Optimising Community Health Worker Programmes: A Search Strategy For 15 Systematic Reviews

Optimising Community Health
Worker Programmes
A Search Strategy for 15 Systematic Reviews
Developed for the WHO
Prepared by:
Aron Shlonsky; Patrick Condron; Bianca Albers; Loyal Pattuwage;
April 2017
Centre for Evidence and Implementation

Level 6, 250 Victoria Parade, East Melbourne VIC 3002
Web: cei.org.au
Twitter: @CEI_org
Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews i
Contents
1. Overarching Research Aims .............................................................................. 3
2. Defining Community Health Workers................................................................... 4
3. Search Strategy and Brief Description of Synthesis Methods ...................................... 5
3.1. The search ........................................................................................... 5
3.2. Databases ............................................................................................ 6
3.3. PICOS specific searches ............................................................................ 7
3.4. Inclusion and exclusion criteria ................................................................ 11
3.5. Screening .......................................................................................... 14
3.6. Data extraction ................................................................................... 15
3.7. Data synthesis ..................................................................................... 17
4. References ................................................................................................. 19
Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews ii
1. Overarching Research Aims
In the last few years, there has been growing interest and attention in the potential of various
types of community health workers (CHWs) in reducing inequities in access to essential health
services, particularly in under-served or excluded, vulnerable populations. The emerging “WHO
Global Strategy on Human Resources for Health (HRH): Workforce 2030” encourages countries to
adopt a diverse, sustainable skills mix, harnessing the potential of community-based and mid-level
health workers in inter-professional primary care teams.1
The contribution of CHWs in successful delivery of population-based health interventions has been
highlighted in several areas such as neonatal and child health, infectious diseases, non-
communicable diseases tropical diseases.4-7 There is also evidence that provision of; education and
training, some form of remuneration, supervision, ongoing training and establishment of their role
in the health care system may improve their integration into the system.7-9
The support for community health workers and their integration into the health system, however,
remain uneven across and within countries. This is hindering the full realization of their potential
contribution to the implementation of health policies based on primary health care. Although they
should be considered as an integral part of the health system, CHW programmes are often fraught
with challenges, including: poor planning; unclear roles and education pathways; multiple
competing actors with little coordination; fragmented, disease-specific training; donor-driven
management and funding; tenuous linkage with the health system; poor coordination, supervision,
quality control and support; and under-recognition of CHWs’ contribution.10
Optimizing the design and performance of CHW programs requires streamlined nomenclature,
clarity on competencies and roles of community health workers, and agreed criteria for sustainable
support by and integration in local and national health systems and plans.11,12
The WHO aims to address these issues through the development of new guidelines on health policy
and system support. The purpose of these guidelines is to improve CHW programmes by identifying
optimal training and working conditions for the CHWs and enhance their functions. The guidelines
will assist national governments as well as national and international partners in improving the
design, implementation, performance and evaluation of CHW programmes, by providing
recommendations in the areas of CHW selection, education, continuing training, linkage with other
health workers, management, supervision, performance enhancement, incentives, remuneration,
governance, health system integration.
To inform the guideline development, WHO has commissioned 15 systematic reviews examining the
current best evidence on optimal training and working conditions for CHWs.
This document details the search strategy for the conduct of these reviews. It has been informed by
key guidance on the conduct of narrative synthesis developed for research teams that conduct
systematic reviews for policy and practice20. This guidance will also inform later steps in the review
process.
Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews
2. Defining Community Health Workers
The term “community health workers” is often used in a non-specific way, referring to a diverse
typology of lay and formally educated, formally and informally assigned, paid and unpaid health
workers.2 A repository of terms such as “lay health workers”, “frontline health workers”, “close-to-
community providers” that are somewhat synonymous to CHWs can currently be found in the
literature but, these terms can also denote some variance in their scope of practice, training, and
their relation to the health system.
Olaniran et al. (2017)3 identified 119 publications that describe and define roles of CHWs. These
differ widely, based on e.g. how CHWs were selected, their roles and tasks, training received and
wages (if any). 90 of the publications described the role of CHWs in relation to the roles and tasks
performed in the community or health care facility. Twenty-one publications also included
educational qualifications or pre-service training in CHW descriptions and definitions. In some of
these studies, CHWs were defined as unpaid volunteers and in others as a cadre service providers
that received a salary, an allowance, or performance-based incentives. Differences like these make
it difficult to find a universally accepted single definition of CHWs.
The international standard classification of occupations by the International Labour Office states:
“Community health workers provide health education, referral and follow-up, case management,
basic preventive health care and home visiting services to specific communities. They provide
support and assistance to individuals and families in navigating the health and social services
system”13 (p. 192).
WHO has used the following definition:
“Community health workers should be members of the communities where they work, should be
selected by the communities, should be answerable to the communities for their activities, should
be supported by the health system but not necessarily a part of its organization, and have shorter
training than professional workers”14 (p. 5).
A similar approach is reflected in a recent systematic review of reviews by Scott et al.2, who also
include a generally lower level of education as a key characteristic of CHWs, who are described as
“… frontline health care providers who live in the community they serve and receive lower levels of
formal education and training than professional health care workers such as nurses and doctors” (p
5).
The commonalities aligning these definitions are that CHWs have a supportive function in health
service delivery, including the provision of direct health services, health advocacy, and community
agency. Furthermore, community health workers are directly connected to the communities they
serve – they live in them and are accountable to them – and have lower levels of education when
compared to trained health workers such as doctors and nurses. These characteristics will be
operationalised in the search strategy presented below.
Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews 4
3. Search Strategy and Brief Description of
Synthesis Methods
The search strategy is summarised in table 1 below. Subsequently, we present each of the steps in
greater detail, including a brief description of methods for data extraction and synthesis. A
complete protocol will be developed and submitted after search methods are finalised.
Table 1: The search strategy
PICOS Category Approach
Population Included in this project will be studies that focus on CHWs as defined through specific
inclusion criteria (see section 3.3). This overarching search will be applied to all PICOS
that are part of this project and is detailed below in section 3.1
Intervention PICOS specific search strings will be developed to capture the different interventions
included in each of the 15 systematic reviews. Each of these specific search strategies
will be combined with the overarching search to form the final search strategy for each
systematic review topic.
Comparison No further search terms will be utilised to limit the output to specific comparison
conditions. All studies will be included, irrespective of the comparisons reported.
Outcomes No further search terms will be utilised to limit the output to specific outcomes. Instead,
we will retrieve all publications, irrespective of the outcomes reported.
Study Design Any study design will be included in the 15 systematic reviews
3.1. The search

