Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries

BMC Public Health

Anna-Karin Hurtig²  Charles Michelo¹  John Kinsman²  Joseph Mumba Zulu² 

[1] Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia;Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden

关键词: Low- and middle-income countries;    Health systems;    Integration;    National community-based health worker programmes;   

Others  :  1126745
DOI  :  10.1186/1471-2458-14-987

 received in 2014-06-12, accepted in 2014-09-15,  发布年份 2014

【 摘 要 】

Background

Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking.

Methods

We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process.

Results

Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries’ human resources for health problems and the associated discourses about how to address these problems; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems’ governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures.

Conclusions

CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.

【 授权许可】

   
2014 Zulu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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