This blog post is an excerpt from Community Health Workers: The State of the Evidence, 2021, written by Elijah Olivas and Hannah Marcus, and edited by Jaime Holbrook.
Community health workers play a critical role in maintaining and improving individual and collective health outcomes. Yet their contributions and potential remain under-recognized and CHW programs underfunded. By sharing learning and improving accessibility to the evidence, CHW Central promotes and supports CHWs, program managers, and policy makers to make the case for improved investment in and working conditions for the CHW workforce.
Every year, CHW Central collects and makes available in our resource database as many resources related to CHWs—articles, gray literature, tools—as we can find. In 2021, we found 442 resources. That’s a lot of information—far too much for most program managers, CHWs, or researchers to go through. To make the scope of evidence more accessible, this brief state of the evidence report summarizes the nature and key findings of the CHW research, tools, and other resources published in 2021.
With the support of the Network of the National Libraries of Medicine, CHW Central partnered with a librarian at the Tufts University Medical Library to develop a search strategy. The librarian and CHW Central interns searched Medline (PubMed), Google Scholar, MedNar, Cochrane Database of Systematic Reviews, World Wide Science, and WHO Global Index Medicus for peer-reviewed and gray literature in English relating to CHWs.
To organize the evidence and relate it to existing global guidelines for CHW programs, we grouped the evidence into four themes: competency development; CHW support structures; logistics of CHW work; intervention or services; and policy and systems structure. The first three themes are organized around the 15 recommendation
areas outlined in the WHO Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes (2018). The fourth reflects the research priorities advocated for in the same document particularly related to CHW training and development, and additional topics covered in the 2021 literature.
The impact of the COVID-19 pandemic on CHW programs was a major focus of analysis and advocacy in 2021.The pandemic disrupted supply chains, strained CHWs by adding to their workload, and compromised data collection and use. However, the pandemic also highlighted the resiliency of CHWs and their importance which
resulted in some countries in an infusion of funding for primary health care, CHWs and other community-based initiatives.
The pandemic also highlighted the lack of prioritization of CHW programming by national governments. Despite more resources being directed to public health, governments underestimated the potential for CHWs to assist and funding for CHW programs decreased as a proportion of overall health budgets. Additionally, although
several publications focused specifically on interventions to combat COVID-19, most included only a brief mention of the role of CHWs in implementing these interventions (mostly community-based outreach). For instance, one resource described strategies for adapting CHW programs to the new context of the pandemic, including expanding CHWs’ scope of work to relieve the burden on hospitals and clinics.
Among the most comprehensive and useful publications in 2021 was a series of 11 papers edited by Zulu and Perry. These papers cover topics ranging from CHW program governance to CHW relationships with health systems and communities.
Full Report available at: CHW Central State of the Evidence 2021.
Masis, L., Gichaga, A., Zerayacob, T., Lu, C., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst, 19(suppl 3). https://doi.org/10.1186/s12961-021-00751-9
Schleiff, M. J., Aitken, I., Alam, M. A., Damtew, Z. A., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Res Policy Syst, 19(suppl 3).
Zulu, J., & Perry, H. (2021). Community health workers at the dawn of a new era. Health Research Policy And Systems, 19(S3). https://doi.org/10.1186/s12961-021-00761-7