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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review

Authors: Rosalind McCollum, Woedem Gomez, Sally Theobald, Miriam Taegtmeyer

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and marginalised groups. A systematic review was conducted to determine the extent of equity of CHW programmes and to identify intervention design factors which influence equity of health outcomes.

Methods

In accordance with our published protocol, we systematically searched eight databases from 2004 to 2014 for quantitative and qualitative studies which assessed access, utilisation, quality or community empowerment following introduction of a CHW programme according to equity stratifiers (place of residence, gender, socio-economic position and disability). Thirty four papers met inclusion criteria. A thematic framework was applied and data extracted and managed, prior to charting and thematic analysis.

Results

To our knowledge this is the first systematic review that describes the extent of equity within CHW programmes and identifies CHW intervention design features which influence equity. CHW programmes were found to promote equity of access and utilisation for community health by reducing inequities relating to place of residence, gender, education and socio-economic position. CHWs can also contribute towards more equitable uptake of referrals at health facility level. There was no clear evidence for equitable quality of services provided by CHWs and limited information regarding the role of the CHW in generating community empowerment to respond to social determinants of health. Factors promoting greater equity of CHW services include recruitment of most poor community members as CHWs, close proximity of services to households, pre-existing social relationship with CHW, provision of home-based services, free service delivery, targeting of poor households, strengthened referral to facility, sensitisation and mobilisation of community. However, if CHW programmes are not well planned some of the barriers faced by clients at health facility level can replicate at community level.

Conclusions

CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level. However, care must be taken by policymakers and implementers to take into account factors which can influence the equity of services during planning and implementation of CHW programmes.
Appendix
Available only for authorised users
Footnotes
1
PROGRESS plus is an acronym referring to: place of residence; race; occupation; gender; religion; education; socioeconomic position; social capital; plus – disability; age; sexual orientation.
 
2
Identified papers which included findings for additional stratifiers were analysed for all PROGRESS plus equity stratifiers.
 
3
CHW inclusion and exclusion criteria are identified in Additional file 1.
 
4
Given that the purpose of the review is to identify lessons for policymakers implementing universal CHW programs, it is difficult to truly assess equity through a targeted study and so only studies with a universal approach were included.
 
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Metadata
Title
How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review
Authors
Rosalind McCollum
Woedem Gomez
Sally Theobald
Miriam Taegtmeyer
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3043-8

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