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Performance of community health workers:situating their intermediary position within complex adaptive health systems

Kok, Maryse. C, Broerse, Jacqueline E.W, Theobald, Sally, Ormel, Hermen, Dieleman, Marjolein and Taegtmeyer, Miriam (2017) 'Performance of community health workers:situating their intermediary position within complex adaptive health systems'. Human Resources for Health, Vol 15, e59.

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Abstract

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community healthworkers (CHWs) in low- a nd middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate.The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts(two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software.Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs’ feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs’ perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships,power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improve

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
QS Anatomy > QS 4 General works. Classify here works on regional anatomy
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12960-017-0234-z
Depositing User: Rachel Dominguez
Date Deposited: 20 Sep 2017 10:48
Last Modified: 21 Sep 2017 09:04
URI: http://archive.lstmed.ac.uk/id/eprint/7599

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