Why is it important?
Community health workers (CHW) 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 marginalized groups.”
This paper is important because it considers whether CHW programmes contribute positively to a more equitable health system, while also detailing considerations which have the potential to improve equity further by extending access to more people and bringing health services closer to communities.
Additional information in this paper enriches the 3MDG review previously published on the website, which examined community based health care interventions and programmes and the implications for the 3MDG Fund transition in Delta and Magway townships.
Uncovering the conditions under which these programmes are most successful in improving access to health is critical for ensuring sustainability of CHW programmes beyond the lifetime of the 3MDG Fund.
What is it about?
The authors, McCollum et al, undertake the first systematic review of 34 papers which consider how the introduction of a CHW programme improved access to health across residence, gender, socioeconomic status, level of education and disability for MNCH and HIV, TB and malaria interventions around the world. Their conclusion was that CHW did improve uptake of services:
“We found that CHW programmes across diverse contexts promote more equitable access and use of CHW services at household level and have the potential to contribute towards improved uptake of referral for health facility services. CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level.”
However, the potential for these programmes to improve health equity is dependent on a number of different factors, which must be taken into account by policymakers and implementers. This includes recruiting staff locally, and ensuring payment, supply and support to community health workers is sustainable and consistent.
What are the next steps?
This paper adds critical evidence to the 3MDG review paper, which outlines concrete steps and issues that need to be addressed in order to institutionalize a successful community based health care programme. Together, these papers can form the basis for dialogue with the Ministry of Health and other stakeholders for future planning and programming. This paper recommends that equity indicators be included in routine monitoring, which was not considered by 3MDG but could be an important future development.