As indicated in the original proposal, all 15 systematic reviews will be underpinned by a primary
search to broadly identify all possible studies involving CHWs across all countries.
The example in table 2 is developed for Ovid Medline and will be tailored to suit other databases.
This primary search will remain the same for all 15 PICOS driving each of the reviews.
Methodological filters will not be applied.
Table 2: CHW Search Terms

No. Search Term
1 community health workers/exp
2 “frontline health worker*”.mp
3 ((community or lay or volunteer or voluntary or family or rural or village or lady or basic or frontline) adj (health or
healthcare or health care or medical or care or drug or nutrition) adj (worker* or aide* or distributor* or surveyor* or
assistant* or promoter* or agent* or auxiliar* or motivator* or helper* or representative* or volunteer* or provider* or
officer*)).mp
4 ((chw or chws or lhw or lhws or vhw or vhws) not "liquid hot water").mp
5 "health promoter*".mp
6 ("community health" adj1 worker*).mp
No. Search Term
7 "community volunteer*".mp
8 "peer educator*".mp
9 "outreach worker*".mp
10 "health agent*".mp
11 (Promotora or promotoras) .mp
12 "community practitioner*".mp
13 "health assistant*".mp
14 Anganwadi.mp
15 "health extension worker*".mp
16 "barefoot doctor*".mp
17 "accredited social health activist*".mp
18 kader.mp
19 "malaria agent*".mp
20 "community based practitioner*".mp
21 "health auxiliar*".mp
22 "health surveillance assistant*".mp
23 (("community healthcare" or "community health care") adj1 worker*).mp
24 animator.mp
25 "nutrition counselor*".mp
26 "family welfare assistant*".mp
27 (child adj (health or healthcare or "health care") adj worker*).mp

28 (Behvarz or Monitora or "barangay health worker*" or Accompagnateur* or Activista or Sevika or Brigadista or
Animatrice or Socorrista or "Agente comunitario de salud" or "Agente comunitario de saude" or "agentes de saude" or
"Colaborador voluntario" or "Shastho karmis" or "Shastho shebika" or "Shasthya Shebika").mp
29 ("close to community provider*" or "Lead Mother*" or "community imci" or "outreach educator*" or "community resource
person*" or "nutrition agent*" or "Mobile Clinic Team*" or "Mother coordinator*" or "village drug-kit manager*" or "Bridge-
to-Health Team*" or "female multipurpose health worker*" or "community case management worker*" or "community
surveillance volunteer*").mp
30 (("family planning" or "health promotion") adj (worker* or aide* or distributor* or surveyor* or assistant* or promoter* or
agent* or auxiliar* or motivator* or helper* or representative* or volunteer* or provider* or officer*)).mp
31 Or/1-30
3.2. Databases
The following databases will be searched as part of this project:
Ovid Medline: Epub Ahead of Print, In-Process & Other Non-Indexed Citations and 1946 to
Present
EMBASE
Cochrane
CINAHL
PsycINFO
LILACS
Global Index Medicus
POPLINE
Furthermore, the grey literature will be searched for further relevant publications. These searches
will be based on the following databases:
OpenGrey
TROVE
Google Scholar
In addition, the research team will reach out to relevant organisations and agencies to solicit grey
literature that may not be available online. The selection of these organisations and agencies will
be confirmed with WHO.
Finally, the references of included articles will be examined for relevant citations.
3.3. PICOS specific searches

To identify relevant literature for each PICOS, the primary CHW focused search string will be
combined with each of the search strings presented in table 3 below. These search strings were
developed with a focus on the particular intervention included in each PICOS.
Table 3: PICOS specific search strategies

