‘This study is the first to systematically examine urban CHW roles in LMICs.’ The citation and abstract are below. Unfortunately, the full text is behind a paywall (it is noticeable that inaccessible articles such as this now stand out amid the growing proportion of papers that are free or open access)
CITATION: Health Policy Plan. 2020 Jun 4;czaa049.
doi: 10.1093/heapol/czaa049. Online ahead of print.
The distinctive roles of urban community health workers in low- and middle-income countries: a scoping review of the literature
Teralynn Ludwick, Alison Morgan, Sumit Kane, Margaret Kelaher, Barbara McPake
Addressing urban health challenges in low- and middle-income countries (LMICs) has been hampered by a lack of evidence on effective mechanisms for delivering health services to the poor. The urban disadvantaged experience poor health outcomes (often worse than their rural counterparts) and face service barriers. While community health workers (CHWs) have been extensively employed in rural communities to address inequities, little attention has been given to understanding the roles of CHWs in urban contexts. This study is the first to systematically examine urban CHW roles in LMICs. It aims to understand their roles vis-à-vis other health providers and raise considerations for informing the future scope of practice and service delivery models. We developed a framework that presents seven key roles performed by urban CHWs and positions these roles against a continuum of technical to political functions. Our scoping review included publications from four databases (MEDLINE, EMBASE, CINAHL, and Social Sciences Citation Index) and two CHW resource hubs. We included all peer-reviewed, CHW studies situated in urban/peri-urban, LMIC contexts. We identify roles (un)commonly performed by urban CHWs, present the range of evidence available on CHW effectiveness in performing each role, and identify considerations for informing future roles. Of 856 articles, 160 met the inclusion criteria. Programmes spanned 34 LMICs. Studies most commonly reported evidence on CHW’s roles related to health education, outreach, and elements of direct service provision. We found little overlap in roles between CHWs and other providers, with some exceptions. Reported roles were biased towards home visiting and individual-capacity building, and not well-oriented to reach men/youth/working women, support community empowerment, or link with social services. Urban-specific adaptations to roles, such as peer outreach to high-risk, stigmatized communities, were limited. Innovation in urban CHW roles and a better understanding of the unique opportunities presented by urban settings are needed to fully capitalize on their potential.