Top

Human Resources for Health

Published in:

Open Access 01-12-2021 | Review

Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review

Authors: Michael Ogutu, Kui Muraya, David Mockler, Catherine Darker

Published in: Human Resources for Health | Issue 1/2021

Abstract

Background

There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs.

Methods

Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.

Results

Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements.

Conclusion

This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.

Available only for authorised users

United Nations Statistics Division. SDG indicators [Internet]. 2018 [cited 2021 Feb 10]. Available from: https://unstats.un.org/sdgs/report/2019/goal-11/.

Ernst KC, Phillips BS, Duncan B. Slums are not places for children to live. Adv Pediatr. 2013;60(1):53–87. https://doi.org/10.1016/j.yapd.2013.04.005.CrossRefPubMedPubMedCentral

Africa Population and Health Research Center (APHRC). Population and health dynamics in Nairobi’s informal settlements: report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012 [Internet]. Nairobi; 2014 [cited 2019 Apr 11]. Available from: https://aphrc.org/wp-content/uploads/2014/08/NCSS2-FINAL-Report.pdf.

Beguy D, Elung’ata P, Mberu B, Oduor C, Wamukoya M, Nganyi B, et al. HDSS profile: the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). HDSS Profile Int J Epidemiol Adv Access [Internet]. 2015 [cited 2019 Apr 11];1–10. Available from: https://www.indepth-network.org/sites/default/files/content/centres/files/Nairobi%20Urban%20profile.pdf.

Ezeh A, Oyebode O, Satterthwaite D, Chen Y-F, Ndugwa R, Sartori J, et al. Series: the health of people who live in slums 1. The history, geography, and sociology of slums and the health problems of people who live in slums. 2016 [cited 2019 Apr 11]; Available from: https://doi.org/10.1016/S0140-6736.

IRIN. The silent crisis of the urban slums [Internet]. 2013 [cited 2019 Mar 28]. Available from: https://www.unric.org/en/latest-un-buzz/28889-the-silent-crisis-of-the-urban-slums.

Lehmann U, Sanders D. Community health workers: what do we know about them? [Internet]. 2007 [cited 2019 Dec 14]. Available from: https://www.hrhresourcecenter.org/node/1587.html.

Roy B. Panel T17-P09 Session X Public Policy and Payment for Performance Programs (P4P/PBF) in health: in high-, middle-and low-income countries title of the paper ASHAs in India: gender, voluntarism and performance based payment-Montréal.

Alam K, Oliveras E, Tasneem S. Retention of female volunteer community health workers [Internet]. Bangladesh; 2009. (MANOSHI Working Paper Series). Report No.: No.8. Available from: http://www.icddrb.org/media-centre/fact-sheets/cat_view/52-publications/10043-icddrb-documents/10058-icddrb-reports-and-working-papers/10069-manoshi-working-papers/10226-manoshi-working-paper-no-08-2009.

10.

Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2014;30(9):1207–27. https://doi.org/10.1093/heapol/czu126.CrossRefPubMedPubMedCentral

11.

Kok MC, Broerse JEW, Theobald S, Ormel H, Dieleman M, Taegtmeyer M. Performance of community health workers: situating their intermediary position within complex adaptive health systems. Hum Resour Health. 2017;15(1):59. https://doi.org/10.1186/s12960-017-0234-z.CrossRefPubMedPubMedCentral

12.

Kok MC. Performance of community health workers optimizing the benefits of their unique position between communities and the health sector [Internet]. [Amsterdam]: VRIJE UNIVERSITEIT; 2015 [cited 2019 Apr 11]. Available from: http://chwcentral.org/sites/default/files/Kok%202015%20Performance%20of%20CHWs.pdf.

13.

Kane SS, Gerretsen B, Scherpbier R, Dal Poz M, Dieleman M. A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Serv Res. 2010. https://doi.org/10.1186/1472-6963-10-286.CrossRefPubMedPubMedCentral

14.

Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health related millennium development goals. Glob Health Work Alliance/World Health Organ. 2010;1–380.

15.

Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Hum Resour Health. 2012;10:1–9.CrossRef

16.

Glenton C, Colvin C, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis (protocol). Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD010414.CrossRefPubMedPubMedCentral

17.

Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018. https://doi.org/10.1186/s12960-018-0304-x.CrossRefPubMedPubMedCentral

18.

Wahl B, Lehtimaki S, Germann S, Schwalbe N. Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage. Health Policy Plan. 2020;35:91–101.PubMed

19.

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13(1):13. https://doi.org/10.1186/s12961-015-0001-3.CrossRefPubMedPubMedCentral

20.

Avis WR. Urban governance topic guide about GSDRC. Urban governance (topic guide) [Internet]. 2016 [cited 2021 Sep 28]; Available from: https://unhabitat.org/sites/default/files/download-manager-files/Habitat-III-Issue-Paper-22_Informal-Settlements-2.0%282%29.pdf.

21.

Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018. https://doi.org/10.1186/s12874-017-0468-4.CrossRefPubMedPubMedCentral

22.

