Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, P.O Box 43640-00100, Nairobi, Kenya.
Trinity Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Hum Resour Health. 2021 Nov 27;19(1):144. doi: 10.1186/s12960-021-00691-z.
There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs.
Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.
Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements.
This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.
在中低收入国家（LMICs）的城市非正规住区中，有关社区卫生志愿者（CHV）计划的信息有限。尽管这些地区的疾病负担很高。许多因素相互交织，影响了在 LMICs 的城市非正规住区工作的 CHV 的绩效。进行这项审查是为了确定影响在 LMICs 的城市非正规住区工作的 CHV 绩效的计划层面和背景因素。
四个数据库中搜索了关于在 LMICs 的城市和城市周边非正规住区工作的 CHV 的定性和混合方法研究。我们专注于 CHV 个体层面的 CHV 计划结果衡量标准。共有 13 项研究符合纳入标准，并进行了双次阅读以提取相关数据。进行了主题编码，并对影响 CHV 绩效的计划和背景因素的十个类别进行了综合分析。使用关键评估技能计划（CASP）和混合方法评估工具（MMAST）评估质量；并使用从定性研究的证据审查中评估证据的信心（CERQual）方法评估证据的确定性。
报告称，在 LMICs 的城市非正规住区中提高 CHV 绩效的关键计划层面因素包括财务和非财务激励、培训、供应品和资源的可用性、卫生系统联系、家庭支持和支持性监督。在广泛的背景层面上，发现对 CHV 绩效产生负面影响的因素包括人身安全方面的不安全以及社区内家庭对财务和物质支持的需求。这些因素相互作用，塑造了 CHV 的绩效，并影响了城市非正规住区的 CHV 计划的实施。
这项审查确定了计划层面和背景因素对在 LMICs 的城市和城市周边非正规住区工作的 CHV 的影响。调查结果表明，在这些地区工作的计划应考虑为 CHV 提供足够的报酬、综合和全面的培训、充足的供应品和资源、充足的卫生系统联系、家庭支持和支持性监督。此外，计划还应考虑 CHV 的人身安全问题和社区期望。
