The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

Marta Schaaf, Caitlin Warthin, Lynn Freedman, Stephanie M Topp, Marta Schaaf, Caitlin Warthin, Lynn Freedman, Stephanie M Topp

Abstract

This paper is a critical interpretive synthesis of community health workers (CHWs) and accountability in low-income and middle-income countries. The guiding questions were: What factors promote or undermine CHWs as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? We conducted an iterative search that included articles addressing the core issue of CHWs and accountability, and articles addressing ancillary issues that emerged in the initial search, such as 'CHWs and equity.'CHWs are intended to comprise a 'bridge' between community members and the formal health system. This bridge function is described in three key ways: service extender, cultural broker, social change agent. We identified several factors that shape the bridging function CHWs play, and thus, their role in fomenting health system accountability to communities, including the local political context, extent and nature of CHW interactions with other community-based structures, health system treatment of CHWs, community perceptions of CHWs, and extent and type of CHW unionisation and collectivisation.Synthesising these findings, we elaborated several analytic propositions relating to the self-reinforcing nature of the factors shaping CHWs' bridging function; the roles of local and national governance; and the human resource and material capacity of the health system. Importantly, community embeddedness, as defined by acceptability, social connections and expertise, is a crucial attribute of CHW ability to foment local government accountability to communities.

Keywords: health systems; review.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Key programme approaches to the CHW bridge function. CHW, community health worker.

References

    1. Lehmann U, Sanders D. Community health workers: what do we know about them. The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization, 2007.
    1. Dixon-Woods M, Cavers D, Agarwal S, et al. . Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol 2006;6:35. 10.1186/1471-2288-6-35
    1. Berman P. Community-based health programmes in Indonesia: the challenge of supporting a national expansion : Frankel S, The community health worker: effective programmes for developing countries. Oxford, England: Oxford University Press, 1992: 63–87.
    1. Desai PB. Community health work: India's experience : Frankel S, The community health worker: effective programmes for developing countries. Oxford, England: Oxford University Press, 1992: 125–55.
    1. Walt G. Community health workers in national programmes: just another pair of hands? Milton Keynes, Buckinghamshire, UK: Open University Press, 1990.
    1. Kowitt SD, Emmerling D, Fisher EB, et al. . Community health workers as agents of health promotion: analyzing Thailand's village health volunteer program. J Community Health 2015;40:780–8. 10.1007/s10900-015-9999-y
    1. Packard RM. A history of global health: interventions into the lives of other peoples. Baltimore: JHU Press, 2016.
    1. Colvin CJ, Swartz A. Extension agents or agents of change? community health workers and the politics of care work in postapartheid South Africa. Ann Anthropol Pract 2015;39:29–41.
    1. Perry H, Crigler L. Developing and strengthening community health worker programs at scale. A reference guide and case studies for program managers and policymakers. USAID/MCHIP, 2014. Available: [Accessed 15 Mar 2019].
    1. Bhutta ZA, Lassi ZS, Pariyo G, et al. . Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into National health systems. Geneva, Switzerland: WHO, Global Health Workforce Alliance, 2010.
    1. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health 2013;13:847. 10.1186/1471-2458-13-847
    1. Perry H, Zulliger R, Scott K, et al. . Case studies of large-scale community health worker programs: examples from Afghanistan, Bangladesh, Brazil, Ethiopia, niger, India, Indonesia, Iran, Nepal, Pakistan, Rwanda, Zambia, and Zimbabwe. Washington, DC, USA: Jhpiego Corporation, 2017.
    1. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014;35:399–421. 10.1146/annurev-publhealth-032013-182354
    1. Schedler A. Conceptualizing Accountability : Schedler A, Diamond L, Plattner MF, The Self-Restraining state: power and accountability in new Democracies. Boulder: Lynne Rienner Publishers, 1999: 13–28.
    1. Freedman LP, Schaaf M. Act global, but think local: accountability at the frontlines. Reprod Health Matters 2013;21:103–12. 10.1016/S0968-8080(13)42744-1
    1. O'Connell L. Program accountability as an emergent property: the role of stakeholders in a program's field. Public Adm Rev 2005;65:85–93.