Question Search Terms
Q1: In CHWs being 1. Primary CHW search

selected for pre- 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
service training, what employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
strategies for selection or remote or village or villages or local) adj4 (health or service or services or program or
of applications for practice)))).mp.
CHWs should be
adopted over what 3. 1 OR 2
other strategies? 4. ((selection or employment or recruitment) adj2 (criteria or process or reasons or
characteristics)).mp.
5. ("personnel selection" or "entry requirement*" or "job requirement*").mp.
6. (attribute* or applicant*).mp.
7. OR/4-6
8. 3 AND 7
Q2: For CHWs 1. Primary CHW search
receiving pre-service 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
training, should the employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
duration of training be or remote or village or villages or local) adj4 (health or service or services)))).mp.
shorter versus longer?
3. 1 OR 2
4. (training or course or class or classes or education or learning).mp.
5. education.fs.
6. 4 OR 5
7. 3 AND 6
8. (duration or length or “period of time”).mp.
9. ((hour or hours or day or days or week or weeks) adj3 (training or course or courses or
education)).mp.
10. 8 OR 9
11. 7 AND 10

curriculum address or remote or village or villages or local) adj4 (health or service or services)))).mp.
specific versus
nonspecific 3. 1 OR 2
competencies? 4. (training or course or class or classes or education or learning).mp.
5. education.fs.
6. 4 OR 5
7. 3 AND 6
8. (curriculum or curricula or "educational activit*" or "educational strateg*").mp.
9. (competency or competencies or certification or approval or accreditation or
registration).mp.
10. community health workers/st
11. standards.mp. or standards.fs.
12. OR/8-11
13. 7 AND 12
curriculum use specific or remote or village or villages or local) adj4 (health or service or services)))).mp.
delivery modalities
versus not? 3. 1 OR 2
4. (training or course or class or classes or education or learning).mp.
5. education.fs.
6. 4 OR 5
7. 3 AND 6
8. ("community based" or "hospital based" or "health facility based").mp.
9. ("flexible learning" or "field placement" or "service training" or "distance education" or
"distance learning" or mooc or moocs).mp.
10. ((training or course or class or classes or education or learning) adj3 (delivery or modality or
modalities)).mp.
11. (("face to face" or online or blended or mobile or "web based" or electronic) adj3 (training or
course or class or classes or education or learning)).mp.
12. OR/8-11
13. 7 AND 12
Q5: In CHWs who have 1. Primary CHW search

received pre-service 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
training, should employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
competency-based or remote or village or villages or local) adj4 (health or service or services)))).mp.
formal certification be
used versus not used? 3. 1 OR 2
4. certification or approval or accreditation or "competency based").mp.
5. ("work performance" or "job performance").mp.
6. community health workers/st
7. health manpower/st
8. ("skill level" or retraining or "performance evaluation" or "performance assessment").mp.
9. ("refresher training" or "continuous education" or "education, continuing").mp.
10. OR/4-9
11. 3 AND 10
Q6: In the context of 1. Primary CHW search

CHWs programmes, 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
what strategies of employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
supportive supervision or remote or village or villages or local) adj4 (health or service or services)))).mp.
should be adopted
over what other 3. 1 OR 2
strategies? 4. (supervision or supervisor or supervisors or supervisory).mp.
5. (coach or coaching or coaches).mp.
6. ("personnel system" or "personnel structure" or manager or managers or mentor or
mentors).mp.
7. (autonomy or accountability).mp.
8. OR/4-7
9. 3 AND 8

should practicing employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
CHWs be paid for their or remote or village or villages or local) adj4 (health or service or services)))).mp.
work versus not?
3. 1 OR 2
4. (payment or salary or salaries or "salaries and fringe benefits" or pay or paid).mp.
5. remuneration or incentive or incentives or financial or finance or income or compensation or
wage or wages).mp.
6. ("employee retention" or "personnel retention" or "community health worker retention" or
"CHW retention" or attrition).mp.
7. (voluntary or volunteer or volunteers or free or unpaid or “in kind” or “non paid”).mp.
8. OR/4-7
9. 3 AND 8

CHWs have a career or remote or village or villages or local) adj4 (health or service or services)))).mp.
ladder opportunity/
framework versus not? 3. 1 OR 2
4. "career ladder*".mp.
5. ((career or job or staff) adj1 (advancement or opportunit* or framework or
development)).mp.
6. "career path" or "career pathway*").mp.
7. ("career plan*" or "career structure*").mp.
8. "professional development".mp.
9. ("personnel turnover" or "retaining staff" or "retaining personnel" or retention).mp.
10. OR/4-9
11. 3 AND 10

CHWs have a formal or remote or village or villages or local) adj4 (health or service or services)))).mp.
contract versus not?
3. 1 OR 2
4. "employment contract".mp.
5. "work contract".mp.
6. "terms of understanding".mp.
7. "conditions of work".mp.
8. "work conditions".mp.
9. "written agreement".mp.
10. (agreement adj5 (work or employment or labour or labor or working or employed or
employee*)).mp.
11. "employment conditions".mp.
12. "conditions of service".mp.
13. ("job expectation*" or "work expectation*" or "employment expectation*").mp.
14. "personnel loyalty".mp.
15. "contract of employment".mp.
16. "employee contract*".mp.
17. or/4-16
18. (contract or contracted or contracts).mp.
19. 3 and 17
20. 3 and 18
21. 19 or 20

