Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice

Authors: Sonia Ahmed, Liana E. Chase, Janelle Wagnild, Nasima Akhter, Scarlett Sturridge, Andrew Clarke, Pari Chowdhary, Diana Mukami, Adetayo Kasim & Kate Hampshire

The goal of this review was to compile research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programs reduce health inequities in the populations they serve? Researchers explored six academic databases for recent (2014-2020) studies reporting on CHW program access, utilization, quality, and effects on health outcomes/behaviors. From this search, one hundred sixty-seven studies were identified, reporting on CHW interventions in thirty-three LMICs. Results from these studies demonstrated that CHW programs successfully reach many marginalized groups, however, health inequalities still exist within the populations they serve. Disadvantaged groups were also found to face outstanding barriers to following up on CHW health advice and referrals. These findings emphasize the need to build meaningful partnerships between CHWs, communities, and policymakers when continuing efforts to confront and address the underlying structures of inequity.