    1. Chynoweth SK, Zwi AB, Whelan AK. Socializing accountability in humanitarian settings: a proposed framework. World Dev 2018;109:149–62. 10.1016/j.worlddev.2018.04.012
    1. Murthy RK, Klugman B. Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services. Health Policy Plan 2004;19:i78–86. 10.1093/heapol/czh048
    1. George A. 'By papers and pens, you can only do so much': views about accountability and human resource management from Indian government health administrators and workers. Int J Health Plann Manage 2009;24:205–24. 10.1002/hpm.986
    1. National Health Mission [India] About accredited social health activist (ASHA). Ministry of health and family welfare, government of India website, 2014. Available: [Accessed Mar 2018].
    1. Standing H, Chowdhury AMR. Producing effective knowledge agents in a pluralistic environment: what future for community health workers? Soc Sci Med 2008;66:2096–107. 10.1016/j.socscimed.2008.01.046
    1. Druetz T, Ridde V, Kouanda S, et al. . Utilization of community health workers for malaria treatment: results from a three-year panel study in the districts of Kaya and Zorgho, Burkina Faso. Malar J 2015;14:71. 10.1186/s12936-015-0591-9
    1. Glenton C, Scheel IB, Pradhan S, et al. . The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives. Soc Sci Med 2010;70:1920–7. 10.1016/j.socscimed.2010.02.034
    1. Maes K. Community health workers and social change: an introduction. Ann Anthropol Pract 2015;39:1–5.
    1. Dias J, Tomé T. Inverted State and Citizens’ Roles in the Mozambican Health Sector, 2018. Available: [Accessed 30 Dec 2019].
    1. Saprii L, Richards E, Kokho P, et al. . Community health workers in rural India: analysing the opportunities and challenges accredited social health activists (ASHAs) face in realising their multiple roles. Hum Resour Health 2015;13:95. 10.1186/s12960-015-0094-3
    1. Scott K, Shanker S. Tying their hands? institutional obstacles to the success of the ASHA community health worker programme in rural North India. AIDS Care 2010;22:1606–12. 10.1080/09540121.2010.507751
    1. Topp SM, Edelman A, Taylor S. "We are everything to everyone": a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. Int J Equity Health 2018;17:67. 10.1186/s12939-018-0779-z
    1. De Koning KO, Kok M, Ormel H, et al. . A common analytical framework on factors influencing performance of close-to-community providers. kit Royal tropical Institute, 2014. Available: [Accessed 30 Dec 2019].
    1. Heaton J, Corden A, Parker G. 'Continuity of care': a critical interpretive synthesis of how the concept was elaborated by a national research programme. Int J Integr Care 2012;12:e12. 10.5334/ijic.794
    1. Ako-Arrey DE, Brouwers MC, Lavis JN, et al. . Health systems guidance appraisal—a critical interpretive synthesis. Implement Sci 2015;11:9.
