Community Health Workers at cross-roads: Systematic review of programmatic indicators including job satisfaction, attrition, training, quality of care and program outcomes Öffentlichkeit
Allana, Salim (2012)
Published
Abstract
Background: Strategies and policy framework for managing
Community Health Worker
(CHW) programs from a Human Resources (HR) perspective have been
staggeringly
slow or lacking altogether. We conducted a systematic review to
identify factors that
influence CHW job satisfaction / motivation, analyze how these
variables affect their
attrition rates and to compare quality of care between CHWs who
receive training,
retraining and supervision with those who do not.
M ethods: Three electronic databases (Pubmed, Cochrane
Library and Popline) were
searched for published papers between 1966 and July 31, 2011.
Original published papers
on CHWs working in developing countries were included. Published
studies identified
through websites and institutional review articles were also
reviewed and included.
Reference lists of published CHW literature / systematic reviews
were also hand-
searched to obtain additional peer-reviewed published
studies.
Results: Fifty-five manuscripts satisfied the inclusion
criteria. These included 28
quantitative and 27 qualitative studies. Overall, study designs and
their measured
(31.2%) and status within community (25%) were cited as the major
job satisfying /
motivating factors. Most common job dissatisfaction factors were
low remuneration
(43.7%) and inadequate material and financial incentives (12.5%),
for CHWs working in
paid and volunteer programs respectively. Nine studies provided
information about
attrition rates (overall rates: 11.8%-47%; annual attrition rates:
3.8%-4.8%), but these
could not be compared because attrition rates across studies were
non-uniform. Based on
12 comparisons from 10 studies that measured different CHW
performance outcomes
with varying study designs, training had a moderate effect of 23.8
%-points (range: -4.1,
37.0 %-points). There was a suggestion of a difference in training
effect depending on the
presence of supervision (effect of training alone: 26.7 %-points;
effect of training plus
supervision: 12.5%-points).
Conclusion: Themes identified and recommendations proposed
in this review for
supporting CHW programs from an HR perspective should be used as a
trigger for
meaningful deliberations and tangible actions by managers, policy
makers and
researchers. This is essential to develop and promote standard best
practices for
managing long-term sustainable CHW programs that would ultimately
translate into
enhanced health outcomes at the population-level.
Keywords: Community health worker, job satisfaction,
attrition, training, supervision.
Table of Contents
TABLE OF CONTENTS
S.# Description
...................................................................................
Page #
1. Introduction
...........................................................................................
1
2. Study Objectives
....................................................................................
9
3. Comprehensive Review of Literature
...........................................................11
4. Methods
..............................................................................................
18
A. Literature search strategy
.......................................................................
18
B. Scope and inclusion / exclusion criteria
...................................................... 19
C. Data management
..................................................................................
24
D. Institutional review board (IRB) consideration
.............................................. 25
5. Results
.................................................................................................
26
6. Discussion
.............................................................................................
40
Critical elements of managing CHW programs at the field and
management level ..... 51
7. Recommendations / Future Directions
......................................................... 53
Synopsis of developing a prototype CHW program (Fieldpractice and
research) ...... 56
8. Study Caveats
......................................................................................
58
9. Conclusion
............................................................................................
60
10. References
..........................................................................................
62
11. Appendices
..........................................................................................
87
Appendix A: Primary health care in a nutshell
.................................................... 87
Appendix B: Summary of studies included for objective 1
.................................... 88
Appendix C: Summary of CHW attrition findings
................................................. 92
Appendix D: Individual study specific outcomes related to training
and supervision ... 95
About this Master's Thesis
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