Contribution and Challenges of Community Health Workers in Achieving Sustainable Development Goals

Authors

DOI:

https://doi.org/10.55489/njcm.131220222525

Keywords:

sustainable development goals, Community Health Worker, Female Health Workers, Community health programs, Challenges

Abstract

Background: Community health workers (CHWs) are a renewed focus in the 2030 SDGs. CHWs support equitable coverage for preventive, promotive, and curative services as healthcare partners. This study aimed to identify the challenges of community health workers (CHWs) in achieving Sustainable Development Goals.

Methods: We searched PubMed, Google Scholar, Science Direct, Web of Science, etc., for the published articles between 2015 to 2022. Twenty publications and WHO documents met the inclusion criteria and were analysed and used in the study.

Results: Findings show that CHWs are valuable and cost-effective and have the potential to help achieve several SDGs. The top 10 issues faced by CHWs were listed in the research, including Lack of advancement chances, Excessive workload, Insufficient pay, Insufficient staff, Poor management culture, Lack of supervision, Poor interpersonal relationship with supervisors, limited access to technology, A lack of training and Reduced patient care time. The article also proposes critical activities to assist CHWs in achieving the SDGs.

Conclusions: CHWs are essential in health care delivery and help expand preventative, promotive, and curative services. Regular evaluation of CHWs' performance is critical for creating health policy and system support that optimizes the utilization of CHWs for SGDs.

References

Assembly U. Resolution adopted by the General Assembly on 10 October 2018: political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. A/RES/73/3; 2018.

Organization WHO. Working for health and growth: investing in the health workforce. 2016.

Ghebreyesus A. Address by Dr. Tedros Adhanom Ghebreyesus, Director-General. 2019.

Lehmann U, Sanders D. Community health workers: what do we know about them. The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers Geneva: World Health Organization. 2007:1-42.

Swider SM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs. 2002;19(1):11-20. Doi: https://doi.org/10.1046/j.1525-1446.2002.19003.x PMid:11841678

Perry HB, Chowdhury M, Were M, LeBan K, Crigler L, Lewin S, et al. Community health workers at the dawn of a new era: 11. CHWs leading the way to "Health for All". Health Res Policy Syst. 2021;19(3):1-21. Doi: https://doi.org/10.1186/s12961-021-00755-5 PMid:34641891 PMCid:PMC8506098

Figueiredo K, Gonçalves GA, Batista HM, Akerman M, Pinheiro WR, Nascimento VB. Actions of primary health care professionals to reduce maternal mortality in the Brazilian Northeast. International Journal for Equity in Health. 2018;17(1):1-8. Doi: https://doi.org/10.1186/s12939-018-0817-x PMid:30012155 PMCid:PMC6048753

Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. The Lancet. 2018;391(10134):2029-35. Doi: https://doi.org/10.1016/S0140-6736(18)30667-6 PMid:29627167

Acharya S, Lin V, Dhingra N. The role of health in achieving the sustainable development goals. Bull World Health Organ. 2018;96(9):591. Doi: https://doi.org/10.2471/BLT.18.221432 PMid:30262936 PMCid:PMC6154063

Organization WH. Optimizing the contributions of the nursing and midwifery workforce to achieve universal health coverage and the Sustainable Development Goals through education, research and practice. 2017.

Chotchoungchatchai S, Marshall AI, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Tangcharoensathien V. Primary health care and sustainable development goals. Bull World Health Organ. 2020;98(11):792. Doi: https://doi.org/10.2471/BLT.19.245613 PMid:33177776 PMCid:PMC7607463

Afzal MM, Pariyo GW, Lassi ZS, Perry HB. Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships. Health Res Policy Syst. 2021;19(3):1-17. Doi: https://doi.org/10.1186/s12961-021-00753-7 PMid:34641912 PMCid:PMC8506104

Tanser F, Gijsbertsen B, Herbst K. Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system. Soc Sci Med. 2006;63(3):691-705. Doi: https://doi.org/10.1016/j.socscimed.2006.01.015 PMid:16574290

Sacks E, Schleiff M, Were M, Chowdhury AM, Perry HB. Communities, universal health coverage and primary health care. Bull World Health Organ. 2020;98(11):773. Doi: https://doi.org/10.2471/BLT.20.252445 PMid:33177774 PMCid:PMC7607457

Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel. Journal of global health. 2017;7(1). Doi: https://doi.org/10.7189/jogh.07.010908 PMid:28685046 PMCid:PMC5475312

Scott VK, Gottschalk LB, Wright KQ, Twose C, Bohren MA, Schmitt ME, et al. Community health workers' provision of family planning services in low‐and middle‐income countries: A systematic review of effectiveness. Stud Fam Plann. 2015;46(3):241-61. Doi: https://doi.org/10.1111/j.1728-4465.2015.00028.x PMid:26347089

Mishra SR, Neupane D, Preen D, Kallestrup P, Perry HB. Mitigation of non-communicable diseases in developing countries with community health workers. Globalization and health. 2015;11(1):43. Doi: https://doi.org/10.1186/s12992-015-0129-5 PMid:26555199 PMCid:PMC4641398

Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The lancet. 2015;386(9993):569-624. Doi: https://doi.org/10.1016/S0140-6736(15)60160-X PMid:25924834

UNAIDS W. Global AIDS monitoring. Geneva: UNAIDS. 2017.

Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet global health. 2018;6(11):e1196-e252. Doi: https://doi.org/10.1016/S2214-109X(18)30386-3 PMid:30196093

Gilson L, Doherty J, Loewenson R, Francis V. Challenging Inequity Through Health Systems. Final Report of the Knowledge Network on Health Systems June 2007. 2007.

Wong KL, Benova L, Campbell OM. A look back on how far to walk: systematic review and meta-analysis of physical access to skilled care for childbirth in sub-Saharan Africa. PLoS One. 2017;12(9):e0184432. Doi: https://doi.org/10.1371/journal.pone.0184432 PMid:28910302 PMCid:PMC5598961

Barros AJ, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, França GV, et al. Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet. 2012;379(9822):1225-33. Doi: https://doi.org/10.1016/S0140-6736(12)60113-5 PMid:22464386

Perry HB. Engaging Communities for Improving Mothers' and Children's Health: reviewing the evidence of effectiveness in resource-constrained settings: [distributor] Edinburgh University Global Health Society; 2017.

Gwatkin DR, Wilcox JR, Wray JD. Can health and nutrition interventions make a difference. ODC monograph (USA). 1980. Doi: https://doi.org/10.2307/1965610

Sarin E, Lunsford SS. How female community health workers navigate work challenges and why there are still gaps in their performance: a look at female community health workers in maternal and child health in two Indian districts through a reciprocal determinism framework. Human resources for health. 2017;15(1):1-10. Doi: https://doi.org/10.1186/s12960-017-0222-3 PMid:28666447 PMCid:PMC5493888

Saprii L, Richards E, Kokho P, Theobald S. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Human resources for health. 2015;13(1):95. Doi: https://doi.org/10.1186/s12960-015-0094-3 PMid:26646109 PMCid:PMC4673775

Mori Junior R, Fien J, Horne R. Implementing the UN SDGs in universities: challenges, opportunities, and lessons learned. Sustainability: The Journal of Record. 2019;12(2):129-33. Doi: https://doi.org/10.1089/sus.2019.0004

Maher D, Cometto G. Research on community-based health workers is needed to achieve the sustainable development goals. Bull World Health Organ. 2016;94(11):786. Doi: https://doi.org/10.2471/BLT.16.185918 PMid:27821877 PMCid:PMC5096357

Shanthosh J, Durbach A, Joshi R. Charting the Rights of Community Health Workers in India: The Next Frontier of Universal Health Coverage. Health Hum Rights. 2021;23(2):225.

Johnson LJ, Schopp LH, Waggie F, Frantz JM. Challenges experienced by community health workers and their motivation to attend a self-management programme. African Journal of Primary Health Care & Family Medicine. 2022;14(1):9. Doi: https://doi.org/10.4102/phcfm.v14i1.2911 PMid:35144456 PMCid:PMC8831930

McConnell M, Mahajan M, Bauhoff S, Croke K, Verguet S, Castro MC, et al. How are health workers paid and does it matter? Conceptualising the potential implications of digitising health worker payments. BMJ Global Health. 2022;7(1):e007344. Doi: https://doi.org/10.1136/bmjgh-2021-007344 PMid:35078811 PMCid:PMC8796226

Manjunath U, Sarala R, Rajendra D, Deepashree M, Chokshi M, Mokashi T. Assessment of Workload of ASHAs: A Multi-stakeholder Perspective Study for Task-sharing and Task-shifting. Journal of Health Management. 2022:09720634221079084. Doi: https://doi.org/10.1177/09720634221079084

Olaniran A, Madaj B, Bar‐Zeev S, Banke‐Thomas A, van den Broek N. Factors influencing motivation and job satisfaction of community health workers in Africa and Asia-A multi‐country study. The International Journal of Health Planning and Management. 2022;37(1):112-32. Doi: https://doi.org/10.1002/hpm.3319 PMid:34476842

Joshi A, Pakhare A. A mixed method study on supportive supervision of Community Health Workers from Central India. 2022.

