Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature

Abstract

ObjectivesUnderstanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs.DesignSystematic scoping review.Data sourcesMEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC.Study selectionOriginal studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies.ResultsThe scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8).ConclusionsThis scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.

Timely Access to Maternal, Neonatal and Child Healthcare for rural communities in Rwanda: Job satisfaction of Community Health Workers delivering Community Based Maternal, Newborn and Child Healthcare

“…In addition to supportive supervision, training of CHWs before the commencement of their duties and other in-service training is seen as particularly useful in enhancing their knowledge and skills for service provision. Training as an indispensable tool in the work of community health workers is useful in the transfer of useful skills and information for the effective delivery of health services to hard-to-reach populations 44,45 . CHWs, therefore, consider training as an essential component in achieving their mandate as health workers.…”

The fidelity of implementation of recommended care for children with malaria by community health workers in Nigeria

“…Despite these encouraging results, future studies that explore the sustainability of these bolstering mechanisms after the intervention has been established will help evaluate the long-term effectiveness of the intervention. If CHWs need to receive repeated trainings to ensure effectiveness, modalities of this must be factored into interventions that rely mostly on CHWs [25].…”

Evaluating the long-term impact of Female Community Health Volunteer involvement in a postpartum family planning intervention in Nepal: a mixed-method study at 1 year post-intervention

“…However, knowledge is likely to decrease further by 50% or more in the next ve years without any further ongoing training or education [16]. A review of ongoing trainings for CHWs from different LMICs on different health topics have shown positive results for knowledge retention following refresher trainings [17]. A study on refresher training for CHWs in India suggested the knowledge retained among CHWs following the refresher training at 1-year post-intervention was higher than the knowledge retained 2 months after the initial training [18].…”