by Feza Kikaya, Communications Assistant, USAID Health Care Improvement Project
June 21, 2012
Three URC staff participated in a U.S. Government-sponsored evidence summit on community health workers (CHWs) this month. Organized by the US Agency for International Development (USAID), the summit convened experts to examine community and formal health system activities that support and improve the performance of CHWs in low- and middle-income countries (LMICs). The experts used evidence—peer-reviewed and “gray” literature, including randomized controlled trial (RCT) studies, case control studies, qualitative studies, and evaluation reports—to identify research priorities and develop recommendations for policy and practice.
The global shortage of skilled, motivated, and supported health care workers is recognized as a significant barrier to reaching health-related Millennium Development Goals. To improve access to care amid the shortage, many LMIC governments rely on CHWs, who can reach populations not served by a country’s more formal health care system.
USAID Health Care Improvement Project (HCI) Senior Quality Improvement Advisors Ms. Lauren Crigler, Mr. Ram Shrestha, and Dr. Tana Wuliji were invited to participate in one of three evidence review teams (ERTs). Comprising no more than 20 reviewers, each ERT addressed specific focal questions to assess the literature on the effectiveness of activities that support CHW programs.
Mr. Shrestha noted that many ERT members were surprised to discover how little evidence exists that demonstrates that community and facility support improves CHWs’ performance. Ms. Crigler also pointed out this deficiency, saying, “We were looking for a linear- and RCT-type of evidence in a field in which results are better captured through operations research and programmatic experience.” She added that “capturing the effectiveness of systems support in a scaled-up environment is a costly and complex task, and most research that we found was focused on single intervention or pilot experiences.”
During the summit, ERTs presented synthesis papers with preliminary findings and recommendations for participants to review. Dr. Wuliji, Vice Chair of the ERT on community and formal health system support activities, stated that links between support activities were essential given that no one system could provide all the support needed to enable CHWs to perform to their potential. She also noted the importance of joint formal health systems and country ownership of CHW programs, without which effective support for CHW performance may not be scalable or sustainable.
At the summit’s conclusion, attendees made recommendations and proposed the next steps needed to develop a research agenda that will address gaps in the evidence base and inform LMIC governments and donors how to effectively support CHWs. Mr. Shrestha recommended quality improvement as one approach; it could be used to both improve the effectiveness of support systems for CHWs and document the results of the improvement efforts.