Skip to main content

Table 10 Summary findings on health system integration

From: What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers

Topic Summary of findings
Integration with the health system is essential for having strong programs • Integration and cooperation with the broader health system and existing healthcare providers was the most frequently cited enabling factor for CHW programs in one review [23] and discussed as a vital enabler in many other reviews [15, 19, 20, 35, 38, 47, 48].
• The lack of a national CHW policy has been linked to:
  • Inadequate support and recognition for CHWs, which limits their ability to function effectively in the community;
  • Issues around role definition (e.g., whether CHWs should treat illnesses and prescribe medications) [24].
Scaling up and integrating CHW programs with health systems has risks and pitfalls • A national CHW policy by itself is insufficient; the health system needs to be equipped to supervise, support, and incentivize CHWs [24].
• Scaled-up, integrated CHW programs are often less effective than small, NGO CHW programs because insufficient attention is given to maintaining the quality of the training, supervision, and motivation of CHWs in scaled-up programs [42].
• Integration with a dysfunctional health system can erode CHW programs [35].
Integration with health systems should be built on collaborative, respectful relationships • Integration must foster respectful collaboration and trust between CHWs and the health system, and it can be facilitated by role clarity and effective two-way communication [15] (potentially supported by mHealth [44]).
• The less hierarchical and the more collaborative are relationships between CHWs and the health system, the greater is the likelihood of benefitting from the unique, practical knowledge that CHWs have [19]; moreover, these collaborative relationships can support CHW retention [19, 24, 38].
• Engagement with stakeholders (policymakers, government officials, civil society and communities) fosters integration by enhancing acceptability and credibility of the CHW program [38].