Setting the global research agenda for community health systems: literature and consultative review View Full Text


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Article Info

DATE

2019-12

AUTHORS

Smisha Agarwal, Karen Kirk, Pooja Sripad, Ben Bellows, Timothy Abuya, Charlotte Warren

ABSTRACT

BACKGROUND: Globally, there is renewed interest in and momentum for strengthening community health systems, as also emphasized by the recent Astana Declaration. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This review aims to propose a global research agenda to strengthen CHW programs. METHODS AND RESULTS: We conducted a search for extant systematic reviews on any intermediate factors affecting the effectiveness of CHW programs in February 2018. A total of 30 articles published after year 2000 were included. Data on research gaps were abstracted and summarized under headings based on predominant themes identified in the literature. Following this data gathering phase, two technical advisory groups comprised of experts in the field of community health-including policymakers, implementors, researchers, advocates and donors-were convened to discuss, validate, and prioritize the research gaps identified. Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time. CONCLUSIONS: As international interest and investment in CHW programs and community health systems continue to grow, it becomes critical not only to analyze the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based. Generally, the literature places a strong emphasis on the need for higher quality, more robust research. More... »

PAGES

22

References to SciGraph publications

  • 2013-12. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review in BMC PUBLIC HEALTH
  • 2011-12. Health workforce skill mix and task shifting in low income countries: a review of recent evidence in HUMAN RESOURCES FOR HEALTH
  • 2013-12. Editorial: can China master the guideline challenge? in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2018-12. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers in HUMAN RESOURCES FOR HEALTH
  • 2012-12. Scaling-up malaria treatment: a review of the performance of different providers in MALARIA JOURNAL
  • 2015-12. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2016-12. How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review in BMC PUBLIC HEALTH
  • 2009-12. Are vaccination programmes delivered by lay health workers cost-effective? A systematic review in HUMAN RESOURCES FOR HEALTH
  • 2013-12. A review of generalist and specialist community health workers for delivering adolescent health services in sub-Saharan Africa in HUMAN RESOURCES FOR HEALTH
  • 2009-12. Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2013-12. Developing the national community health assistant strategy in Zambia: a policy analysis in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2012-12. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment in HUMAN RESOURCES FOR HEALTH
  • 2008-12. Motivation and retention of health workers in developing countries: a systematic review in BMC HEALTH SERVICES RESEARCH
  • 2015-12. Costs and cost-effectiveness of community health workers: evidence from a literature review in HUMAN RESOURCES FOR HEALTH
  • 2009-12. Is U.S. health care an appropriate system? A strategic perspective from systems science in HEALTH RESEARCH POLICY AND SYSTEMS
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    41 schema:description BACKGROUND: Globally, there is renewed interest in and momentum for strengthening community health systems, as also emphasized by the recent Astana Declaration. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This review aims to propose a global research agenda to strengthen CHW programs. METHODS AND RESULTS: We conducted a search for extant systematic reviews on any intermediate factors affecting the effectiveness of CHW programs in February 2018. A total of 30 articles published after year 2000 were included. Data on research gaps were abstracted and summarized under headings based on predominant themes identified in the literature. Following this data gathering phase, two technical advisory groups comprised of experts in the field of community health-including policymakers, implementors, researchers, advocates and donors-were convened to discuss, validate, and prioritize the research gaps identified. Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time. CONCLUSIONS: As international interest and investment in CHW programs and community health systems continue to grow, it becomes critical not only to analyze the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based. Generally, the literature places a strong emphasis on the need for higher quality, more robust research.
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