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Abstract
Background Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach.
Methods We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature.
Findings 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care.
Conclusion Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.
- systematic review
- public health
- health education and promotion
- prevention strategies
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Footnotes
Handling editor Seye Abimbola
Contributors Activities undertaken by the authors were as follows: establishment of research questions, methods design: JOD; development of search strategy, database search and record screening: JOD and OF; extraction of data from primary studies included in this review: JOD, OF and MKCMR; initial drafting of the manuscript: MKCMR and JOD; final approval of the manuscript: all authors. All authors agreed to take public responsibility for the paper’s contents and approved the final paper prior to submission.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Dr James O’Donovan is a DPhil candidate at The University of Oxford supported by a grant from the Economic and Social Research Council (ES/P000649/1).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was not sought for this study because this is a review of existing published literature and does not directly involve human subjects.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.