CHW programmes, 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
should there be a employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
target population size or remote or village or villages or local) adj4 (health or service or services)))).mp.
versus not?
3. 1 OR 2
4. (coverage or "target population" or catchment).mp.
5. ("client number" or "client numbers" or "number of clients").mp.
6. workload.mp.
7. ((worker* or employee* or volunteer*) adj2 distribution).mp.
8. ("time management" or "personnel staffing and scheduling").mp.
9. (proximity adj2 (service or services)).mp.
10. (travel or "spatial access").mp.
11. (deploy or deployed or deployment).mp.
12. (per adj1 (population or inhabitants or persons)).mp.
13. or/4-12
14. 3 and 413

CHWs collect, collate, or remote or village or villages or local) adj4 (health or service or services)))).mp.
and use health data
versus not? 3. 1 OR 2
4. ((data or record or records or information) adj2 (collection or collector or collectors or
collate or collation or collating or "use" or quality or capture)).mp.
5. ((cell or mobile or smart or cellular) adj1 (phone* or telephone* or device* or tablet*)).mp.
6. smartphone*.mp.
7. ("mobile health" or mhealth).mp.
8. ("record keeping" or "report writing" or reporting or documentation or "health record*" or
"medical record*").mp.
9. feedback.mp.
10. "activity report*".mp.
11. or/4-10
12. 3 and 11

should practicing CHW employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
work in a multi-cadre or remote or village or villages or local) adj4 (health or service or services)))).mp.
team versus in a single
cadre CHW system? 3. 1 OR 2
4. (specialist* or specialisation or specialization or specialised or specialized).mp.
5. (cadre or cadres or multicadre*).mp.
6. (polyvalent or multivalent or monovalent or "poly valent" or "multi valent" or "mono
valent").mp.
7. (team or teams or teamwork).mp.
8. (generalist or general).mp.
9. advanced.mp.
10. multimodal.mp.
11. ((work or workforce or employee* or worker*) adj2 (role or roles)).mp.
12. or/4-11
13. 3 and 12
practicing CHW 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
programmes, are employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
community or remote or village or villages or local) adj4 (health or service or services)))).mp.
engagement strategies
effective in improving 3. 1 OR 2
CHW program 4. ((community or village) adj2 (engagement or engaged or committee* or participation or
performance and participatory or involved or involvement or liaison or group or groups or network* or
utilisation? ownership or learning or collaboration or relations)).mp.
5. committee*.mp.
6. ((mother or mothers or father or fathers or parent or parents or youth or religious or support
or development or savings or credit or farmers or rural or health or project) adj1 (group or
groups)).mp.
7. "local participation".mp.
8. (build* adj1 relationship*).mp.
9. social network*.mp.
10. ((peer adj1 leader*) or "change agent*").mp.
11. or/4-10
12. 3 and 11

should practicing CHW employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
mobilize wider or remote or village or villages or local) adj4 (health or service or services)))).mp.
community resources
for health vs. not? 3. 1 OR 2
4. (mobilisation or mobilization).mp.
5. (community adj2 (knowledge or empowerment or promotion or help or helping or
support)).mp.
6. (community adj2 (informant* or leader* or stakeholder*)).mp.
7. (((priority or objective or objectives or goal or goals) adj1 (set or setting)) or prioritisation
or prioritization).mp.
8. (coordinate or coordination or "co ordinate" or "co ordination").mp.
9. ((outcome or program) adj1 evaluation).mp.
10. (disseminate or dissemination or spread).mp.
11. (link or linking or linkage or linkages).mp.
12. or/4-11
13. 3 and 12
practicing CHWs 2. ((workforce or manpower or employment or (occupation or occupations) or (employee or
programmes, what employees) or "labor force") adj10 ("community health" or ((voluntary or volunteer* or rural
strategies should be or remote or village or villages or local) adj4 (health or service or services)))).mp.
used for ensuring
adequate availability 3. 1 OR 2
of commodities and 4. (acquisition or acquire or logistics or logistical or provide or provision or available or
consumable supplies availability).mp.
over what other 5. (stock or resupply or transport or transportation or distribution or handling or storage or
strategies? purchasing or allocation or purchase).mp.
6. (goods or commodity or commodities or supplies or materials or equipment or consumables
or consumable).mp.
7. (4 or 5) and 6
8. ((medicine or medicines or drug or drugs or pharmaceutical*) adj1 (management or supply or
distribute or access)).mp.
9. "supply chain".mp.
10. supply & distribution.fs.
11. 7 or 8 or 9 or 10
12. 3 and 11
3.4. Inclusion and exclusion criteria
The yielded titles and abstracts of the database search will be screened using a combination of (a)
general inclusion and exclusion criteria applicable to all PICOS and (b) PICOS specific inclusion and
exclusion criteria. Table 4 below summarises the general criteria, whereas PICOS specific criteria
are listed in table 5.
Table 4: General inclusion and exclusion criteria
Included Excluded
Publications that report a study Publications that do not report a study, e.g. opinion
pieces, editorials, conference abstracts; single case
studies; letters; advocacy materials
Studies focused on practicing Community Health Studies focused on non-Community Health Workers
Workers: such as nurses, doctors, formally trained nurse-aids;
Medical assistants, physician assistants; paramedical
= health care workers who carry out population-
workers in emergency and fire services; others who
based, health-related activities in their community
are auxiliaries, e.g.mid-level workers and self-defined
= these activities take place in a community they are health professionals or health paraprofessionals;
directly connected to (they live in the community; traditional, faith and complementary healers and
are accountable to the community) traditional birth attendants
= workers, who have received no or only basic formal Studies focused on non-practicing (i.e. retired or
training; this training may be recognised by health unemployed) community health workers
services or a certification authority, but it is not a
Included Excluded
part of a formal tertiary education programme or