Deussom R, Mwarey D, Bayu M, Abdullah SS, Marcus R. Systematic review of performance-enhancing health worker supervision approaches in low-and middle-income countries. Human resources for health. 2022;20(1):1-12. Doi: https://doi.org/10.1186/s12960-021-00692-y PMid:34991608 PMCid:PMC8734232

Siddiqui S, Gonsalves PP, Naslund JA. Scaling up of mental health services in the digital age: The rise of technology and its application to low-and middle-income countries. Mental Health in a Digital World: Elsevier; 2022. p. 459-79. Doi: https://doi.org/10.1016/B978-0-12-822201-0.00004-6

Joshi U, Naslund JA, Anand A, Tugnawat D, Vishwakarma R, Bhan A, et al. Assessing costs of developing a digital program for training community health workers to deliver treatment for depression: A case study in rural India. Psychiatry Res. 2022;307:114299. Doi:https://doi.org/10.1016/j.psychres.2021.114299 PMid:34871874

Scott K, Ummer O, Chamberlain S, Sharma M, Gharai D, Mishra B, et al. At the frontlines of digitisation: a qualitative study on the challenges and opportunities in maintaining accurate, complete and timely digital health records in India's government health system. BMJ open. 2022;12(2):e051193. Doi: https://doi.org/10.1136/bmjopen-2021-051193 PMid:35140145 PMCid:PMC8830249

Schneider H, Zulu JM, Mathias K, Cloete K, Hurtig A-K. The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts. BMJ global health. 2019;4(3):e001645. Doi: https://doi.org/10.1136/bmjgh-2019-001645 PMid:31263592 PMCid:PMC6570980

Lewin S, Lehmann U, Perry HB. Community health workers at the dawn of a new era: 3. Programme governance. Health Res Policy Syst. 2021;19(3):1-12. Doi: https://doi.org/10.1186/s12961-021-00749-3 PMid:34641914 PMCid:PMC8506073

Pálsdóttir B, Barry J, Bruno A, Barr H, Clithero A, Cobb N, et al. training for impact: the socio-economic impact of a fit for purpose health workforce on communities. Human resources for health. 2016;14(1):1-9. Doi: https://doi.org/10.1186/s12960-016-0143-6 PMid:27523088 PMCid:PMC4983779

Odugleh-Kolev A, Parrish-Sprowl J. Universal health coverage and community engagement. Bull World Health Organ. 2018;96(9):660. Doi: https://doi.org/10.2471/BLT.17.202382 PMid:30262948 PMCid:PMC6154062

Campbell J. The route to effective coverage is through the health worker: there are no shortcuts. Lancet. 2013;381(9868):725. Doi: https://doi.org/10.1016/S0140-6736(13)60579-6 PMid:23472917

INTERNATIONAL PS, editor Contribution of Community Health Workers in attainment of the Sustainable Development Goals. The 1st International Symposium on Community Health Workers (CHWs) 2017; Kampala, Uganda: The global online knowledge library and campaign builder.

Perry HB, Hodgins S. Health for the people: past, current, and future contributions of national community health worker programs to achieving global health goals. Global Health: Science and Practice. 2021;9(1):1-9. Doi: https://doi.org/10.9745/GHSP-D-20-00459 PMid:33795359 PMCid:PMC8087430

Praveen D, Patel A, Raghu A, Clifford GD, Maulik PK, Abdul AM, et al. SMARTHealth India: development and field evaluation of a mobile clinical decision support system for cardiovascular diseases in rural India. JMIR mHealth and uHealth. 2014;2(4):e54. Doi: https://doi.org/10.2196/mhealth.3568 PMid:25487047 PMCid:PMC4275493

WHO. Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps. News release September. 2019;22.

Lu C, Palazuelos D, Luan Y, Sachs SE, Mitnick CD, Rhatigan J, et al. Development assistance for community health workers in 114 low-and middle-income countries, 2007-2017. Bull World Health Organ. 2020;98(1):30. Doi: https://doi.org/10.2471/BLT.19.235499 PMid:31902960 PMCid:PMC6933433

USAID. U.S. Agency for International Development (USAID). Strengthening Primary Health Care though Community Health Workers: Closing the $2 Billion Gap. . 2018.

Schneider H, Okello D, Lehmann U. The global pendulum swing towards community health workers in low-and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014. Human resources for health. 2016;14(1):65. Doi: https://doi.org/10.1186/s12960-016-0163-2 PMid:27784298 PMCid:PMC5081930

Organization WH. WHO guideline on health policy and system support to optimize community health worker programmes: World Health Organization; 2018.

Cometto G, Ford N, Pfaffman-Zambruni J, Akl EA, Lehmann U, McPake B, et al. Health policy and system support to optimise community health worker programmes: an abridged WHO guideline. The Lancet Global Health. 2018;6(12):e1397-e404. Doi: https://doi.org/10.1016/S2214-109X(18)30482-0 PMid:30430994

Assembly WH. World Health Assembly. Community health workers delivering primary health care: opportunities and challenges. . 2019.

Downloads

Published

2022-12-31

How to Cite

1.
Kurapati J, Chandanadur Thippaiah A. Contribution and Challenges of Community Health Workers in Achieving Sustainable Development Goals. Natl J Community Med [Internet]. 2022 Dec. 31 [cited 2023 Feb. 4];13(12):896-903. Available from: https://njcmindia.com/index.php/file/article/view/2525

Issue

Section

Review Articles