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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. 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 ...

    Authors: 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…
    Citation: Human Resources for Health 2015 13:98
  2. 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 ...

    Authors: Lipekho Saprii, Esther Richards, Puni Kokho and Sally Theobald
    Citation: Human Resources for Health 2015 13:95
  3. 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...

    Authors: Emma Sacks, Soumya Alva, Sophia Magalona and Linda Vesel
    Citation: Human Resources for Health 2015 13:81
  4. 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...

    Authors: Maryse C. Kok, Aschenaki Z. Kea, Daniel G. Datiko, Jacqueline E.W. Broerse, Marjolein Dieleman, Miriam Taegtmeyer and Olivia Tulloch
    Citation: Human Resources for Health 2015 13:80
  5. 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...

    Authors: Emmanueil Benon Turinawe, Jude T. Rwemisisi, Laban K. Musinguzi, Marije de Groot, Denis Muhangi, Daniel H. de Vries, David K. Mafigiri and Robert Pool
    Citation: Human Resources for Health 2015 13:73
  6. This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue ...

    Authors: Kelsey Vaughan, Maryse C Kok, Sophie Witter and Marjolein Dieleman
    Citation: Human Resources for Health 2015 13:71
  7. 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 ...

    Authors: Sozinho Daniel Ndima, Mohsin Sidat, Celso Give, Hermen Ormel, Maryse Catelijne Kok and Miriam Taegtmeyer
    Citation: Human Resources for Health 2015 13:63
  8. 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...

    Authors: Asha George, Sally Theobald, Rosemary Morgan, Kate Hawkins and Sassy Molyneux
    Citation: Human Resources for Health 2015 13:57
  9. 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...

    Authors: Celso Soares Give, Mohsin Sidat, Hermen Ormel, Sozinho Ndima, Rosalind McCollum and Miriam Taegtmeyer
    Citation: Human Resources for Health 2015 13:54
  10. 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...

    Authors: Ilias Mahmud, Sadia Chowdhury, Bulbul Ashraf Siddiqi, Sally Theobald, Hermen Ormel, Salauddin Biswas, Yamin Tauseef Jahangir, Malabika Sarker and Sabina Faiz Rashid
    Citation: Human Resources for Health 2015 13:51
  11. 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...

    Authors: Joseph F. Naimoli, Henry B. Perry, John W. Townsend, Diana E. Frymus and James A. McCaffery
    Citation: Human Resources for Health 2015 13:46
  12. 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...

    Authors: Joanna Raven, Patricia Akweongo, Amuda Baba, Sebastian Olikira Baine, Mohamadou Guelaye Sall, Stephen Buzuzi and Tim Martineau
    Citation: Human Resources for Health 2015 13:45
  13. 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...

    Authors: 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
    Citation: Human Resources for Health 2015 13:44
  14. 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...

    Authors: 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
    Citation: Human Resources for Health 2015 13:19
  15. Close-to-community (CTC) providers, including community health workers or volunteers or health extension workers, can be effective in promoting access to and utilization of health services. Tasks are often shi...

    Authors: Sarah Smith Lunsford, Kate Fatta, Kim Ethier Stover and Ram Shrestha
    Citation: Human Resources for Health 2015 13:12