Community Health Workers at cross-roads: Systematic review of programmatic indicators including job satisfaction, attrition, training, quality of care and program outcomes Open Access

Allana, Salim (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/f1881m09t?locale=en
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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




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