Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, U.S.A.
Health Policy Plan. 2018 Dec 1;33(10):1128-1143. doi: 10.1093/heapol/czy094.
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as 'systematic' if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers.
许多基础研究和系统评价都集中在社区卫生工作者(CHWs)在提供基本卫生服务方面的作用。在许多国家,还有一群非正式的卫生工作者也以志愿者的身份提供服务[社区卫生志愿者(CHV)],但没有综合研究来调查他们在一系列健康状况下的角色和潜在贡献;大多数现有研究都集中在单一条件上。随着这一队伍的重要性不断增加,需要研究 CHV 是否以及如何能够改善中低收入国家(LMICs)获得和使用基本卫生服务的情况。我们对系统评价进行了伞式综述,检索了 PubMed、Cochrane 图书馆、效果摘要数据库(DARE)、EMBASE、ProQuest 论文和论文、坎贝尔图书馆和 DOPHER。如果一项评价有明确的搜索策略,并对数据进行定性或定量总结,我们就认为它是“系统的”。我们使用乔安娜·布里格斯研究所(JBI)的批判性评估评估检查表来评估方法学质量。使用预先准备的数据提取格式提取数据。结果以叙述性的方式进行综合。通过搜索策略最初发现的 422 条记录中,我们确定了 39 项符合纳入标准的系统评价。大多数结论认为 CHWs 提供的服务并不逊于其他卫生工作者提供的服务,有时甚至更好。然而,CHWs 在更复杂的任务(如诊断和咨询)中的表现较差。通过定期的支持性监督、在职培训和充足的后勤支持,以及高水平的社区所有权,可以加强他们的表现。在提供有限获得的人群的特定卫生服务方面使用 CHWs,特别是在 LMICs 中,似乎很有前景。然而,成功需要仔细的实施、强有力的政策支持和管理者的持续支持。