qualification (e.g. degree, diploma, title, certificate
course).
Studies conducted in high income countries, and in

low and middle income countries
Studies conducted in underserved community settings Studies conducted in well-served community settings
Studies conducted in general population settings Studies conducted in specific population settings (e.g.
refugee camps, nomadic populations etc.)
Each PICOS focuses on a particular aspect of CHWs’ training and working conditions that will guide
the definition of specific inclusion and exclusion criteria for each systematic review. These are
summarised below.
Table 5: PICOS specific inclusion and exclusion criteria

Research Question Included Excluded
Q 1: In CHWs being selected for Studies reporting on the role of Studies reporting on the role of
pre-service training, what pre-service training training other than pre-service
strategies for selection of training (e.g., professional
applications for CHWs should be development, ongoing support,
adopted over what other other forms of training)
strategies? Studies reporting on strategies for Studies reporting on strategies for
selecting applicants for pre- selecting job applicants only [no
service training pre-service training involved]; for
selecting trainees for ongoing
training, on-the-job training or
other types of training
Q 2: For CHWs receiving pre- Studies reporting on the role of Studies reporting on the role of
service training, should the pre-service training training other than pre-service
duration of training be shorter training (e.g., professional
versus longer? development, ongoing support,
other forms of training)
Studies reporting on the role of Studies reporting on other factors
duration of the pre-service related to the conduct of pre-
training, including e.g. length, service training (e.g.,
structure (conduct in one vs. certification, aptitude))
several sessions), dosage etc.
curriculum address specific versus training (e.g., professional
non-specific competencies? development, ongoing support,
Studies reporting the content of a
curriculum describing the
subjects and content that
comprise the course of the pre-
service training.
Studies specifying the Studies specifying the
competencies of CHWs promoted competencies of others than
through a pre-service curriculum. CHWs promoted through a pre-
service curriculum.
curriculum use specific delivery training (e.g., professional
modalities versus not? development, ongoing support,
Studies reporting on the
modalities of a curriculum
delivery (e.g. face-to-face,
electronic, in family settings etc.)
Q 5: In CHWs who have received Studies reporting on the role of Studies reporting on the role of
pre-service training, should pre-service training other than pre-service training
competency-based formal (e.g., professional development,
certification be used versus not ongoing support, other forms of
used? training)
Studies reporting on approaches
to formal certification including
e.g., level of formality,
accrediting body, core criteria for
accreditation, etc.
Q 6: In the context of CHWs Studies reporting on practices of Studies focused on other forms of
programmes, what strategies of supervision, including coaching professional support of CHWs
supportive supervision should be and consultation, e.g., individual (e.g. on-the-job training, study or
adopted over what other vs. group; peer vs. professional reading groups, etc.)
strategies? supervision; supervisor role;
supervision frameworks;
supervisor training etc.
Q 7: In the context of CHWs Studies reporting on approaches
programmes, should practicing to compensate CHWs for their
CHWs be paid for their work work, including salaries,
versus not? payment, remuneration, wage,
reimbursement, non-financial
compensation through e.g.
advancement etc.
Q 8: In the context of CHWs Studies reporting on opportunities
programmes, should practicing for advancement for CHWs and
CHWs have a career ladder describe e.g. career pathways,
opportunity/ framework versus structures for professional
not? development etc.
Q 9: In the context of CHWs Studies reporting on contracting
programmes, should practicing conditions for CHWs including
CHWs have a formal contract information about level of
versus not? formality; form (written or not);
contracting body (formal
authority or other) etc.
Q 10: In the context of CHW Studies providing information
programmes, should there be a about the optimal population size
target population size versus not? for individual or groups of CHWs,
including community population
sizes, case load, agency load etc.
Q 11: In the context of CHWs Studies reporting on the role of
programmes, should practicing data collection as part of CHWs
CHWs collect, collate, and use work routines, e.g. processes of
health data versus not? regular data collection, regular
data use etc. including those
related to either written, oral or
electronic data reporting to
peers, supervisors or others
Q 12: In the context of CHWs Studies reporting on CHW teaming
programmes, should practicing structures and team composition
CHWs work in a multi-cadre team including information on the
versus in a single-cadre CHW degree of specialisation and the
system? presence of competencies in team
members and teams.
Q 13: In the context of practicing Studies reporting on the role of
CHW programmes, are community community engagement strategies
engagement strategies effective in delivering community health
in improving CHW program programmes through community
performance and utilisation? health workers – e.g. through
village groups and committees;
community networks; community
wide action plans; community
involvement in decision making
etc.
Q 14: In the context of CHWs Studies reporting on CHWs’
programmes, should practicing practices for resource
CHW mobilize wider community mobilisation in their community,
resources for health vs. not? e.g. through resource
identification and mapping;
service coordination and
streamlining; strengthening of
referral pathways; utilisation of
research resources etc.
Q 15: In the context of practicing Studies reporting on CHWs’
CHWs programmes, what practices for ensuring the
strategies should be used for availability of commodities and
ensuring adequate availability of consumable supplies, including
commodities and consumable e.g. through the utilisation of
supplies over what other national supply planning, stock
strategies? management tools, mobile phone
applications and social media,
coordination of re-supply
procedures, etc.
3.5. Screening
Each review team involved in this project will be assigned 1-4 PICOS and will be responsible for the
conduct of these reviews with oversight from the PI and advisory group. The distribution of reviews
across teams is summarised in table 6 below.
Table 6: Distribution of reviews across research teams
Review team No of reviews Team lead
University of Adelaide 3 Zohra Lassi
University of Newcastle 2 Luke Wolfenden
University of Sydney 1 Katie Conte
University of Toronto 1 Peter Newman
University of Melbourne 2 Sharon Licqurish
Aga Khan University 4 Jai Das
Review team No of reviews Team lead
Centre for Evidence and Implementation 2 Bianca Albers
Covidence will be the joint work platform for these review teams. The Centre for Evidence and
Implementation (CEI) will be responsible for administering the literature searches and supporting
review teams in their use of Covidence.
Upon de-duplication, studies will be uploaded to Covidence, and review teams assigned to PICOS.
During title and abstract screening, two reviewers will independently screen each study for
inclusion. Any disagreements will be resolved by the review team lead (as per table 6 above).
The full texts of agreed citations will be retrieved and uploaded to Covidence.
Two independent reviewers will screen full texts for inclusion. Any discrepancies will be resolved
by the responsible review team lead.
As part of the screening process, the research team will establish a cross-PICO mechanism for
passing excluded studies from one review to another. This will ensure that a reviewer, who works
on one PICO and identifies and excludes a study of potential relevance to another PICO passes this
study on to the relevant PICO team. This will create an additional layer of security that relevant
studies will not be missed.
The final selection of included studies will be prepared for data extraction to be conducted
independently by each review team.
3.6. Data extraction

