Who is a community health worker? – a systematic review of definitions

ABSTRACT

Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers.

Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers.

Design: A systematic review of peer-reviewed papers and grey literature.

Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried.

Conclusions: This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.

KEYWORDS:

• Lay health worker
• health workforce
• role
• scope of practice

Responsible Editor John Kinsman, Umeå University, Sweden

Responsible Editor John Kinsman, Umeå University, Sweden

Acknowledgments

We are grateful to Caroline Hercod for her assistance with retrieving papers that were not available in the searched databases and for editing the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval and patient consent were not necessary for this literature review.

Supplemental

Supplemental data for this article can be accessed here

Paper context

Community health worker (CHW) definitions and categories are nuanced differently within and across contexts and stakeholder groups. Our review utilised a methodical approach in identifying the common themes in the various CHW definitions and subsequently developed a competency-based definition and categories that accommodate the peculiarities of the various contexts. This categorisation may inform a common understanding within and across stakeholder groups and also guide community health policy making, programme planning, and research across contexts.

Additional information

Funding

The authors alone are responsible for the content and writing of this article. This work is part of the lead author’s PhD and no external funding was received.

Notes on contributors

Abimbola Olaniran

AO, RU, and NvdB contributed to the review design. AO and RU independently screened titles and abstracts and the full text for included papers. All authors were involved in the analysis of the data. AO prepared the initial draft of the manuscript and HS, RU, SB, and NvdB provided review comments. The final draft of the manuscript was prepared by AO, HS, and NvdB. All authors approved the final draft of the manuscript.

Helen Smith

AO, RU, and NvdB contributed to the review design. AO and RU independently screened titles and abstracts and the full text for included papers. All authors were involved in the analysis of the data. AO prepared the initial draft of the manuscript and HS, RU, SB, and NvdB provided review comments. The final draft of the manuscript was prepared by AO, HS, and NvdB. All authors approved the final draft of the manuscript.

Regine Unkels

AO, RU, and NvdB contributed to the review design. AO and RU independently screened titles and abstracts and the full text for included papers. All authors were involved in the analysis of the data. AO prepared the initial draft of the manuscript and HS, RU, SB, and NvdB provided review comments. The final draft of the manuscript was prepared by AO, HS, and NvdB. All authors approved the final draft of the manuscript.

Sarah Bar-Zeev

AO, RU, and NvdB contributed to the review design. AO and RU independently screened titles and abstracts and the full text for included papers. All authors were involved in the analysis of the data. AO prepared the initial draft of the manuscript and HS, RU, SB, and NvdB provided review comments. The final draft of the manuscript was prepared by AO, HS, and NvdB. All authors approved the final draft of the manuscript.

Nynke van den Broek

AO, RU, and NvdB contributed to the review design. AO and RU independently screened titles and abstracts and the full text for included papers. All authors were involved in the analysis of the data. AO prepared the initial draft of the manuscript and HS, RU, SB, and NvdB provided review comments. The final draft of the manuscript was prepared by AO, HS, and NvdB. All authors approved the final draft of the manuscript.