Performance of community health workers: situating their intermediary position within complex adaptive health systems

Human Resources for Health

Review

Jacqueline E. W. Broerse¹  Miriam Taegtmeyer²  Sally Theobald²  Marjolein Dieleman³  Hermen Ormel³  Maryse C. Kok³ 

[1] Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, De Boelelaan 1081, 1081 HV, Amsterdam, The Netherlands;Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, United Kingdom;KIT

[2]  Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands;

关键词: Community health workers;    Performance;    Low- and middle-income countries;    Complex adaptive systems;   

DOI  :  10.1186/s12960-017-0234-z

 received in 2016-10-20, accepted in 2017-08-24,  发布年份 2017

来源: Springer

【 摘 要 】

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts (two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software. Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs’ feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs’ perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships, power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improve.

【 授权许可】

CC BY   
© The Author(s). 2017