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Am J Public Health. 2013 Jul;103(7):e74-82. doi: 10.2105/AJPH.2012.301102. Epub 2013 May 16.

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

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  • 1Yale School of Public Health, New Haven, CT 06520-8034, USA. sarah.pallas@yale.edu

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.

PMID:
23678926
[PubMed - indexed for MEDLINE]
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