    1. Moat KA, Lavis JN, Abelson J. How contexts and issues influence the use of policy-relevant research syntheses: a critical interpretive synthesis. Milbank Q 2013;91:604–48. 10.1111/1468-0009.12026
    1. Greenhalgh T, Robert G, Macfarlane F, et al. . Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med 2005;61:417–30. 10.1016/j.socscimed.2004.12.001
    1. Schaaf M, Fox J, Topp SM, et al. . Community health workers and accountability: reflections from an international "think-in". Int J Equity Health 2018;17:66. 10.1186/s12939-018-0781-5
    1. McCollum R, Gomez W, Theobald S, et al. . How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review. BMC Public Health 2016;16:419. 10.1186/s12889-016-3043-8
    1. Blanchard AK, Prost A, Houweling TAJ. Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2019;4:e001308. 10.1136/bmjgh-2018-001308
    1. Mumtaz Z, Salway S, Nykiforuk C, et al. . The role of social geography on lady health workers' mobility and effectiveness in Pakistan. Soc Sci Med 2013;91:48–57. 10.1016/j.socscimed.2013.05.007
    1. Ved R, Scott K, Gupta G, et al. . How are gender inequalities facing India's one million ASHAs being addressed? policy origins and adaptations for the world's largest all-female community health worker programme. Hum Resour Health 2019;17:3. 10.1186/s12960-018-0338-0
    1. McKenna B, Fernbacher S, Furness T, et al. . "Cultural brokerage" and beyond: piloting the role of an urban Aboriginal Mental Health Liaison Officer. BMC Public Health 2015;15:881. 10.1186/s12889-015-2221-4
    1. Grossman-Kahn R, Schoen J, Mallett JW, et al. . Challenges facing community health workers in Brazil's family health strategy: a qualitative study. Int J Health Plann Manage 2018;33:309–20. 10.1002/hpm.2456
    1. Mohajer N, Singh D. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: meta-synthesis using the concept of social capital. Hum Resour Health 2018;16:63. 10.1186/s12960-018-0331-7
    1. Roman G, Gramma R, Enache A, et al. . The health mediators-qualified interpreters contributing to health care quality among Romanian Roma patients. Med Health Care Philos 2013;16:843–56. 10.1007/s11019-013-9467-3
    1. Bilal NK, Herbst CH, Zhao F. Health extension workers in Ethiopia: improved access and coverage for the rural poor In: Yes Africa can: success stories from a dynamic continent. 24, 2011: 433–43.
    1. Musinguzi LK, Turinawe EB, Rwemisisi JT, et al. . Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital. Hum Resour Health 2017;15:4. 10.1186/s12960-016-0177-9
    1. Schaaf M. Mediating Romani health. policy and program opportunities. New York: Open Society Institute, 2004.
    1. Lehmann U, Friedman I, Sanders D. Review of the utilisation and effectiveness of community-based health workers in Africa. global health trust, joint learning initiative on human resources for health and development (JLI), JLI working paper, 2004. Available: [Accessed 30 Dec 2019].
    1. Kane S, Kok M, Ormel H, et al. . Limits and opportunities to community health worker empowerment: a multi-country comparative study. Soc Sci Med 2016;164:27–34. 10.1016/j.socscimed.2016.07.019
    1. Nandi S, Schneider H. Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India. Health Policy Plan 2014;29:ii71–81. 10.1093/heapol/czu074
    1. Werner D. The village health worker: lackey or liberator? Palo Alto, California, USA: Hesperian Foundation, 1981.
    1. Cometto G, Ford N, Pfaffman-Zambruni J, et al. . Health policy and system support to optimise community health worker programmes: an abridged who guideline. Lancet Glob Health 2018;6:e1397–404. 10.1016/S2214-109X(18)30482-0
    1. Hamal M, Dieleman M, De Brouwere V, et al. . How do accountability problems lead to maternal health inequities? A review of qualitative literature from Indian public sector. Public Health Rev 2018;39:9. 10.1186/s40985-018-0081-z
    1. Joshi SR, George M. Healthcare through community participation: role of ASHAs. Econ Polit Wkly 2012;10:70–6.
    1. Gilson L, Walt G, Heggenhougen K, et al. . National community health worker programs: how can they be strengthened? J Public Health Policy 1989;10:518–32.
    1. Maes K, Closser S, Vorel E, et al. . Using community health workers: discipline and hierarchy in Ethiopia's women's development army. Ann Anthropol Pract 2015;39:42–57.
    1. Kok MC, Kane SS, Tulloch O, et al. . How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst 2015;13:13. 10.1186/s12961-015-0001-3
    1. Flores W. Community Defenders of the right to health in Guatemala. community of practitioners on accountability and social action in health (COPASAH), 2015. Available: [Accessed 1 Jun 2018].
    1. Hernández A, Ruano AL, Hurtig AK, et al. . Pathways to accountability in rural Guatemala: a qualitative comparative analysis of citizen-led initiatives for the right to health of Indigenous populations. World Dev 2019;113:392–401.
