School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Open. 2022 Feb 2;12(2):e051940. doi: 10.1136/bmjopen-2021-051940.
OBJECTIVE: To identify which primary healthcare (PHC) principles are reflected in the implementation of national community health worker (CHW) programmes and how they may contribute to the outcomes of these programmes in the context of low-income and middle-income countries (LMICs). DESIGN: Scoping review. DATA SOURCES: A systematic search was conducted through PubMed, CINAHL, EMBASE and Scopus databases. ELIGIBILITY CRITERIA: The review considered published primary studies on national programmes, projects or initiatives using the services of CHWs in LMICs focused on maternal and child health. We included only English language studies. Excluded were programmes operated by non-government organisations, study protocols, reviews, commentaries, opinion papers, editorials and conference proceedings. DATA EXTRACTION AND SYNTHESIS: We reviewed the application of four PHC principles (universal health coverage, community participation, intersectoral coordination and appropriateness) in the CHW programme's objectives, implementation and stated outcomes. Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was not performed in this scoping review. RESULTS: From 1280 papers published between 1983 and 2019, 26 met the inclusion criteria. These 26 papers included 14 CHW programmes from 13 LMICs. Universal health coverage and community participation were the two commonly reported PHC principles, while intersectoral coordination was generally missing. Similarly, the cultural acceptability aspect of the principle of appropriateness was present in all programmes as these programmes select CHWs from within the communities. Other aspects, particularly effectiveness, were not evident. CONCLUSION: The implementation of PHC principles across national CHW programmes in LMICs is patchy. For comprehensiveness and improved health outcomes, programmes need to incorporate all attributes of PHC principles. Future research may focus on how to incorporate more attributes of PHC principles while implementing national CHW programmes in LMICs. Better documentation and publications of CHW programme implementation are also needed.
目的：确定初级卫生保健（PHC）原则在实施国家社区卫生工作者（CHW）方案中是如何体现的，以及这些原则在中低收入国家（LMIC）的背景下如何促进这些方案的结果。
设计：范围审查。
数据来源：通过 PubMed、CINAHL、EMBASE 和 Scopus 数据库进行了系统检索。
入选标准：该综述考虑了在 LMIC 中使用 CHW 服务的国家方案、项目或倡议的已发表的初级研究，重点是母婴健康。我们只纳入了英语语言的研究。排除了非政府组织运营的方案、研究方案、综述、评论、意见论文、社论和会议记录。
数据提取和综合：我们审查了四项 PHC 原则（全民健康覆盖、社区参与、部门间协调和适宜性）在 CHW 方案目标、实施和既定结果中的应用。数据提取是在电子表格中系统进行的，而研究结果则以叙述方式综合。在本范围审查中，没有对选定研究进行质量评估。
结果：从 1983 年至 2019 年发表的 1280 篇论文中，有 26 篇符合纳入标准。这 26 篇论文包括来自 13 个 LMIC 的 14 个 CHW 方案。全民健康覆盖和社区参与是报告最多的两项 PHC 原则，而部门间协调通常缺失。同样，适宜性原则的文化可接受性方面也存在于所有方案中，因为这些方案从社区中选择 CHW。其他方面，特别是有效性，并不明显。
结论：在 LMIC 的国家 CHW 方案中，PHC 原则的实施参差不齐。为了全面性和提高健康结果，方案需要纳入 PHC 原则的所有属性。未来的研究可能侧重于在实施 LMIC 的国家 CHW 方案时如何纳入 PHC 原则的更多属性。还需要更好地记录和发表 CHW 方案的实施情况。
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