The review teams will use a standardised approach to extracting data from included studies. The
components of this extraction will be modified based on the final included studies and may differ
between different questions/topics. At a minimum, the following general information will be
extracted from each study.
• Study details, including:
author, year, location, study design, delivery setting (high versus low and middle income;
community or health facility; etc.), sector (primary or secondary health; allied health;
etc.), participants (type of CHW and others), sample size
• Intervention details, including
Interventions delivered (programmes, practices), core components of interventions,
delivery mode and location, other characteristics as relevant
• Outcomes
for quantitative studies, we will extract data related to each outcome accordingly. We will
report measures of intervention effects in the same way the study authors have reported. If
necessary, comparisons will be made using standardised measures of effect such as mean
standardised difference (SMD) or Odds Ratios (OR). We may also use a standardised scale to
facilitate comparisons across studies along the dimension of quality.
For qualitative studies, we will extract the major themes reported by the study authors.
In addition to this general data extraction, each PICOS implies the extraction of data specifically
tailored to the different research questions. Table 6 below lists information that, if present in a
study, should be extracted. This list is not exhaustive and will be expanded as new findings emerge
from studies.
Table 6: PICOS specific data extraction

Research Question Potential stratifiers for sub-group analysis
Q 1: In CHWs being selected for pre- Literacy level based

service training, what strategies for Gender based
selection of applications for CHWs
should be adopted over what other Marital status based
strategies? Age based
Membership of the community of interest
Preference to volunteer
Preference for certain type of work by potential CHWs
Availability of time
Q 2: For CHWs receiving pre-service Training depending on the complexity of the task (i.e. promotive, preventative, data
training, should the duration of collection, health education)
training be shorter versus longer? Competency requirements
Q 3: For CHWs receiving pre-service Technical competencies for CWEs that will work in biological or medical environments
training, should the curriculum (i.e. basic human physiology for identifying issues and arranging referrals, basic
address specific versus non-specific pharmacology for identifying vitamin supplements)
competencies Counselling and motivational skills
Understanding of the health system to direct patients
Basic knowledge and skills about household preventative habits
Q 4: For CHWs receiving pre-service Face to face delivery
training, should the curriculum use Classroom delivery
specific delivery modalities versus
not? Electronic, web-based, telephone, paper-based training
Training in community or an educational facility away from the community
Q 5: In CHWs who have received Formal certification/accreditation

pre-service training, should Competency based
competency-based formal
certification be used versus not Approval of regulatory bodies, government authorities, approval by academic
used? institutions
Q 6: In the context of CHWs Coaching

programmes, what strategies of Supervisor-supervisee ratios
supportive supervision should be
adopted over what other strategies? Checklists
Category of supervisors (dedicate, non-dedicated, peers as supervisors)
Supervisor visits, observation
Q 7: In the context of CHWs Payments
programmes, should practicing CHWs Salary
be paid for their work versus not?
Remuneration package
Formal contract
Absorption into health force
Q 8: In the context of CHWs Career ladder / pathways
programmes, should practicing CHWs Career opportunities
have a career ladder opportunity/
framework versus not? Promotions
Q 9: In the context of CHWs Formal contract

