Effectiveness of community health workers (CHWS) in the provision of basic preventive and curative maternal, newborn and child health (MNCH) interventions:

Abstract

Due to a shortage of health workers, many low income countries rely on community health workers (CHWs) for the provision of a wide range of primary health care services, both curative and preventive, including maternal newborn and child health (MNCH) interventions. Several systematic reviews have analysed the contribution of CHWs although none has specifically focused on their role in relation to MNCH. This review was designed to find evidence of the effectiveness of CHWs in providing basic preventive and curative MNCH interventions, and to identify the factors that are crucial to their performance. It was restricted to articles published from 1998-2008 in the English language. It included studies with qualitative and quantitative designs. Six electronic databases were searched and data was extracted using a pretested data extraction form designed basing on the Centre for Reviews and Dissemination (CRD) guidelines (2008). A narrative synthesis approach was used. The quality of included studies was assessed using pretested validity assessment tools and the applicability of interventions was evaluated using the RE-AIM framework. After the filtering, 14 studies were critically appraised, and the majority (12/14) demonstrated that CHWs were effective at reducing neonatal/child mortality rates; promoting breastfeeding practices; increasing sulfadoxine-pyrimethamine (SP) coverage for intermittent preventive treatment of malaria in pregnancy (IPTp); they provided depot medroxyprogesterone acetate (DMPA) injections as safely as qualified staff; and treated malaria in children effectively, thereby reducing workload of health professionals at peripheral health facilities. Crucial factors to their performance included training, remuneration, inadequate medical supplies, and lack of career development structure. The review shows that CHWs can be effective at providing basic curative and preventive MNCH interventions. Developing country health systems can make use of this available resource to increase access of MNCH interventions.