Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review

• Published in: Health policy and planning 2018-12, Vol.33 (10), p.1128-1143
• Main Authors: Woldie, Mirkuzie, Feyissa, Garumma Tolu, Admasu, Bitiya, Hassen, Kalkidan, Mitchell, Kirstin, Mayhew, Susannah, McKee, Martin, Balabanova, Dina
• Format: Article
• Language: English
• Subjects: Access; Backing; Community; Community health care; Community Health Workers; Community volunteers; Complex tasks; Counseling; Data quality; Developing Countries; Extraction; Health services; Health Services Accessibility; Humans; Inservice training; Libraries; Medical diagnosis; Medical personnel; Ownership; Patient Acceptance of Health Care; Qualitative analysis; Quality assessment; REVIEWS; Search methods; Search strategies; Supervision; Systematic review; Task complexity; Task performance; Volunteers; Workers
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czy094

A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low-and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as ‘systematic’if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers. Un certain nombre d’études préliminaires et de revues systématiques ont mis l’accent sur la contribution des agents de santé communautaires (ASC) dans le cadre de la prestation des services de santé essentiels. Dans de nombreux pays, un groupe d’agents de santé informels fournit également des services sur une base volontaire [agents de santé communautaires bénévoles (CHV)], mais on ne dispose d’aucune synthèse d’études portant sur leur rôle et leur contribut