.
    11. Kane, Sumit & Kok, Maryse & Ormel, Hermen & Otiso, Lilian & Sidat, Mohsin & Namakhoma, Ireen & Nasir, Sudirman & Gemechu, Daniel & Rashid, Sabina & Taegtmeyer, Miriam & Theobald, Sally & de Koning, Ko, 2016. "Limits and opportunities to community health worker empowerment: A multi-country comparative study," Social Science & Medicine, Elsevier, vol. 164(C), pages 27-34.

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