Korhonen A, Hakulinen-Viitanen T, Jylhä V, Holopainen A. Meta-synthesis and evidence-based health care—a method for systematic review. Scand J Caring Sci. 2013;27(4):1027–34.CrossRef

23.

Butler A, Hall H, Copnell B. A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care. Worldviews Evid Based Nurs. 2016;13(3):241–9.CrossRef

24.

World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization; 2018.

25.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef

26.

Porritt K, Gomersall J, Lockwood C. JBI’s systematic reviews: study selection and critical appraisal. Am J Nurs. 2014;114(6):47–52.CrossRef

27.

Glenton C, Colvin C, Carlsen B, Swartz A, Lewin S, Noyes J. A systematic review of barriers and facilitators to the implementation of lay health worker programmes for maternal and child health. Cochrane database Syst Rev. 2013;(10):1–4.

28.

CASP. Critical Appraisal Skills Programme (2018). CASP (Qualitative) Checklist [Internet]. 2018 [cited 2019 Dec 14]. Available from: https://casp-uk.net/.

29.

Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. MIXED METHODS APPRAISAL TOOL (MMAT) VERSION 2018 User guide [Internet]. Canada: Canadian Intellectual Property Office, Industry Canada; #1148552, 2018. Available from: http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf.

30.

Evans C, Tweheyo R, Mcgarry J, Eldridge J, Albert J, Nkoyo V, et al. Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting. BMJ Open. 2019. https://doi.org/10.1136/bmjopen-2018-027452.CrossRefPubMedPubMedCentral

31.

Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gülmezoglu M, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med. 2015. https://doi.org/10.1371/journal.pmed.1001895.CrossRefPubMedPubMedCentral

32.

Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, et al. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. Health Serv Deliv Res. 2013. https://doi.org/10.3310/hsdr01120.CrossRef

33.

Tso LS, Best J, Beanland R, Doherty M, Lackey M, Ma Q, et al. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS. 2016;30(10):1639–53.CrossRef

34.

Joanna Briggs Institute. Appendix 2.3: JBI Qualitative data extraction tool—JBI Reviewer’s Manual—JBI GLOBAL WIKI [Internet]. 2019 [cited 2020 Jan 11]. Available from: https://wiki.joannabriggs.org/display/MANUAL/Appendix+2.3%3A+JBI+Qualitative+data+extraction+tool.

35.

Dixon-Woods M. Using framework-based synthesis for conducting reviews of qualitative studies. BMC Med. 2011;9:9–10.CrossRef

36.

George MS, Pant S, Devasenapathy N, Ghosh-Jerath S, Zodpey SP. Motivating and demotivating factors for community health workers: a qualitative study in urban slums of Delhi, India. WHO South-East Asia J Public Health. 2017;6(1):82–9.CrossRef

37.

Sarma H, Uddin MF, Islam MA, Rahman M, Aaron GJ, Harbour C, et al. Use of concurrent evaluation to improve implementation of a home fortification programme in Bangladesh: a methodological innovation. Public Health Nutr. 2020. https://doi.org/10.1017/S1368980020000865.CrossRefPubMedPubMedCentral

38.

Laston SL, Hel Baqui A, Paljor N. Urban volunteer service in the slums of Dhaka: community and volunteer perceptions. Bangladesh; 1993. Report No.: Working Paper no. 41.

39.

Goudet S, Griffiths PL, Wainaina CW, Macharia TN, Wekesah FM, Wanjohi M, et al. Social value of a nutritional counselling and support program for breastfeeding in urban poor settings, Nairobi. BMC Public Health. 2018;18(1):424.CrossRef

40.

Alam K, Tasneem S, Oliveras E. Performance of female volunteer community health workers in Dhaka urban slums. Soc Sci Med. 2012;75(3):511–5. https://doi.org/10.1016/j.socscimed.2012.03.039.CrossRefPubMed

41.

Swartz A, Colvin CJ. ‘It’s in our veins’: caring natures and material motivations of community health workers in contexts of economic marginalisation. Crit Public Health. 2015;25(2):139–52.CrossRef

42.

Odhiambo GO, Musuva RM, Odiere MR, Mwinzi PN. Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, Western Kenya. BMC Public Health. 2016;16(1):986. https://doi.org/10.1186/s12889-016-3662-0.CrossRefPubMedPubMedCentral

43.

Aseyo RE, Mumma J, Scott K, Nelima D, Davis E, Baker KK, et al. Realities and experiences of community health volunteers as agents for behaviour change: evidence from an informal urban settlement in Kisumu, Kenya. Hum Resour Health. 2018;16(1):1–12.CrossRef

44.

Boros AK. Clinics and home-based care organisations: an interface between the formal and informal health sectors. Afr J AIDS Res. 2011;9(4):315–24.CrossRef

45.

