Human Resources for Health: Setting the global research agenda for community health systems

22 March, 2019

Dear HIFA colleagues,

This study finds: 'Research gap areas... include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs.'

Citation, abstract and a comments/questions from me below.

CITATION: Setting the global research agenda for community health systems: literature and consultative review

Smisha Agarwal, Karen Kirk, Pooja Sripad, Ben Bellows, Timothy Abuya and Charlotte Warren

Human Resources for Health 2019 17:22

https://doi.org/10.1186/s12960-019-0362-8

ABSTRACT

Background: Globally, there is renewed interest in and momentum for strengthening community health systems, as also emphasized by the recent Astana Declaration. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This review aims to propose a global research agenda to strengthen CHW programs.

Methods and results: We conducted a search for extant systematic reviews on any intermediate factors affecting the effectiveness of CHW programs in February 2018. A total of 30 articles published after year 2000 were included. Data on research gaps were abstracted and summarized under headings based on predominant themes identified in the literature. Following this data gathering phase, two technical advisory groups comprised of experts in the field of community health—including policymakers, implementors, researchers, advocates and donors—were convened to discuss, validate, and prioritize the research gaps identified.

Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time.

Conclusions: As international interest and investment in CHW programs and community health systems continue to grow, it becomes critical not only to analyze the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based. Generally, the literature places a strong emphasis on the need for higher quality, more robust research.

--

Comments/questions (NPW):

1. This list of evidence gaps appears to span most if not all the areas of CHW programming and I couldn't see an acknowledgement of areas that are well researched.

2. The authors 'used a “snowball” technique, where one article led to the discovery of additional reports'. As a general question, what are the pros and cons of such an approach as compared with, say, systematic review?

3. What does this review add to the recent systematic reviews conducted in association with the development of the recent WHO guideline on optimising CHW programmes?

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org