TABLE 2—

Enabling Factors and Barriers for Scale-Up and Sustainability of Community Health Workers

Factors	Articles Citing Factor, No.
Enabling factors
Program design and management
Consistent management and supervision of CHWs and CHW program	8
Respected and motivated people were selected as CHWs	6
Intensive training (some articles specify ongoing or interval training)	4
Pay, stipend, or transportation support provided	4
Effective supply chain	3
Female involvement	3
CHW position was viewed as path to a job later	2
Data about program efficacy were based on credible trial	1
Charismatic initial leader of CHW program	1
CHWs were given preferential treatment or access to other health and development services (e.g., microcredit, clinician appointments at health clinic)	1
Flexible schedule for fulfilling CHW role	1
Narrowly focused set of tasks or role (disease-specific)	1
Regular monitoring and feedback; evaluation data used	1
Adaptation encouraged during early program phases	1
Program conducted in community with educated residents but limited employment options	1
Community fit
CHWs were recruited from or by the community	8
CHW approach was aligned with religious and moral norms of social service	5
Tasks of CHW viewed as valuable and focused by community	5
Strong community partnership, support, or champions, including cooperation of CHW program with existing community organizations	2
Adaptation to community needs	2
Integration with the broader environment
Integration or cooperation with broader health system or existing health care providers	8
Ministry of Health or other government support, as reflected in financial support and rewards for CHWs, advocacy for CHWs, or initiation of CHW program	7
CHWs coordinated their activities with nonhealth development programs	1
Barriers
Program design and management
Not enough pay or incentive for CHWs; CHWs wanted other employment, found other employment that paid more, or had other employment or work that competed with CHW role	8
Weak management and supervision of CHWs and CHW program	6
Poor training of CHWs	4
Lack of fidelity to recommended disease diagnosis and treatment practices	2
Work overload for CHWs because of bureaucratic procedures	1
Distance between houses and work sites	1
Lack of supplies needed by CHWs	1
Stress or low morale among CHWs	1
Community fit
Lack of community support or lack of perceived value of CHW	5
Lack of support from family members or spouses for CHWs’ role	1
Integration with the broader environment
CHW was not respected or not integrated in hierarchy of health system	5
Provider resistance to CHW role	3
Lack of or reduction in support from Ministry of Health, competition from other health programs	2
Political upheaval	1
Unpredictability or reduction of donor funding for CHW program	1

Note. CHW = community health worker. The sample size was n = 19 articles.