Who is a community health worker? – a systematic review of definitions

Abstract

Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. Design: A systematic review of peer-reviewed papers and grey literature. Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. Conclusions: This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.

Experiences of households using municipal ward-based primary health care outreach teams in Kwa-Zulu Natal, South Africa: a cross-sectional survey

“…CHWs are often either selected by community members and leaders, a relevant unit within the Department of Health, 29 or, in some cases, by the facility management and non-governmental organisations. 30 However, there is need to review the skill set and functions of CHWs in the context of outreach teams. Generally, the educational qualification of CHWs into three categories; firstly, individuals with little or no formal education who have undergone a few days' or a week of training; secondly, individuals with some form of secondary education and sub-sequent job-related pre-service training outside a recognised institution; and lastly, individuals with some form of secondary education and sub-sequent pretraining of a few months to a year at a recognised institution.…”

“…Generally, the educational qualification of CHWs into three categories; firstly, individuals with little or no formal education who have undergone a few days' or a week of training; secondly, individuals with some form of secondary education and sub-sequent job-related pre-service training outside a recognised institution; and lastly, individuals with some form of secondary education and sub-sequent pretraining of a few months to a year at a recognised institution. 30 It remains to be seen how the training and functions of CHWs will evolve as heterogeneous outreach teams become more prevalent in sub-Saharan Africa.…”

Categorization of Factors Influencing Community Health Workers from a Socio-Technical Systems Perspective

“…Among the key challenges presented in the study, the definition and optimization of the impact of the CHWs' roles are highlighted as an influence on CHW performance. Also, [3] argues that government and non-governmental institutions are continuously adding functions and tasks to CHWs, which buttresses the need to inform the type of tasks and position they hold within the healthcare system through competency-based or educational qualification rather than on functionalities. In most LMICs such as South Africa, the roles and responsibilities of CHWs with regards to technical and social capital is limited and yet to be understood [11].…”

“…Given South Africa's limited resources, the need for costeffective strategies is paramount. Recent studies [3,4] identify an adequately competent workforce with multi-faceted roles as having the potential to relieve some of the healthcare system burdens by bridging the healthcare equity gap.…”

Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

“…They are employed to mitigate the ongoing professional health workforce shortages in South Africa [2,3]. In addition, they facilitate linkage between communities most in need and PHC facilities, thereby increasing access to basic health services and contributing to improved health [2,3,[7][8][9][10][11][12].…”