ReviewHealth research policy and systems2021
Community health workers at the dawn of a new era: 1. Introduction: tensions confronting large-scale CHW programmes.
Review in Health research policy and systems, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
62 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Exploring parental knowledge, care-seeking, and support strategies for neonatal illness: an integrative review of the African Great Lakes region.Global health action · 2025Pooled it
- Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review.JMIR mHealth and uHealth · 2024Pooled it
- Lay health workers in primary and community health care for maternal and child health: identification and treatment of wasting in children.The Cochrane database of systematic reviews · 2023Pooled it
- Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education.Health research policy and systems · 2021Pooled it
- Community case management to accelerate access to healthcare in Mali: a realist process evaluation nested within a cluster randomized trial.Health policy and planning · 2024Trial
- Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana.Global health action · 2023Trial
- Community Health Workers' Multiple Understandings of Schistosomiasis Transmission Pathways: Exploring Contextual Factors in Côte d'Ivoire, Kenya and Uganda.Tropical medicine & international health : TM & IH · 2026Article
- IMPACT: A Structured Human-Centered Design Process for Integrating Community Health Worker Insights Into Program Policy in Pakistan.Global health, science and practice · 2026Article
- Community health worker involvement across domains and national infectious disease programmes in rural Madagascar: evidence of fragmentation and determinants of engagement.BMJ global health · 2026Article
- Assessment of community health workforce governance in federal Nepal.Health policy and planning · 2026Article
- Article
- Outcomes of Digital Training for Community Health Workers in Low- and Middle-Income Countries: Scoping Review.JMIR medical education · 2026Article
- Co-designing PROFESS: a community health worker support framework to strengthen engagement in TB and HIV care in Madagascar.Frontiers in health services · 2026Article
- Community health worker support to adolescents and young adults with sickle cell disease: A multi-method analysis on transition-related support.Health care transitions · 2026Article
- Early impact of the Liberian National Community Health Assistant Program on under-five mortality in Grand Bassa County: A non-randomized stepped wedge evaluation.PLOS global public health · 2026Article
- Seroprevalence of markers and immunization for hepatitis B in community health workers: a scoping review.Revista da Escola de Enfermagem da U S P · 2026Article
- Article
- What does resilience and well-being mean to community health workers? An exploratory study in the upper east region, Ghana.BMJ public health · 2026Article
- Non-communicable disease care in peri-urban Nepal: Potential for community-based interventions.PLOS global public health · 2026Article
- Assessing the gap between policy and practice: community health workers' contributions to nutrition services in Sub-Saharan Africa.BMC health services research · 2025Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundCommunity health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a series of 11 articles for a supplement entitled "Community Health Workers at the Dawn of a New Era".
methodsDrawing on lessons from case studies of large well-established CHW programmes, published literature, and the authors' experience, the paper highlights major issues that need to be acknowledged to design and deliver effective CHW programmes at large scale. The paper also serves as an introduction to a set of articles addressing these issues in detail.
resultsThe article highlights the diversity and complexity of CHW programmes, and offers insights to programme planners, policymakers, donors, and others to inform development of more effective programmes. The article proposes that be understood as actors within community health system(s) and examines five tensions confronting large-scale CHW programmes; the first two tensions concern the role of the CHW, and the remaining three, broader strategic issues: 1) What kind of an actor is the CHW? A lackey or a liberator? Provider of clinical services or health promoter? 2) Lay versus professional? 3) Government programme at scale or nongovernmental organization-led demonstration project? 4) Standardized versus tailored to context? 5) Vertical versus horizontal?
conclusionCHWs can play a vital role in primary healthcare, but multiple conditions need to be met for them to reach their full potential.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.