Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

Blanchard, Andrea Katryn; Prost, Audrey; Houweling, Tanja A. J.

doi:10.1136/bmjgh-2018-001308

Cited by 45 publications

(66 citation statements)

References 55 publications

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“…The authors found that home based care practices improved more equitably than care seeking, raising important questions about CHW ability to address health systems challenges. 36 Moreover, CHW programmes can replicate some of the barriers community members face at the clinic level at the community level. For example, a study in Pakistan found that lower caste CHWs were more likely to visit (and to be respected by) their lower caste peers 37 ; Ved et al had similar findings in India.…”

Section: Findings Chw Function and Accountabilitymentioning

confidence: 99%

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

Schaaf¹,

Warthin

Freedman

et al. 2020

BMJ Glob Health

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This paper is a critical interpretive synthesis of community health workers (CHWs) and accountability in low-income and middle-income countries. The guiding questions were: What factors promote or undermine CHWs as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? We conducted an iterative search that included articles addressing the core issue of CHWs and accountability, and articles addressing ancillary issues that emerged in the initial search, such as ‘CHWs and equity.’CHWs are intended to comprise a ‘bridge’ between community members and the formal health system. This bridge function is described in three key ways: service extender, cultural broker, social change agent. We identified several factors that shape the bridging function CHWs play, and thus, their role in fomenting health system accountability to communities, including the local political context, extent and nature of CHW interactions with other community-based structures, health system treatment of CHWs, community perceptions of CHWs, and extent and type of CHW unionisation and collectivisation.Synthesising these findings, we elaborated several analytic propositions relating to the self-reinforcing nature of the factors shaping CHWs’ bridging function; the roles of local and national governance; and the human resource and material capacity of the health system. Importantly, community embeddedness, as defined by acceptability, social connections and expertise, is a crucial attribute of CHW ability to foment local government accountability to communities.

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Section: Findings Chw Function and Accountabilitymentioning

confidence: 99%

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

Schaaf¹,

Warthin

Freedman

et al. 2020

BMJ Glob Health

View full text Add to dashboard Cite

show abstract

“…Notable examples are trained community health workers (CHWs) and mother/peer groups for health and nutrition promotion [7][8][9]. Though evidence supports CHW home visits and women's groups for improving maternal and newborn health in low and middle-income countries (LMICs) [10][11][12], evidence from high-quality studies involving such community platforms for delivering nutrition-specific interventions is limited across diverse populations [5]. This is partly…”

Section: Introductionmentioning

confidence: 99%

The Effects of Community Home Visit and Peer Group Nutrition Intervention Delivery Platforms on Nutrition Outcomes in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

et al. 2020

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Weak delivery systems reduce the potential of evidence-supported interventions to improve nutrition. We synthesized the evidence for the effectiveness of nutrition-specific intervention delivery platforms for improving nutrition outcomes in low and middle-income countries (LMIC). A systematic literature search for studies published from 1997 to June 2018 resulted in the inclusion of 83 randomized controlled trials (RCTs), quasi-randomized, and controlled before-after studies across a variety of delivery platforms. In this paper, we report on meta-analysed outcomes for community health worker (CHW) home visits and mother/peer group delivery platforms. Compared to care as usual, CHW home visits increased early initiation of breastfeeding (EIBF) (OR: 1.50; 95% CI: 1.12, 1.99; n = 10 RCTs) and exclusive breastfeeding (EBF) (OR: 4.42; 95% CI: 2.28, 8.56; n = 9 RCTs) and mother/peer groups were effective for improving children's minimum dietary diversity (OR: 2.34; 95% CI: 1.17, 4.70; n = 4) and minimum meal frequency (OR: 2.31; 95% CI: 1.61, 3.31; n = 3). Pooled estimates from studies using both home visit and group platforms showed positive results for EIBF (OR: 2.13; 95% CI: 1.12, 4.05; n = 9), EBF (OR: 2.43; 95% CI: 1.70, 3.46; n = 12), and < 5 wasting (OR: 0.77; 95% CI: 0.67, 0.89; n = 4). Our findings underscore the importance of interpersonal community platforms for improving infant and young child feeding practices and children's nutritional status in LMICs.Nutrients 2020, 12, 440 2 of 16 due to limited knowledge surrounding how best to integrate nutrition-focused interventions into these routine activities at the country level [13].Emerging evidence indicates that advancements in nutrition require nutrition-sensitive programmes that enhance the coverage and effectiveness of direct nutrition interventions [14]. Cash transfers requiring compliance with specific health/nutrition behaviours are commonly used in social protection/safety net programmes in LMICs [15,16]. Though evidence suggests they are effective for poverty reduction [14,17,18], there is limited high-quality evidence on the effectiveness of conditional cash transfers (CCTs) for improving nutrition-specific outcomes among women and children [19]. Mobile health (mHealth) technologies (e.g., SMS messaging) are increasingly being used in global nutrition programming, yielding potentially cross-cutting benefits through linkages with community and financial platforms [20]. However, knowledge gaps remain surrounding the effectiveness of mHealth platforms for delivering nutrition-specific interventions [21,22].We reviewed the available evidence to assess the effects of community-, financial-and technology-based nutrition intervention delivery platforms for improving nutrition outcomes in LMICs. In this paper, we report on meta-analysed outcomes for community health worker (CHW)/lay counselor home visits and mother/peer groups, which emerged as the most widely used community-based platforms for delivering nutrition-specific interventions in our review. Whil...

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“…However, this concept receives multiple interpretations in the literature, which are reflected in the use of apparently equivalent terms such as community midwives, lay midwives or TBAs. 30 These terms are often conflated under the broader concept of community health worker, 31 32 which, although it recognises the community roots of traditional midwives, neglects the culture specific roots of their practice. In a similar way, the appellation of lay midwives is used to suggest lack of professional qualification or expert knowledge.…”

Section: Methodsmentioning

confidence: 99%

Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review

et al. 2020

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IntroductionIndigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence maternal outcomes. These maps will allow for comparison with local stakeholder knowledge and discussion to identify what needs to change to promote culturally safe care.Methods and analysisA librarian will search studies with iterative and documented adjustments in CINAHL, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE, Embase and Google Scholar without any time restrictions, and use Google search engine for grey literature. Included studies will be empirical (quantitative, qualitative or mixed); address maternal health issues among indigenous communities in the Americas; and report on the role or influence of traditional midwives. Two researchers will independently screen and blindly select the included studies. The quality assessment of included manuscripts will rely on the Mixed Methods Appraisal Tool (MMAT). Two independent researchers will extract data on factors promoting or reducing maternal health in indigenous communities, including the role or influence of traditional midwives. Fuzzy cognitive mapping will summarise the findings as a list of relationships between identified factors and outcomes with weights indicating strength of the relationship and the evidence supporting this.Ethics and disseminationThis review is part of a proposal approved by the ethics committees at McGill University and the Centro de Investigación de Enfermedades Tropicales in Guerrero. Participating indigenous communities in Guerrero State approved the study in 2015. The results of the scoping review will contribute to the field of cultural safety and intercultural dialogue for the promotion of maternal health in indigenous communities.

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Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

Cited by 45 publications

References 55 publications

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

The Effects of Community Home Visit and Peer Group Nutrition Intervention Delivery Platforms on Nutrition Outcomes in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review

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