programmes, should practicing CHWs Written document
have a formal contract versus not?
Legal contract/document
Document issued by a formal authority stipulating working conditions, rights and
responsibilities, job description or terms of remuneration (if any)
Q 10: In the context of CHW Threshold size for the target population
programmes, should there be a Caseload information
target population size versus not?
Q 11: In the context of CHWs Collection and submission of data during their routine activities
programmes, should practicing CHWs e-health data collection and transmission platforms
collect, collate, and use health data
versus not? The data may be used to receive feedback and supervision and motivation
Q 12: In the context of CHWs Single cadre of CHWs
Research Question Potential stratifiers for sub-group analysis
programmes, should practicing CHWs Two or more cadres CHWs
work in a multi-cadre team versus in Multi cadre CHWs
a single cadre CHW system?
Q 13: In the context of practicing Engagement with:
CHW programmes, are community community health committees
engagement strategies effective in
improving CHW program village development committees
performance and utilisation? community liaison committees
facility-liaison committees
hygiene and sanitation committees
mothers’ groups
fathers’ groups
youth groups
religious groups
support groups
savings and credit or farmers’ groups
community health action planning activities involvement of community representatives
in decision making, planning and, budgeting processes
Q 14: In the context of CHWs Some of the activities the studies may report on the engagement of CHWs in the
programmes, should practicing CHW community:
mobilize wider community resources identifying priority health and social problems
for health vs. not?
mobilizing and helping coordinate relevant, local resources representing different
stakeholders, sectors and civil society organizations to address priority health problems
participating in evaluating and disseminating outcomes of interventions
strengthening linkages between community and health facility
Q 15: In the context of practicing Inclusion of relevant commodities in the programme (e.g. condoms in sexual health
CHWs programmes, what strategies programmes)
should be used for ensuring Maintenance and management of stocks using basic procedures
adequate availability of commodities
and consumable supplies over what Making sure to replenish stock through re-supply procedures
other strategies? Use of social media to inform community
Co-ordination, supervision and standardization of resupply procedures, checklists and
incentives  
Use of mobile phone applications
3.7. Data synthesis

If possible and relevant, meta-analyses will be conducted to obtain an overall estimate of the
effect of an intervention when more than one study has examined similar interventions using
similar methods, the studies have been conducted in similar populations, and outcomes were
measured and are similar. For each meta-analysis, we will test for heterogeneity and, if present,
will use a random-effects model for synthesis.
For qualitative studies, we will conduct a narrative synthesis, grouping the findings by the type of
intervention, population, delivery context and outcome(s).
Furthermore, relevant stratifiers such as
• Volunteer vs. paid;
• Level of training;
• Polyvalent vs. monovalent;
• Full time vs part time;
• Expert client/patient;
• Type of CH work [preventive/promotive/curative]
will be included as part of sub-group analyses. Not all literature may allow for this analyses but to
the degree possible, the research team will emphasise this part of the analysis.
The process of data synthesis will involve the utilisation of the GRADE19 (Grading of
Recommendations Assessment, Development and Evaluation) approach, a well-developed formal
process to rate the quality of scientific evidence in systematic reviews.
The goal of assessing the strength of the evidence identified through included studies is to provide
clearly explained, well-reasoned judgments about reviewers’ confidence in their systematic review
conclusions so that decision makers in developing guidelines can use them effectively17,18.
Grading the strength and quality of evidence requires assessment of within-study risk of bias
(methodological quality), directness of evidence, heterogeneity, precision of effect estimates and
risk of publication bias15.
4. References
1. WHO. Global strategy on human resources for health: Workforce 2030, DRAFT for the 69th World
Health Assembly; The World Health Organisation. (URL:
http://www.who.int/hrh/resources/global_strategy2030en-printversion.pdf), [Accessed:
21/04/2017]. 2016.
2. Scott K, Beckham S, Gross M, Pariyo G, Rao K, Perry H. Systematic Review of Existing Reviews of
Community-based Practitioners (Including Community Health Workers and Close-to-Community
Practitioners) and Their Integration with Health Systems: Complete Report; Department of
International Health Johns Hopkins Bloomberg School of Public Health. 2017 Jan.
3. Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? – a
systematic review of definitions. Global Health Action. 2017;10(1):1272223.
4. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive
interventions for maternal and child health in low- and middle-income countries: a systematic review.
BMC Public Health. 2013;13:847.
5. Glenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood
immunisation? Systematic review and typology. Tropical medicine & international health : TM & IH.
2011;16(9):1044-1053.
6. Mwai GW, Mburu G, Torpey K, Frost P, Ford N, Seeley J. Role and outcomes of community health
workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18586.
7. Vouking MZ, Takougang I, Mbam LM, Mbuagbaw L, Tadenfok CN, Tamo CV. The contribution of
community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon. Pan Afr Med
J. 2013;16:63.
8. GHWA W. Global experience of community health workers for delivery of health related millennium
development goals: a systematic review, country case studies, and recommendations for scaling up.
2010. 2014.
9. Raphael JL, Rueda A, Lion KC, Giordano TP. The role of lay health workers in pediatric chronic
disease: a systematic review. Acad Pediatr. 2013;13(5):408-420.
10. Tulenko K, Mgedal S, Afzal MM, et al. Community health workers for universal health-care coverage:
from fragmentation to synergy. Bulletin of the World Health Organization. 2013;91(11):847-852.
11. Campbell J, Buchan J, Cometto G, et al. Human resources for health and universal health coverage:
fostering equity and effective coverage. Bulletin of the World Health Organization. 2013;91(11):853-
863.
12. Dahn B, Woldemariam AT, Perry H, et al. Strengthening primary health care through community
health workers: Investment case and financing recommendations. 2015.
13. ILO. International Standard Classification of Occupations Structure, group definitionsand
correspondence tables; ISCO-08, International Labour Office, Geneva. (URL:
http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---
publ/documents/publication/wcms_172572.pdf); [Accessed: 21/04/2017]. 2012.
14. WHO. Community health workers: What do we know about them? The state of the evidence on
programmes, activities, costs and impact on health outcomes of using community health workers.
World Health Organisation, Evidence and Information for Policy, Department of Human Resources for
Health Geneva, January 2007. 2007.
15. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias
in randomised trials. Bmj. 2011;343:d5928.
16. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of
nonrandomized studies in meta-analyses. Department of Epidemiology and Community Medicine,
University of Ottawa, Canada. www ohr i ca/programs/clinical_ epidemiology/oxford htm. 2012.
17. Atkins D, Fink K, Slutsky J, Agency for Healthcare R, Quality, North American Evidence-based Practice
C. Better information for better health care: the Evidence-based Practice Center program and the
Agency for Healthcare Research and Quality. Ann Intern Med. 2005;142(12 Pt 2):1035-1041.
18. Berkman ND, Lohr KN, Ansari M, et al. Grading the Strength of a Body of Evidence When Assessing
Health Care Interventions for the Effective Health Care Program of the Agency for Healthcare
Research and Quality: An Update. Methods Guide for Effectiveness and Comparative Effectiveness
Reviews. Rockville (MD) 2008.
19. GRADE. The Grading of Recommendations Assessment, Development and Evaluation, The GRADE
WOrking Group, (URL: http://www.gradeworkinggroup.org/), Accessed [20/04/2017]. 2017.
20. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N with Katrina Roen and
Steven Duffy. Guidance on the Conduct of Narrative Synthesis in Systematic Reviews - A Product from
the ESRC Methods Programme, York 2006
Our mission
We are dedicated to using the best evidence in practice
and policy to improve the lives of children, families and
communities facing adversity.
How we achieve this

