Table 2.

Examples of stressors and challenges faced by CHWs

Type of CHW	Stressors
Lady health workers (Pakistan) [29]	Lack of adequate training to communicate effectively with families Lack of skills to perform the tasks required Low socioeconomic status (can cause lack of respect and harassment) Need to travel long distances by foot Stock-outs of medical supplies Low salary Lack of a career structure
ASHA workers (India) [30]	Violent attacks by men Lack of respect from superiors due to families’ standing and level of education Low salary (this has psychosocial implications such as feeling alienated and undervalued for the disproportionate burden they now bear, particularly in light of their new role in India’s battle against COVID-19) [30]
HEWs (Ethiopia) [31]	Lack of community trust in the services and the products HEWs provide
Village health team members (Uganda) [32–34]	Lack of trust from other health-care providers who view CHWs as not appropriately trained and a government ploy for control Conflicts with higher-level staff Stock-outs of medicines and equipment Lack of respect from community members and government officials (mistrust and stigma can lead to emotional trauma and depressive symptoms, as seen during the Ebola and Marburg virus outbreaks)
CHWs (Tanzania) [35]	Stock-outs of medicines and supplies
CHEWs (Nigeria) [36]	Lack of training for the reality of the job
Health surveillance assistants (Malawi) [37]	Lack of adequate training Inadequate supervision Work overload due to the extensive needs of the community Low pay
Women’s Development Army volunteers (Ethiopia) [38]	Psychosocial challenges, including becoming the subject of gossip
CHWs in Papua New Guinea [39]	Young female CHWs feel unsafe and afraid because of abuse from young men, violent assaults, and accusations

ASHA accredited social health activist, HEWs health extension workers, CHEWs community health extension workers