Osindo J, Bakibinga P, Ngomi N, Kamande E, Muriuki P, Kyobutungi C. Challenges and opportunities for promoting maternal, new born, and child health in urban informal settlements: perspectives of community health volunteers in Nairobi, Kenya. Afr Popul Stud. 2016;30(3):3124–32.

46.

Lopes DMQ, Beck CLC, Cassol Prestes F, Weiller HT, Colomé JS, Mafaccioli da Silva G. Experiences of pleasure and distress. Rev Esc Enferm USP. 2012;46(3):630–7.

47.

Karuga RN, Mireku M, Muturi N, McCollum R, Vallieres F, Kumar M, et al. Supportive supervision of close-to-community providers of health care: findings from action research conducted in two counties in Kenya. PLoS ONE. 2019;14(5):1–19. https://doi.org/10.1371/journal.pone.0216444.CrossRef

48.

Goudet S, Wainaina CW, Macharia TN, Wanjohi MN, Wekesah FM, Muriuki P, Samburu B, Griffiths PL, Kimani-Murage EW. Social Return on Investment (SROI) assessment of a Baby-Friendly Community Initiative in urban poor settings, Nairobi, Kenya. Field Exch. 2016;(Field Exchange 52):41. Available from: https://www.ennonline.net/fex/52/sroibabyfriendlyurbanpoor.

49.

Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S, Shrestha V. The female community health volunteer programme in Nepal: decision makers’ perceptions of volunteerism, payment and other incentives. Soc Sci Med. 2010;70(12):1920–7.CrossRef

50.

Sarma HI, Jabeen I, Khan Luies S, Fakhar Uddin M, Ahmed T, Bossert TJ, et al. Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: a qualitative investigation. PLoS ONE. 2020. https://doi.org/10.1371/journal.pone.0230709.CrossRefPubMedPubMedCentral

51.

Alcock GA, More NS, Patil S, Porel M, Vaidya L, Osrin D. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. https://doi.org/10.1093/her/cyp038.CrossRefPubMedPubMedCentral

52.

Ashwell HE, Barclay L. Outcome evaluation of community health promotion intervention within a donor funded project climate in Papua New Guinea. Rural Remote Health. 2009. https://doi.org/10.22605/RRH1219.CrossRefPubMed

53.

Kaler A, Watkins SC. Disobedient distributors: street-level bureaucrats and would-be patrons in community-based family planning programs in rural Kenya. Stud Fam Plan. 2001;32(3):254–69. https://doi.org/10.1111/j.1728-4465.2001.00254.x.CrossRef

54.

Nankunda J, Tumwine JK, Soltvedt Å, Semiyaga N, Ndeezi G, Tylleskär T. Community based peer counsellors for support of exclusive breastfeeding: experiences from rural Uganda. Int Breastfeed J. 2006. https://doi.org/10.1186/1746-4358-1-19.CrossRefPubMedPubMedCentral

55.

Daniels K, Nor B, Jackson D, Ekström EC, Doherty T. Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study. Hum Resour Health. 2010;8(1):6. https://doi.org/10.1186/1478-4491-8-6.CrossRefPubMedPubMedCentral

56.

Sunguya BF, Mlunde LB, Ayer R, Jimba M. Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review. Malar J. 2017;16(1):1–14.CrossRef

57.

Curtis P, Woodhill R, Stapleton H. The peer-professional interface in a community-based, breast feeding peer-support project. Midwifery. 2007;23(2):146–56.CrossRef

58.

Woodgate R, Heaman M, Chalmers K, Brown J. Issues related to delivering an early childhood home-visiting program. MCN Am J Matern Nurs. 2007;32(2):95–101.CrossRef

59.

Rashid SF, Hadi A, Afsana K, Ara BS. Acute respiratory infections in rural Bangladesh: cultural understandings, practices and the role of mothers and community health volunteers. Trop Med Int Health. 2001;6(4):249–55.CrossRef

60.

Nankunda J, Tumwine JK, Soltvedt Å, Semiyaga N, Ndeezi G, Tylleskär T. Community based peer counsellors for support of exclusive breastfeeding: experiences from rural Uganda. Int Breastfeed J. 2006;1(1):19. https://doi.org/10.1186/1746-4358-1-19.CrossRefPubMedPubMedCentral

Title: Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review
Authors: Michael Ogutu
Kui Muraya
David Mockler
Catherine Darker
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Human Resources for Health / Issue 1/2021
Electronic ISSN: 1478-4491
DOI: https://doi.org/10.1186/s12960-021-00691-z

At a glance: The STEP trials

Springer Medicine

Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Characterization and distribution of medicine vendors in 2 states in Nigeria: implications for scaling health workforce and family planning services

Becoming a resident in a high demanded medical specialty: an unequal race? Evidence from the Spanish resident market

Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare

The State of the World’s Midwifery 2021 report: findings to drive global policy and practice

Reflecting on the current scenario and forecasting the future demand for medical doctors in South Africa up to 2030: towards equal representation of women

Correction to: Optimizing the contributions of nursing and midwifery workforces: #Protect, #Invest, #Together