We work with a diverse range of key stakeholders who
want to achieve social impact for children and families
facing adversity. We bring specialist skills in:
• Supporting sustained change in the behaviour of
systems, organisations and individuals. We put a strong
emphasis on supporting and strengthening the core
components of effective program implementation.
• Providing knowledge translation to policymakers, and
relevant stakeholders, so they can access – and use –
research for evidence-informed decision-making.
• Program design – selecting and creating evidence-
informed programs and services to achieve outcomes
for children, family and communities.
• Conducting rigorous evaluations, and assessing the
long-term effect of outcomes.
Working with us
Through national and international collaborations, we
conduct a range of activities to achieve our mission.
Centre for Evidence and Implementation

Level 6, 250 Victoria Parade, East Melbourne VIC 3002
Web: cei.org.au
Twitter: @CEI_org

Optimising Community Health Worker Programmes: A Search Strategy For 15 Systematic Reviews

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Optimising Community Health

Centre for Evidence and Implementation

Table 1: The search strategy

PICOS Category Approach

3.1. The search

Table 2: CHW Search Terms

1 community health workers/exp

2 “frontline health worker*”.mp

6 ("community health" adj1 worker*).mp

11 (Promotora or promotoras) .mp

15 "health extension worker*".mp

17 "accredited social health activist*".mp

20 "community based practitioner*".mp

22 "health surveillance assistant*".mp

23 (("community healthcare" or "community health care") adj1 worker*).mp

26 "family welfare assistant*".mp

27 (child adj (health or healthcare or "health care") adj worker*).mp

3.3. PICOS specific searches

Table 3: PICOS specific search strategies

Q1: In CHWs being 1. Primary CHW search

Q3: For CHWs 1. Primary CHW search

Q5: In CHWs who have 1. Primary CHW search

Q6: In the context of 1. Primary CHW search

Q7: In the context of 1. Primary CHW search

Q8: In the context of 1. Primary CHW search

Q9: In the context of 1. Primary CHW search

Q10: In the context of 1. Primary CHW search

Q11: In the context of 1. Primary CHW search

Q12: In the context of 1. Primary CHW search

Q14: In the context of 1. Primary CHW search

3.4. Inclusion and exclusion criteria

Table 4: General inclusion and exclusion criteria

part of a formal tertiary education programme or

Studies conducted in high income countries, and in

Table 5: PICOS specific inclusion and exclusion criteria

Table 6: Distribution of reviews across research teams

Review team No of reviews Team lead

University of Adelaide 3 Zohra Lassi

University of Newcastle 2 Luke Wolfenden

University of Sydney 1 Katie Conte

University of Toronto 1 Peter Newman

University of Melbourne 2 Sharon Licqurish

Aga Khan University 4 Jai Das

Centre for Evidence and Implementation 2 Bianca Albers

3.6. Data extraction

Table 6: PICOS specific data extraction

Q 1: In CHWs being selected for pre- Literacy level based

Q 5: In CHWs who have received Formal certification/accreditation

Q 6: In the context of CHWs Coaching

Q 9: In the context of CHWs Formal contract

Q 12: In the context of CHWs Single cadre of CHWs

3.7. Data synthesis

How we achieve this

Centre for Evidence and Implementation

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