The role of community health worker-based care in post-conflict settings: a systematic review

Abstract

Countries affected by conflict often experience the deterioration of health system infrastructure and weakened service delivery. Evidence suggests that healthcare services that leverage local community dynamics may ameliorate health system-related challenges, however, little is known about implementing these interventions in contexts where formal delivery of care is hampered subsequent to conflict. We reviewed the evidence on community health worker (CHW)-delivered healthcare in conflict-affected settings and synthesized reported information on the effectiveness of interventions and characteristics of care delivery. We conducted a systematic review of studies in OVID MedLine, Web of Science, Embase, Scopus, CINHAL, and Google Scholar databases. Included studies (1) described a context that is post-conflict, conflict-affected, or impacted by war or crisis; (2) examined the delivery of healthcare by CHWs in the community; (3) reported a specific outcome connected to CHWs or community-based healthcare (CBHC); (4) were available in English, Spanish, or French; and (5) were published between 1 January 2000 and 6 May 2021. We identified 1976 articles, of which 55 met the inclusion criteria. Nineteen countries were represented, and five categories of disease were assessed. Evidence suggests that CHW interventions not only may be effective but also efficient in circumventing the barriers associated with access to care in conflict-affected areas. CHWs may leverage their physical proximity and social connection to the community they serve to improve care by facilitating access to care, strengthening disease detection, and improving adherence to care. Specifically, case management (e.g. integrated community case management) were was documented to be effective in improving a wide range of health outcomes and should be considered as a strategy to reduce barrier to access in hard-to-reach areas. Furthermore, task-sharing strategies have been emphasized as a common mechanism for incorporating CHWs into health systems

Mapping and analysing community health worker programmes in the Eastern Mediterranean region

“…Hence, CHWs can not only play an important service delivery role, but can also facilitate access to health services' to communities in times of crisis, where such access may otherwise be hampered by mistrust, lack of communication and other barriers. Internationally, the important role that CHWs can play in health crises and pandemics is increasingly being recognised 28,29 . In a recent international review of the role CHWs can play in post‐conflict settings, Werner et al found “four key functions of CHWs in healthcare delivery in post‐conflict settings including (1) access to care and treatment coverage, (2) case management and adherence support, (3) disease detection and monitoring and (4) scaling up of services” 29 (p267) – the latter through facilitating access to services and through task shifting and task sharing.…”

“…Internationally, the important role that CHWs can play in health crises and pandemics is increasingly being recognised 28,29 . In a recent international review of the role CHWs can play in post‐conflict settings, Werner et al found “four key functions of CHWs in healthcare delivery in post‐conflict settings including (1) access to care and treatment coverage, (2) case management and adherence support, (3) disease detection and monitoring and (4) scaling up of services” 29 (p267) – the latter through facilitating access to services and through task shifting and task sharing. However, more systematic research and policy action is needed to better understand the role CHWs have been playing and can play during health emergencies and in rebuilding health systems after conflicts, both globally and in the Eastern Mediterranean Region, and to advance policy solutions that support their roles.…”

Effectiveness of decentralizing outpatient acute malnutrition treatment with community health workers and a simplified combined protocol: a cluster randomized controlled trial in emergency settings of Mali

“…The present study shows that using the ComPAS simplified protocol and adding CHWs as treatment providers outside health facilities in emergency settings can effectively improve SAM coverage while maintaining effectiveness and reducing expenditures on nutritional intrants. A recent systematic review of post-conflict situations stated that in contexts with high disease burdens and weak infrastructure, CHWs are key actors in increasing access to basic healthcare ( 58 ). The present study showed a significant increase in SAM coverage in the groups that incorporated CHWs.…”

Global Emergency Medicine: A Scoping Review of the Literature from 2022

“…Their clinical prediction score has the potential to significantly improve Ebola screening procedures in resource‐limited environments that may lack laboratory facilities. Finally, the systematic review by Werner et al 39 . systematic review demonstrated that community health workers can improve health outcomes in postconflict settings by providing essential health care services to difficult‐to‐reach populations.…”