Table 2.
Challenges cited by authors of 29 case studies of national CHW programmes [13]
| Type of challenge | Number of national programmes for which this challenge was mentioned | Countries in which they challenge was mentioned and name of CHW cadre involved |
|---|---|---|
| Lack of supplies and commodities | 20 | Ethiopia (HEW, WDA); India (ANM, AWW, ASHA, VHG); Kenya (CHW); Liberia (CHA, CHSS); Malawi (CHW); Mozambique (APE); Niger (ASC, RV); Rwanda (Binome, ASM); Sierra Leone (CHW); South Africa (WBPHCOT); Zambia (CHA, CBV); Zimbabwe (VHW) |
| Inadequate, unstable, or unsustainable financing | 20 | Brazil (ASC Agent); Ghana (CHO, CHV); Indonesia (Kader); Liberia (CHA, CHSS); Malawi (CHW); Mozambique (APE); Myanmar (AMW, CHW, MV, TBV, TBA), Pakistan (LHW); Rwanda (Binome, ASM); Sierra Leone (CHW); South Africa (WBPHCOT); Tanzania (CHW); Zimbabwe (VHW) |
| Low compensation of CHWs | 17 | Brazil (CHW); Ghana (CHO, CHV); India (ANM, AWW, ASHA, VHG); Iran (B, MS), Kenya (CHV); Malawi (CHW); Mozambique (APE); Pakistan (LHW); South Africa (WBPHCOT), Zambia (CHW, CBV); Zimbabwe ( VHW) |
| Inadequate supervision | 15 | Brazil (ASC-agent); Ethiopia (HEW, WDA); India (ANM, AWW, SAHA, VHG); Mozambique (APE); Niger (ASC, RV); Rwanda (Binome; ASM); South Africa (WBPHCOT); Zambia (CH-assistant, CBV) |
| Management challenges | 11 | Brazil (ASC-agent); Ghana (CHO, CHV). Iran (B, MS); Kenya (CHV); Malawi (CHW); Nigeria (CHW, CHIPS, CDD); Tanzania (CHW) |
| Overall shortage of human resources | 10 | Indonesia (Kader); Liberia (CHA, CHSS); Kenya (CHV), Madagascar (AC, ACN); Malawi (CHW); Niger (ASC, RV), Pakistan (LHW) |
| Weak linkage with the formal health system | 10 | Brazil (ASC-agent); Ethiopia (HEW, WDA); Kenya (CHW), Malawi (CHW). Myanmar (AMW, CHW, MV, TBV, TBA) |
| Unavailability of health facilities | 9 | India (ANM, AWW, ASHA, VHG); Iran (B, MS); Malawi (CHW), Niger (ASC, RV) |
| Deficient training | 8 | Brazil (ASC-agent); Ethiopia (HEW, WDA); India (ANM, AWW, ASHA, VHG); Mozambique (APE) |
| Low level of community involvement | 7 | India (ANM, AWW, ASHA, VHG); Thailand (VHV); Kenya (CHV); Malawi (CHW) |
| Inappropriate workload | 7 | Ethiopia (HEW, WDA); Rwanda (Binome, ASM); Malawi (CHW); Zambia (CHA, CBV) |
| Role constraints | 6 | Nepal (FCHV); Nigeria (CHEW, CHIP, CDD, CHA); Zambia (CHA, CBV) |
| Limited career progression | 6 | Bangladesh (FWA, HA, CHCP); Ethiopia (HEW, WDA); Mozambique (APE) |
| Fragmented (vertical) programming | 5 | Myanmar (AMW, CHW, MV, TBV, TBA) |
| Low quality of services | 5 | Bangladesh (FWA, HA, CHCP), Kenya (CHV); Tanzania (CHW) |
| Violence and sexual harassment against CHWs | 4 | India (ANM, AWW, ASHA, VHG) |
| Increased health needs | 4 | Bangladesh (SS, SK); Madagascar (AC, ACN) |
| Discrimination | 4 | Bangladesh (SS, SK); Iran (B, MS) |
| Programme inefficiencies | 4 | Afghanistan (CHW); Ethiopia (HEW, WDA), Kenya (CHV) |
| Lack of political support for the CHW programme | 3 | Indonesia (Kader), Kenya (CHV); South Africa (WBPHCOT) |
| Limited educational background of CHWs | 2 | South Africa (WBPHCOT); Thailand (VHV) |
| High turnover of CHWs | 2 | Brazil (CH-agent); Kenya (CHV) |
AWW: aganwadi worker; AC: agent communautaire; ACN: agent communautaire nutritional; AMW: auxiliary midwife; ANM: auxiliary nurse midwife; APE: agent polivalente elementares; ASC: agent de santé communautaire; ASHA: accredited social health activist; ASM: agent de santé maternelle; B: behvarzs; CBV: community-based volunteer; CDD: community-directed distributor; CHA: community health agent; CHCP: community healthcare provider; CHEW: community health extension worker; CHIP: community health influencer and promoter; CHO: community health officer; CHSS: community health service supervisor; CHW: community health worker; CHV: community health volunteer; FWA: family welfare assistant; FCHV: female community health volunteer; HA: health assistant; HEW: health extension worker; LHW: lady health worker; MS: moraghebe-salamat; MV: malaria volunteer; RV: relais volunteer; SK: shasthya korbi; SS: shasthya shebika TBA: traditional birth attendant; TBV: traditional birth volunteer; VHG: village health guide; VHV: village health volunteer; WBPHCOT: ward-based primary healthcare outreach team; WDA: Women’s Development Army; VHW: village health worker