Community Health Workers: what do international studies tell us?

Abstract This is a narrative review whose objective is to understand the state of the art of the literature on Community Health Worker (CHW) programs worldwide, identifying their nomenclatures, practices, training, and working conditions. The major concentration of CHW programs can still be found in low- and middle-income countries in Africa (18), Asia (12), and Latin America (05), with a few experiences in high-income countries in North America (02) and Oceania (01). In total, 38 experiences were cataloged, and the practices of care, surveillance, education, health communication, administrative practices, intersectoral articulation, and social mobilization were described. The levels and duration of CHW training were characterized, as were the different working conditions in each country. Much of the work is precarious, often voluntary and carried out by women. This review provided a comparative overview that can contribute to enrich the view of managers and decision-makers in contexts of the implementation, expansion, and reconfiguration of such programs.

摘要 本研究为一篇叙事性综述，旨在梳理全球范围内社区卫生工作者（Community Health Worker，CHW）项目相关文献的研究现状，明确其命名规范、实践模式、培训体系与工作条件。当前社区卫生工作者项目仍主要集中于非洲（18项）、亚洲（12项）与拉丁美洲（5项）的中低收入国家，北美（2项）与大洋洲（1项）的高收入国家仅存在少量实践案例。本次综述共收录38个实践案例，对其中涵盖的照护、监测、教育、健康传播、行政事务、跨部门协作与社会动员等工作内容进行了梳理。研究同时明确了社区卫生工作者的培训层级与时长，以及各国各不相同的工作条件。多数社区卫生工作者的岗位缺乏职业保障，往往以志愿形式开展，且从业人员以女性为主。本综述形成了一项比较性研究概览，可为该类项目在落地、扩容与重构过程中的管理者与决策者拓宽认知视野、提供有效借鉴。