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Abstract
Introduction A variety of community health workers (CHWs) provide maternal and newborn health (MNH) services in low-income and middle-income settings. However, there is a need for a better understanding of the diversity in type of CHW in each setting and responsibility, role, training duration and type of remuneration.
Methods We identified CHWs providing MNH services in Bangladesh, India, Kenya, Malawi and Nigeria by reviewing 23 policy documents and conducting 36 focus group discussions and 131 key informant interviews. We analysed the data using thematic analysis.
Results Irrespective of training duration (8 days to 3 years), all CHWs identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. Therapeutic care, antenatal care and skilled birth attendance, and provision of long-acting reversible contraceptives are within the exclusive remit of CHWs with training greater than 3 months. In contrast, community mobilisation and patient tracking are often done by CHWs with training shorter than 3 months. Challenges CHWs face include pressure to provide MNH services beyond their scope of practice during emergencies, and a tendency in some settings to focus CHWs on facility-based roles at the expense of their traditional community-based roles.
Conclusion CHWs are well positioned geographically and socially to deliver some aspects of MNH care. However, there is a need to review and revise their scope of practice to reflect the varied duration of training and in-country legislation.
- community health worker
- lay health worker
- maternal and newborn health
- scope of practice
- training
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Footnotes
Handling editor Stephanie M Topp
Twitter @CMNHLSTM
Contributors AO and NvdB conceived the study with contributions from BM and SB-Z. AO collected and analysed the data and drafted the PhD thesis which informed the manuscript. NvdB, BM and SB-Z reviewed the thesis and contributed to interpretation of the results. AO drafted the initial version of the manuscript while NvdB, BM and SB-Z reviewed it. NvdB, BM and AO drafted the final version of the manuscript.
Funding This study is funded by Department for International Development (DFID) through the Liverpool School of Tropical Medicine “Making it Happen” programme (202945-101).
Disclaimer The funders played no role in drafting the manuscript or the choice of journal where the manuscript is to be submitted.
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval The Liverpool School of Tropical Medicine, Liverpool, UK granted full ethical approval (LSTM 15.007). Ethical approval was also obtained from each of the study country–specific research ethics committee: Ethical Review Committee, Centre for Injury Prevention and Research, Bangladesh; Institutional Research Ethics Committee (IREC) of The Foundation for Research in Community Health (IREC/2015/11/4/2) Kenyatta National Hospital and University of Nairobi, Ethics and Research Committee, Nairobi, Kenya (P485/07/2015); The College of Medicine Research and Ethics Committee, College of Medicine, Blantyre, Malawi (P.07/15/1765); Federal Capital Territory Health Research Ethics Committee, Abuja (FHREC/2015/01/52/24-08-15).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.