ArticleHuman resources for health2017
An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study.
Article in Human resources for health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia.BMC primary care · 2024Pooled it
- Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.Human resources for health · 2022Pooled it
- Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial.Journal of global health · 2018Trial
- Analysis of Perinatal Care in Zambia in the Context of WHO Recommendations.Healthcare (Basel, Switzerland) · 2026Review
- From intervention studies to national programs, what are the favoring and hindering factors? a scoping review.BMC public health · 2025Article
- We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia.BMJ global health · 2025Article
- Scope of work and contributions of female community health volunteers in Nepal's healthcare sector: a qualitative study.BMJ open · 2024Article
- Article
- Institutionalizing Innovation: From Pilot to Scale for Co-Packaged Oral Rehydration Salts and Zinc-A Case Study in Zambia.Global health, science and practice · 2024Article
- Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia.International journal of health geographics · 2023Article
- Community Health Worker programmes' integration into national health systems: Scoping review.African journal of primary health care & family medicine · 2023Article
- Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey.BMC women's health · 2022Article
- Community health workers at the dawn of a new era: 7. Recent advances in supervision.Health research policy and systems · 2021Review
- Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia-HPTN 071 (PopART).Health policy and planning · 2021Article
- Developing a district level supportive supervision framework for community health workers through co-production in South Africa.BMC health services research · 2021Article
- Community Health Workers' Experiences in Strengthening the Uptake of Childhood Immunization and Malaria Prevention Services in Urban Sierra Leone.Frontiers in public health · 2021Article
- How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries.Health policy and planning · 2020Article
- 'Do you trust those data?'-a mixed-methods study assessing the quality of data reported by community health workers in Kenya and Malawi.Health policy and planning · 2020Article
- A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries.Frontiers in medicine · 2020Article
- Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn 2010 a public sector cadre of community health workers called Community Health Assistants (CHAs) was created in Zambia through the National Community Health Worker Strategy to expand access to health services. This cadre continues to be scaled up to meet the growing demands of Zambia's rural population. We summarize factors that have facilitated the scale-up of the CHA program into a nationwide CHW cadre and the challenges of introducing and institutionalizing the cadre within the Zambian health system.
methodsSemi-structured, individual interviews were held across 5 districts with 16 CHAs and 6 CHA supervisors, and 10 focus group discussions were held with 93 community members. Audio recordings of interviews and focus group discussions were transcribed and thematically coded using Dedoose web-based software.
resultsThe study showed that the CHAs play a critical role in providing a wide range of services at the community level, as described by supervisors and community members. Some challenges still remain, that may inhibit the CHAs ability to provide health services effectively. In particular, the respondents highlighted infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system.
conclusionsThe study shows that in order to optimize the impact of CHAs or other community health workers, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting. The Ministry of Health with support from partners are currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017-2021. This study contributes to the evidence base on the introduction of formalized community health worker cadres in developing countries.
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