    1. Perry H, Zulliger R, Scott K. Case studies of large-scale community health worker programs: examples from Bangladesh, Brazil, Ethiopia, India, Iran, Nepal, and Pakistan. Afghanistan: community-based health care to the Ministry of public health, 2013. Available: [Accessed 30 Dec 2019].
    1. Smith-Nonini S. "Popular" health and the state: dialectics of the peace process in El Salvador. Soc Sci Med 1997;44:635–45. 10.1016/s0277-9536(96)00216-x
    1. Schneider H. The governance of national community health worker programmes in low- and middle-income countries: an empirically based framework of governance principles, purposes and tasks. Int J Health Policy Manag 2019;8:18. 10.15171/ijhpm.2018.92
    1. Agarwal S, Kirk K, Sripad P, et al. . Setting the global research agenda for community health systems: literature and consultative review. Hum Resour Health 2019;17:22. 10.1186/s12960-019-0362-8
    1. Scott K, Beckham SW, Gross M, et al. . What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 2018;16:39. 10.1186/s12960-018-0304-x
    1. Østebø MT, Cogburn MD, Mandani AS. The silencing of political context in health research in Ethiopia: why it should be a concern. Health Policy Plan 2017;33:258–70.
    1. Closser S, Jooma R. Why we must provide better support for Pakistan's female frontline health workers. PLoS Med 2013;10:e1001528. 10.1371/journal.pmed.1001528
    1. Kahssay HM, Taylor ME, Berman P, World Health Organization . Community health workers: the way forward. Available: [Accessed 30 Dec 2019].
    1. Singh R, Purohit B. Limitations in the functioning of village health and sanitation committees in a North Western state in India. Int J Med Public Health 2012;2:39–46. 10.5530/ijmedph.2.3.9
    1. Kok MC, Ormel H, Broerse JEW, et al. . Optimising the benefits of community health workers' unique position between communities and the health sector: a comparative analysis of factors shaping relationships in four countries. Glob Public Health 2017;12:1404–32. 10.1080/17441692.2016.1174722
    1. Garg S, Pande S. Learning to sustain change: Mitanin community health workers promote public accountability in India. accountability research center, 2018. Available: [Accessed 30 Dec 2019].
    1. Scott K, George AS, Ved RR. Taking stock of 10 years of published research on the ASHA programme: examining India's national community health worker programme from a health systems perspective. Health Res Policy Syst 2019;17:29. 10.1186/s12961-019-0427-0
    1. Maes K, Closser S, Tesfaye Y, et al. . Volunteers in Ethiopia's women's development army are more deprived and distressed than their neighbors: cross-sectional survey data from rural Ethiopia. BMC Public Health 2018;18:258. 10.1186/s12889-018-5159-5
    1. Maes K, Closser S, Tesfaye Y, et al. . Psychosocial distress among unpaid community health workers in rural Ethiopia: comparing leaders in Ethiopia's women's development army to their Peers. Soc Sci Med 2019;230:138–46. 10.1016/j.socscimed.2019.04.005
    1. Closser S. Pakistan's lady health worker labor movement and the moral economy of heroism. Ann Anthropol Pract 2015;39:16–28.
    1. Ormel H, Kok M, Kane S, et al. . Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health 2019;17:59. 10.1186/s12960-019-0387-z
    1. Bhattacharyya K, Winch P, LeBan K. Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention, and Sustainability : Basic support for Institutionalizing child survival project (basics II). Arlington, VA, USA: United States Agency for International Development (USAID), 2020.
    1. Singh D, Negin J, Otim M, et al. . The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries. Hum Resour Health 2015;13:58. 10.1186/s12960-015-0051-1
    1. Vareilles G, Pommier J, Marchal B, et al. . Understanding the performance of community health volunteers involved in the delivery of health programmes in underserved areas: a realist synthesis. Implement Sci 2017;12:22. 10.1186/s13012-017-0554-3
    1. Oxford Policy Management (OPM) Lady health worker programme: external evaluation of the National programme for family planning and primary health care: summary of results. Islamabad, Pakistan: OPM Ltd, 2009.
