ReviewSSM - health systems2025
Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis.
Review in SSM - health systems, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Community knowledge, attitudes, and preferences towards vitamin A supplementation in a semi-rural health zone, Kasai Oriental, Democratic Republic of the Congo: a mixed-methods study.Global health action · 2026Article
- Community-Based Models for Type 2 Diabetes Care: A Review of Effectiveness, Implementation, and Health System Integration.Advances in therapy · 2026Review
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
No grant is acknowledged in the PubMed record.
Abstract
Introduction: The role of Community Health Workers (CHWs) in sub-Saharan Africa is critical to achieve people-centred health systems. Despite a large evidence base, there is a dearth of knowledge regarding the contextual factors and mechanisms that shape CHW performance in providing people-centred care. This study aims to map out conditions that enable people-centred care by CHWs in sub-Saharan Africa by identifying the key mechanisms and contextual factors. Methodology: A realist synthesis approach was employed to explore how, why, and under what conditions CHW interventions lead to desired outcomes for people-centred care. A systematic review of the literature was undertaken from 2014 to 2024, focusing on studies conducted in sub-Saharan Africa. The review followed a six-phase process, including the development of the initial programme theory, search for evidence, evidence review and quality appraisal, data extraction, data synthesis and analysis, and refinement of the programme theory, followed by formulation of context-mechanism-outcome (CMO) configurations. Results: This synthesis included 36 studies from 14 sub-Saharan African countries. In total, 101 CMO configurations were identified and condensed into 17 preliminary configurations. Specific contexts and mechanisms emerged that influence outcomes related to CHW programmes. The study identified trust, motivation, and adaptive leadership as fundamental meta-mechanisms that challenge the siloed structure of the IPCHS framework, emphasizing the need for greater flexibility to capture interactions across different strategies of the framework. Conclusion: This study demonstrates that integrating CHWs into formal systems, aligning CHW-specific interventions with community-based initiatives, establishing intersectoral partnerships, and updating the IPCHS framework to incorporate adaptive leadership and feedback mechanisms can enhance the delivery of people-centred care.
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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.