Population Council, 4301 Connecticut Avenue NW, Suite 280, Washington DC, 20009, United States of America.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States of America.
Hum Resour Health. 2019 Mar 21;17(1):22. doi: 10.1186/s12960-019-0362-8.
Globally, there is renewed interest in and momentum for strengthening community health systems, as also emphasized by the recent Astana Declaration. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This review aims to propose a global research agenda to strengthen CHW programs.
We conducted a search for extant systematic reviews on any intermediate factors affecting the effectiveness of CHW programs in February 2018. A total of 30 articles published after year 2000 were included. Data on research gaps were abstracted and summarized under headings based on predominant themes identified in the literature. Following this data gathering phase, two technical advisory groups comprised of experts in the field of community health-including policymakers, implementors, researchers, advocates and donors-were convened to discuss, validate, and prioritize the research gaps identified. Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time.
As international interest and investment in CHW programs and community health systems continue to grow, it becomes critical not only to analyze the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based. Generally, the literature places a strong emphasis on the need for higher quality, more robust research.
全球范围内，加强社区卫生系统的兴趣和动力正在重新燃起，正如最近的《阿斯塔纳宣言》所强调的那样。最近的审查确定了对成功的社区卫生工作者（CHW）计划至关重要的因素，但也指出了重大的证据差距。本次审查旨在提出加强 CHW 计划的全球研究议程。
我们于 2018 年 2 月针对影响 CHW 计划有效性的任何中间因素的现有系统评价进行了检索。共纳入了 2000 年后发表的 30 篇文章。数据摘要并根据文献中确定的主要主题进行了总结。在收集数据阶段之后，召集了两个由社区卫生领域的专家组成的技术咨询小组，包括决策者、实施者、研究人员、倡导者和捐助者，以讨论、验证和优先考虑确定的研究差距。在文献中确定并通过专家咨询验证的研究差距领域包括 CHW 的选拔和培训、社区嵌入、CHW 计划的制度化（转诊、监督和供应链）、CHW 的需求，包括激励和报酬、CHW 计划的治理和可持续性、护理绩效和质量以及 CHW 计划的成本效益。优先研究问题包括有关 CHW 和社区卫生系统的有效政策、融资、治理、监督和监测系统的问题、数字技术的作用、CHW 偏好、以及 CHW 动机和保留的驱动因素等实施问题。
随着国际上对 CHW 计划和社区卫生系统的兴趣和投资持续增长，不仅需要分析现有的证据，还需要明确界定研究问题并收集更多证据，以确保 CHW 计划是有效、高效、促进公平和基于证据的。总体而言，文献强烈强调需要更高质量、更稳健的研究。
