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Supporting and strengthening the role of close-to-community (CTC) providers for health system development

Close-to-community (CTC) providers are health workers who carry out promotional, preventive and/or curative health services and who are often the first point of contact at community level in countries in the global south. CTC providers usually have at least a minimum level of training in the context of the intervention that they carry out and include a broad variety of health workers, including community health workers (CHWs) and auxiliary health workers. CTC providers are strategically placed as the interface between health systems and the communities they serve. National and international decision-makers are once again turning to (CTC) services in order to strengthen health systems in the context of the momentum generated by strategies to support universal access, delivery of the Millennium Development Goals (MDGs) and the post-MDG agenda. However there are a number of flaws in current systems that need to be better understood. We are at a critical stage in the development of CTC programming and policy which requires the creation and communication of new knowledge to ensure the safety, sustainability, quality and accessibility of services, and their links with both the broader health system and the communities that CTC’s serve.

The series covers a range of topics on close to community providers for health systems development, including, but not limited to, the following:

  • Conceptualising the range of CTC providers in different contexts
  • Methods and tools for analysing CTC programmes
  • Cost effectiveness of CTC programmes
  • Challenges and opportunities CTC providers face in reaching and supporting marginalised groups
  • Diverse community perspectives and ownership of CTC programmes
  • Opportunities for CTC providers to act as champions for social change
  • The interface between health systems and CTC programmes
  • Strategies to motivate, retain and sustain CTC providers
  • Integrating vertical programmes using CTC providers within national programmes

This series is published in collaboration with the Thematic Working Group on Supporting and Strengthening the Role of Community Health Workers in Health System Development and REACHOUT.

The editors express no competing interests and the view expressed in the articles are a sole responsibility of the authors.

  1. Research

    Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania

    Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health ...

    Amnesty E. LeFevre, Rose Mpembeni, Dereck Chitama, Asha S. George, Diwakar Mohan, David P Urassa, Shivam Gupta, Isabelle Feldhaus, Audrey Pereira, Charles Kilewo, Joy J Chebet, Chelsea M Cooper, Giulia Besana, Harriet Lutale, Dunstan Bishanga, Emmanuel Mtete…

    Human Resources for Health 2015 13:98

    Published on: 24 December 2015

  2. Research

    Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles

    Globally, there is increasing interest in community health worker’s (CHW) performance; however, there are gaps in the evidence with respect to CHWs’ role in community participation and empowerment. Accredited ...

    Lipekho Saprii, Esther Richards, Puni Kokho and Sally Theobald

    Human Resources for Health 2015 13:95

    Published on: 9 December 2015

  3. Research

    Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana

    A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically prov...

    Emma Sacks, Soumya Alva, Sophia Magalona and Linda Vesel

    Human Resources for Health 2015 13:81

    Published on: 8 October 2015

  4. Research

    A qualitative assessment of health extension workers’ relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance

    Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the c...

    Maryse C. Kok, Aschenaki Z. Kea, Daniel G. Datiko, Jacqueline E.W. Broerse, Marjolein Dieleman, Miriam Taegtmeyer and Olivia Tulloch

    Human Resources for Health 2015 13:80

    Published on: 30 September 2015

  5. Case study

    Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion

    Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer hig...

    Emmanueil Benon Turinawe, Jude T. Rwemisisi, Laban K. Musinguzi, Marije de Groot, Denis Muhangi, Daniel H. de Vries, David K. Mafigiri and Robert Pool

    Human Resources for Health 2015 13:73

    Published on: 7 September 2015

  6. Research

    Using a human resource management approach to support community health workers: experiences from five African countries

    Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managi...

    Joanna Raven, Patricia Akweongo, Amuda Baba, Sebastian Olikira Baine, Mohamadou Guelaye Sall, Stephen Buzuzi and Tim Martineau

    Human Resources for Health 2015 13:45

    Published on: 1 September 2015

  7. Review

    Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach

    There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and susta...

    Joseph F. Naimoli, Henry B. Perry, John W. Townsend, Diana E. Frymus and James A. McCaffery

    Human Resources for Health 2015 13:46

    Published on: 1 September 2015

  8. Research

    Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation

    Community health workers (CHWs) in Mozambique (known as Agentes Polivalentes Elementares (APEs)) are key actors in providing health services in rural communities. Supervision of CHWs has been shown to improve ...

    Sozinho Daniel Ndima, Mohsin Sidat, Celso Give, Hermen Ormel, Maryse Catelijne Kok and Miriam Taegtmeyer

    Human Resources for Health 2015 13:63

    Published on: 1 September 2015

  9. Commentary

    Snap shots from a photo competition: what does it reveal about close-to-community providers, gender and power in health systems?

    In this commentary, we discuss a photography competition, launched during the summer of 2014, to explore the everyday stories of how gender plays out within health systems around the world. While no submission...

    Asha George, Sally Theobald, Rosemary Morgan, Kate Hawkins and Sassy Molyneux

    Human Resources for Health 2015 13:57

    Published on: 1 September 2015

  10. Research

    Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study

    A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh’s pluralist...

    Ilias Mahmud, Sadia Chowdhury, Bulbul Ashraf Siddiqi, Sally Theobald, Hermen Ormel, Salauddin Biswas, Yamin Tauseef Jahangir, Malabika Sarker and Sabina Faiz Rashid

    Human Resources for Health 2015 13:51

    Published on: 1 September 2015

  11. Research

    Exploring competing experiences and expectations of the revitalized community health worker programme in Mozambique: an equity analysis

    Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, w...

    Celso Soares Give, Mohsin Sidat, Hermen Ormel, Sozinho Ndima, Rosalind McCollum and Miriam Taegtmeyer

    Human Resources for Health 2015 13:54

    Published on: 1 September 2015

  12. Research

    Motivation and satisfaction among community health workers in Morogoro Region, Tanzania: nuanced needs and varied ambitions

    In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (I...

    Rose N M Mpembeni, Aarushi Bhatnagar, Amnesty LeFevre, Dereck Chitama, David P Urassa, Charles Kilewo, Rebecca M Mdee, Helen Semu, Peter J Winch, Japhet Killewo, Abdullah H Baqui and Asha George

    Human Resources for Health 2015 13:44

    Published on: 5 June 2015

  13. Research

    Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania

    Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, an...

    Timothy Roberton, Jennifer Applegate, Amnesty E Lefevre, Idda Mosha, Chelsea M Cooper, Marissa Silverman, Isabelle Feldhaus, Joy J Chebet, Rose Mpembeni, Helen Semu, Japhet Killewo, Peter Winch, Abdullah H Baqui and Asha S George

    Human Resources for Health 2015 13:19

    Published on: 9 April 2015

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