    1. Zulu JM, Kinsman J, Michelo C, et al. . Hope and despair: community health assistants' experiences of working in a rural district in Zambia. Hum Resour Health 2014;12:30. 10.1186/1478-4491-12-30
    1. Topp SM, Price JE, Nanyangwe-Moyo T, et al. . Motivations for entering and remaining in volunteer service: findings from a mixed-method survey among HIV caregivers in Zambia. Hum Resour Health 2015;13:72. 10.1186/s12960-015-0062-y
    1. Kok MC, Dieleman M, Taegtmeyer M, et al. . Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan 2015;30:1207–27. 10.1093/heapol/czu126
    1. Andreoni J, Callen M, Khan Y, et al. . Using preference estimates to customize incentives: an application to polio vaccination drives in Pakistan. National Bureau of Economic Research, 2016.
    1. Miller G, Babiarz KS. Pay-For-Performance incentives in low- and middle-income country health programs. (NBER working paper 18932). Cambridge, MA, USA: National Bureau of Economic Research, 2020.
    1. Lohmann J, Houlfort N, De Allegri M. Crowding out or no crowding out? A Self-Determination theory approach to health worker motivation in Performance-based financing. Soc Sci Med 2016;169:1–8. 10.1016/j.socscimed.2016.09.006
    1. Alonge O, Lin S, Igusa T, et al. . Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan. Health Policy Plan 2017;32:1417–26. 10.1093/heapol/czx122
    1. Smith S, Deveridge A, Berman J, et al. . Task-shifting and prioritization: a situational analysis examining the role and experiences of community health workers in Malawi. Hum Resour Health 2014;12:24. 10.1186/1478-4491-12-24
    1. Kok MC, Namakhoma I, Nyirenda L, et al. . Health surveillance assistants as intermediates between the community and health sector in Malawi: exploring how relationships influence performance. BMC Health Serv Res 2016;16:164. 10.1186/s12913-016-1402-x
    1. Vallières F, Hyland P, McAuliffe E, et al. . A new tool to measure approaches to supervision from the perspective of community health workers: a prospective, longitudinal, validation study in seven countries. BMC Health Serv Res 2018;18:806. 10.1186/s12913-018-3595-7
    1. Ludwick T, Turyakira E, Kyomuhangi T, et al. . Supportive supervision and constructive relationships with healthcare workers support CHW performance: use of a qualitative framework to evaluate CHW programming in Uganda. Hum Resour Health 2018;16:11. 10.1186/s12960-018-0272-1
    1. Grant C, Nawal D, Guntur SM, et al. . 'We pledge to improve the health of our entire community': improving health worker motivation and performance in Bihar, India through teamwork, recognition, and non-financial incentives. PLoS One 2018;13:e0203265. 10.1371/journal.pone.0203265
    1. Roberton T, Applegate J, Lefevre AE, et al. . Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania. Hum Resour Health 2015;13:19. 10.1186/s12960-015-0010-x
    1. Henry JV, Winters N, Lakati A, et al. . Enhancing the supervision of community health workers with WhatsApp mobile messaging: qualitative findings from 2 low-resource settings in Kenya. Glob Health Sci Pract 2016;4:311–25. 10.9745/GHSP-D-15-00386
    1. National Health Systems Resource Centre (NHSRC) [India] ASHA: which way forward…? executive summary – evaluation of ASHA programme. New Delhi, India: NHSRC, 2011.
