Community health workers and health equity in low- and middle-income countries
Citation: Ahmed S, Chase LE, Wagnild J, et al. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. International Journal for Equity in Health. 2022;21(1):49.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: GlaxoSmithKline.
What is this? Community health workers are widely used as a means to reduce health inequity in low- and middle-income countries (LMICs).
In this systematic review, the authors searched for studies of community health worker interventions conducted in LMICs. They restricted their searches to articles published in English after 2014 and did the search in early 2020. They included 167 studies.
What works: Community health workers successfully reached many marginalized groups that experienced barriers to accessing health services. However, the enhanced access did not always lead to better population health outcomes.
Despite addressing some barriers, community health workers did not seem to effectively reach all marginalized groups.
The impact of community health workers on health inequities might be overestimated by failing to recognize the importance of structural drivers on health inequities and might be underestimated when considered an instrumental intervention that would only increase healthcare provision capacity.
Findings from qualitative research suggested that disadvantaged groups experienced barriers to taking up advice from community health workers and referrals, and point to a range of strategies for improving the reach and impact of community health worker programmes for these groups.
Implications: The authors of the review concluded that building meaningful partnerships between community health workers, communities and policymakers will help to confront and address the underlying structures of inequity. They also stated that further research is needed to investigate the wellbeing of community health workers and to understand their role in service quality.
Other considerations: The authors of the review discussed their findings in the context of place of residence and occupation.
This summary was prepared by Joly Ghanawi, checked by Yasmeen Saeed and Cristián Mansilla, and finalized by Mike Clarke.