What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers.
What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers.
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DOI：
10.1186/s12960-018-0304-x
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发表时间：
2018-08-16
影响因子：
4.5
通讯作者：
Perry HB
中科院分区：
文献类型：
--
作者：
Scott K;Beckham SW;Gross M;Pariyo G;Rao KD;Cometto G;Perry HB
综合目前对如何在卫生系统中最好地设计和操作基于社区的卫生工作者（CHW）计划的理解。我们在11个数据库中检索了2005年1月1日至2017年6月15日期间发表的评论文章。纳入了有关CHW的评论文章，CHW定义为社区非专业有偿或志愿卫生工作者，培训时间少于2年。我们根据AMSTAR标准评估了综述的方法学质量，并根据PRISMA标准报告了我们的研究结果。我们确定了122篇综述（75篇系统性综述，其中34篇为荟萃分析，47篇为非系统性综述）。其中83篇来自中低收入国家，29篇来自高收入国家，10篇来自全球。这些审查中包括的社区卫生工作者方案在提供的干预措施、社区卫生工作者的选择和培训、监督、报酬和融入卫生系统方面各不相同。使CHW计划取得积极成果的特征包括社区嵌入性（社区成员对该计划有主人翁感，并与CHW建立积极的关系），支持性监督，继续教育以及充足的后勤支持和供应。有效地将社区卫生工作者方案纳入卫生系统可以加强方案的可持续性和可信度，明确社区卫生工作者的作用，并促进社区卫生工作者与更高级别的卫生系统行为者之间的合作。我们发现了审查证据中的差距，包括CHW的权利和需求，有效的培训和监督方法，CHW作为社区变革的推动者，以及卫生系统权力下放，社会责任和治理的影响。有关CHW计划有效性的证据可以帮助决策者确定一系列可供考虑的选择。然而，这一证据需要根据不同的背景加以调整，以便为政策和实践提供信息。推进具有特定背景元素的证据库对于帮助这些计划充分发挥潜力至关重要。本文的在线版本（10.1186/s12960-018-0304-x）包含补充材料，可供授权用户使用。
To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential. The online version of this article (10.1186/s12960-018-0304-x) contains supplementary material, which is available to authorized users.
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影响因子：
4.5
作者：
Corluka A;Walker DG;Lewin S;Glenton C;Scheel IB
通讯作者：
Scheel IB
影响因子：
2.1
作者：
Abbott, Laurie S.;Elliott, Lynn T.
通讯作者：
Elliott, Lynn T.
DOI：
10.2471/blt.07.050666
发表时间：
2009-01-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Darmstadt, Gary L;Baqui, Abdullah H;El Arifeen, Shams
通讯作者：
El Arifeen, Shams
影响因子：
3.8
作者：
Darmstadt, Gary L.;Lee, Anne C. C.;Cousens, Simon;Sibley, Lynn;Bhutta, Zulfiqar A.;Donnay, France;Osrin, Dave;Bang, Abhay;Kumar, Vishwajeet;Wall, Steven N.;Baqui, Abdullah;Lawn, Joy E.
通讯作者：
Lawn, Joy E.
影响因子：
3.3
作者：
Campbell, C.;Scott, K.
通讯作者：
Scott, K.