    1. Jackson D, Brady W, Stein I. Towards (re)conciliation: (re)constructing relationships between indigenous health workers and nurses. J Adv Nurs 1999;29:97–103. 10.1046/j.1365-2648.1999.00866.x
    1. Grant M, Wilford A, Haskins L, et al. . Trust of community health workers influences the acceptance of community-based maternal and child health services. Afr J Prim Health Care Fam Med 2017;9:1–8. 10.4102/phcfm.v9i1.1281
    1. Steege R, Taegtmeyer M, McCollum R, et al. . How do gender relations affect the working lives of close to community health service providers? empirical research, a review and conceptual framework. Soc Sci Med 2018;209:1–3. 10.1016/j.socscimed.2018.05.002
    1. Mumtaz Z, Salway S, Waseem M, et al. . Gender-Based barriers to primary health care provision in Pakistan: the experience of female providers. Health Policy Plan 2003;18:261–9. 10.1093/heapol/czg032
    1. Simmons R, Mita R, Koenig MA. Employment in family planning and women's status in Bangladesh. Stud Fam Plann 1992;23:97–109.
    1. Geoffrey B, Lorna M, Clare K. Village health team functionality in Uganda: implications for community system effectiveness. Sci J Pub Health 2016;4:117–26.
    1. Okuga M, Kemigisa M, Namutamba S, et al. . Engaging community health workers in maternal and newborn care in eastern Uganda. Glob Health Action 2015;8:23968. 10.3402/gha.v8.23968
    1. Panday S, Bissell P, Van Teijlingen E, et al. . Perceived barriers to accessing Female Community Health Volunteers’(FCHV) services among ethnic minority women in Nepal: A qualitative study. PloS one 2019;10:e0217070.
    1. Mlotshwa L, Harris B, Schneider H, et al. . Exploring the perceptions and experiences of community health workers using role identity theory. Glob Health Action 2015;8:28045. 10.3402/gha.v8.28045
    1. Musoke D, Ssemugabo C, Ndejjo R, et al. . Reflecting strategic and conforming gendered experiences of community health workers using photovoice in rural Wakiso district, Uganda. Hum Resour Health 2018;16:41. 10.1186/s12960-018-0306-8
    1. Gopalan SS, Durairaj V, Varatharajan D. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India. BMC Health Serv Res 2012;12:319. 10.1186/1472-6963-12-319
    1. Mukhopadhyay DK, Mukhopadhyay S, Mallik S, et al. . A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India. Indian J Public Health 2016;60:118. 10.4103/0019-557X.184543
    1. Kok MC, Kea AZ, Datiko DG, et al. . A qualitative assessment of health extension workers' relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance. Hum Resour Health 2015;13:80. 10.1186/s12960-015-0077-4
    1. Singh D, Cumming R, Negin J. Acceptability and trust of community health workers offering maternal and newborn health education in rural Uganda. Health Educ Res 2015;30:947–58. 10.1093/her/cyv045
    1. Puett C, Alderman H, Sadler K, et al. . 'Sometimes they fail to keep their faith in US': community health worker perceptions of structural barriers to quality of care and community utilisation of services in Bangladesh. Matern Child Nutr 2015;11:1011–22. 10.1111/mcn.12072
    1. Express News Service Asha workers protest, burn effigy of health minister. the Indian express, 2014. Available: [Accessed 3 Mar 2017].
    1. The Hindu ASHA workers seek better wages. The Hindu, 2018. Available: [Accessed 3 Mar 2017].
    1. Bhatia K. The contemporary Rights-based debate on community health workers: an analytical perspective from India. Indian J Soc Work 2019;80:141–8. 10.32444/IJSW.2019.80.2.141-148
    1. Daily Times Ministers served notices for not regulating LHWs. daily times, 2017. Available: [Accessed 2 May 2017].
    1. Mason T, Wilkinson GW, Nannini A, et al. . Winning policy change to promote community health workers: lessons from Massachusetts in the health reform era. Am J Public Health 2011;101:2211–6. 10.2105/AJPH.2011.300402
    1. National Academy for State Health Policy State community health worker models, 2017. Available: [Accessed 2 Jan 2020].
    1. Closser S, Napier H, Maes K, et al. . Does volunteer community health work empower women? Evidence from Ethiopia's women's development army. Health Policy Plan 2019;34:298–306. 10.1093/heapol/czz025
    1. Fox JA. Scaling accountability through vertically integrated civil society policy monitoring and advocacy. Washington DC: Accountability Research Center, 2016.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel