Community health workers and health equity in low‑ and middle‑income countries: systematic review and recommendations for policy and practice

Sonia Ahmed, Liana E. Chase, Janelle Wagnild, Nasima Akhter, Scarlett Sturridge, Andrew Clarke, Pari Chowdhary, Diana Mukami, Adetayi Kasim, Kate Hampshire

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Background: The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing
health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW
programmes achieve this. This systematic review aimed to synthesise research fndings on the following questions:
(1) How efective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What
evidence exists on whether and how these programmes reduce health inequities in the populations they serve?
Methods: We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access,
utilisation, quality, and efects on health outcomes/behaviours in relation to potential stratifers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted,
tabulated, and subjected to meta-analysis where appropriate. Qualitative fndings were synthesised using thematic
Results: One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups,
but that health inequalities often persist in the populations they serve. Qualitative fndings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for
improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and
expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps.
Conclusion: In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs
as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policymakers to confront and address the underlying structures of inequity
Original languageEnglish
Article number49
Number of pages30
JournalInternational Journal for Equity in Health
Publication statusPublished - 11 Apr 2022


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