Community Health Impact Coalition-Research Round-Up Issue 13

Hi everyone Beatrice Wasunna here, Senior Researcher at Medic Mobile, following up on @isaacholeman previous community heath research round up Issue 012 , below are six articles from the Community Health Impact Coalition -Research Round-Up Issue 013.
Happy reading!

Issue 013

June 18 - July 15, 2019

  1. Unintended Consequences of Community Health Worker Programs in South Africa

Comments: Would vigorously dispute the characterization of the evidence base for the efficacy of CHW programs as “limited”–the six year old Singh & Sachs article cited in this piece does not make this claim & frankly, in what other field is 100+ positive RCTs characterized in this way? That said, this is an important paper on something that is understudied: the potential unintended consequences of these programs when they are not integrated into the health system

Methods: Ethnographic

Takeaway: In the context of a bureaucratically weak health system and local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals, unintended consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care.

  1. The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey [version 2; peer review: 2 approved]

Comments: Great use of the Performance Monitoring and Accountability 2020 survey by Lisa, Dan and others!

Methods: Descriptive analyses of survey data

Takeaway: There was variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the
expected frequency of supervision while there were substantial differences by region in CHW service provision, which requires further

  1. Community Health Worker (CHW) Movement in Hawai‘i: Moving Towards a CHW Association

Comments: Of interest to our US colleagues and all who care about accreditation/organizing! (Part of a special issue on community-clinical linkages within health care in Hawai‘i)

Methods: Editorial

Takeaway: Presents the perspectives of allies (governmental, university & public health organizations) in support the efforts of Hawai’i CHWs as they organize and move towards establishing a professional association.

  1. Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

Comments: Add to the arsenal of ‘CHWs are pro-equity!’ arguments

Methods: Mixed-methods systematic review of quantitative and qualitative studies

Takeaway: CHW interventions involving home visits, cash transfers, participatory women’s groups or multiple components can improve equity in maternal and newborn health

  1. A systematic review of vital events tracking by community health agents

Comments: While community health agents remain at the core of many birth and death reporting efforts, previous literature has not explored elements for their successful integration into civil registration and vital statistics (CRVS) systems

Methods: Systematic review

Takeaway: Creating a programmatic norm of integrating with CRVS systems the vital events information collected from existing community health programs has the potential to provide governments with information essential for public health decision-making.

  1. BONUS: The Missing Billion: Access to health services for 1 billion people with disabilities

Comments: New report out this week by Phyllis Heydt, a longtime member of the community health family, and team! A cross-cutting issue that I believe is relevant to all our work

Methods: Review

Takeaway: People with disabilities have poorer healthcare access, coverage, and outcomes for all SDG 3 indicators.


Thanks for posting @beatrice! I wanted to share two notes about some of this issue’s papers.

  1. I hadn’t seen the review of vital events tracking, but it looks interesting and relevant to another ongoing interest. A couple years ago we designed a workflow for enabling CHWs to report deaths in the community and have supervisors/clinicians confirm death reports. This was an important step towards being able to integrate disease surveillance into routine, integrated doorstep care. Since then a lot of literature has come out about real time monitoring of mortality and we haven’t had a chance/found the right partner to review this literature and help us understand any changes we would do well to make in these software-supported workflows. In particular, here’s a PLOS collection I’d like to look into: Real-Time Monitoring of Under-Five Mortality - PLOS Collections

  2. The second thing I wanted to share is about The Missing Billion report, which I was very excited to see published. @joshnesbit was able to give the report authors some feedback on a draft, based in part on the ongoing Equity Lens work that @Amanda and others at Medic have been working on for a few years now. I was really happy to see Josh’s suggestion incorporated into the final draft:

Metrics – local level measures to ensure performance management for equity: Data on coverage and access to health services for people with disabilities, as well as other social determinants of health and equity measures, need to be included at local levels of health systems. Such data should be integrated with routine health information systems and made actionable for primary health care workers, in real time, at a granular and local level.

I’m looking forward to thinking more about this report and how it might inform our ongoing work on Equity Lens and algorithms for proactive, differentiated care.


Hi all,

It’s awesome to arrive here and see these research discussions already happening! Thanks, @isaacholeman and @beatrice!

Just wanted to flag that the entire archive of Community Health Research Round-Ups can now be accessed here.

We’re up to 17 issues now–the next one comes out on Monday!


Glad to have you here @mballard!