Abstract:
Background: Developing countries have the potential to reach vulnerable and underserved
populations marginalized by the country’s health care systems by way of community health workers
(CHWs). It is imperative that health care systems focus on improving access to quality continuous
primary care through the use of CHWs while paying attention to the factors that impact on
CHWs and their effectiveness.
Objective: To explore the possible opportunities and challenges of integrating CHWs into the
health care systems of developing countries.
Methods: Six databases were examined for quantitative, qualitative, and mixed-methods studies
that included the integration of CHWs, their motivation and supervision, and CHW policy
making and implementation in developing countries. Thirty-three studies met the inclusion criteria
and were double read to extract data relevant to the context of CHW programs. Thematic coding
was conducted and evidence on the main categories of contextual factors influencing integration of
CHWs into the health system was synthesized.
Results: CHWs are an effective and appropriate element of a health care team and can assist in
addressing health disparities and social determinants of health. Important facilitators of integration
of CHWs into health care teams are support from other health workers and inclusion of CHWs in
case management meetings. Sustainable integration of CHWs into the health care system requires
the formulation and implementation of polices that support their work, as well as financial and
nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable
workload.
Conclusions: For sustainable integration of CHWs into health care systems, high-performing
health systems with sound governance, adequate financing, well-organized service delivery, and
adequate supplies and equipment are essential. Similarly, competent communities could contribute
to better CHW performance through sound governance of community resources, promotion
of inclusiveness and cohesion, engagement in participatory decision making, and mobilization of
local resources for community welfare.
