What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers

Abstract

Other infection (Buruli ulcer, tuberculosis, hepatitis B and C, neglected tropical disease) 3 1 0 4 Other (adolescent health, palliative care, physical activity promotion) 1 2 1## 4 Total 83 29 10 122 LMIC low- and middle-income country, HIC high-income country *CHW program scale up [23]; CHW program integration [38]; peer telephone calls for multiple health issues [69]; intervention design factors that influence CHW performance [15]; role of allied health assistants in the health system [70, 71]; the dimensions of lay health worker programs [13] **Two articles on maternal mental health are classified under maternal health [72, 73] #One review on pediatric chronic disease had no regional focus and included only non-communicable chronic diseases (asthma, diabetes, obesity and failure to thrive) [56]; another review was specific to childhood asthma [57]; one study on adult chronic disease in South Africa primarily dealt with HIV, so is classified under “HIV”, but we note that five of the 29 articles in that review were on mental health [74] ##For one review (on CHWs for palliative care) [75], no articles met the inclusion criteria but the search included LMICs and HICs We now present findings from the reviews on considerations for CHW programmatic design and operation in health systems. Provide health education and behavior change motivation to community members Provide education to reduce HIV stigma [50] or promote behaviors that reduce risk of acquiring HIV [74]; assist with family planning [80], depression, or assessment of child mental development [97]; encourage physical activity among those with non-communicable disease [98]; promote exclusive breastfeeding [82], antenatal and postnatal care and family planning [82]; advise on tetanus vaccination [82] or family planning [82]; provide education on cancer [87, 99], hypertension [43] and diabetes [89, 100]; reduce childhood asthma-triggering behaviors and environmental pathogens that provoke asthma [56, 57] 4. Provide psychosocial support Form support groups for people with HIV [14, 50] or women [93, 105]; provide anti-retroviral treatment adherence reminders [50]; provide one-to-one psychosocial support to reduce maternal depression [73, 106], for people with hypertension [43], or for USA Latino parents of youth with mental health issues [106]; support adherence to drug regimens by sending short messages to cell phones to remind people living with HIV to take their medication [107] The number, complexity, and range of functions CHWs perform vary substantially among programs according to context-specific needs and opportunities; functions also evolve over time [13]. [...]a meta-synthesis across the reviews was unfeasible. [...]while Table 3 summarizes evidence on CHW contributions to health outcomes, we encourage readers to refer to each individual review in Additional file 3 and Additional file 4 for details.