Community Health Research Round-Up, Issue 103

Hi All,

Below is issue 103 of the Research Round-Up, happy reading!

April 18 - May 16 2023

1. Workload and emerging challenges of Community Health Workers in low- and middle-income countries: A mixed-methods systematic review.

Geographical region: Low- and middle-income countries (LMICs).
Of particular interest to: Program managers.
Design: Mixed-methods systematic review.
Study aims: To summarize and present CHWs’ perceived workload in LMICs.
Key messages:

  • In 98% of the articles included in this review, CHWs report high workload. Having multiple tasks was the most commonly reported subcomponent of workload (78%).
  • Program managers should give careful consideration when additional tasks are shifted to CHWs.


  • Further research is needed to comprehensively evaluate the full scope and workload of CHWs. When proposing ‘task shifting’ or ‘task sharing’ to CHWs, don’t see it as a pancea. First evaluate existing workloads, speak to CHWs and involve them in decision making process to understand their capacities for any additional work.
  • Being proactive in assessing CHW workload capacity is important and using existing validated tools - such as the C3 tool - can help with this. For more information as to how this has been done in practice, check out this important study covered in RRU 56: “Applying the community health worker coverage and capacity tool (C3) for time-use modeling for program planning in Rwanda and Zanzibar”.

Read the full study here.

2. Training and experience outperform literacy and formal education as predictors of Community Health Worker knowledge and performance, results from Rongo sub-county, Kenya.

Geographical region: Kenya.
Of particular interest to: Program managers; policy makers; those interested in CHW selection, training and supervision.
Design: Cohort study.
Study aims: To explore predictors of CHW knowledge of obstetric and early infant danger signs, performance in achieving antenatal care and immunization uptake among their clients.
Key messages:

  • Recency of training and experience were predictive of increased knowledge.
  • Though education and literacy are often used in the selection processes of CHWs globally, the link between these characteristics and CHW knowledge and performance are mixed.


  • Policymakers and practitioners should reconsider the use of education and literacy as means of CHW selection.
  • Program managers should pay particular attention to ongoing supervision and refresher training, since recency of training was associated with increased knowledge of pregnancy and postpartum danger signs amongst CHWs.

Read the full study here.

3. Motivation and job satisfaction of Community Health Workers in Ethiopia: a mixed-methods approach.

Geographical region: Ethiopia.
Of particular interest to: CHW program managers; policy makers.
Design: Nested mixed-methods study.
Study aims: To explore the motivation and job satisfaction, and factors influencing these with 584 CHWs in Ethiopia.
Key messages:

  • Only 48.6% of CHWs were satisfied with their jobs.
  • Areas of high job satisfaction were attributed to autonomy, relationships and co-workers and recognition; whereas low job satisfaction was associated with inadequate pay, limited education and career advancement opportunities.
  • CHWs appeared motivated by a desire to help their community, recognition, or respect gained from the community. However, inadequate pay and benefits, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunities to change their workplace were demotivating factors.
  • This quote from a CHW was particularly telling: “If you look at their work, they deserve great respect, but their salary is not adequate.…we also feel that it is unfair to complain about their performance, given low salary…”


  • Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation…(yet another reason to #joinCHIC as we push for better working conditions for CHWs!)

Read the full study here.

4. Role of Mitanin Community Health Workers in improving complementary feeding practices in under scaled-up home-based care of young children in a rural region of India.

Geographical region: India.
Of particular interest to: Program managers; those interested in maternal and child health.
Design: Cross-sectional study.
Study aims: To explore the coverage of home-based care of young children in the Indian state of Chhattisgarh, where it has been implemented through 67,000 rural CHWs known as Mitanins.
Key messages:

  • Receiving advice from CHWs was significantly associated with timely initiation of complementary feeding, increasing the frequency of feeding, increasing diet diversity, addition of oil, weighing and consumption of food received from government’s supplementary nutrition programme.
  • Along with improving food security of households, covering a large share of young children population with quality home visits under scaled-up CHW programmes can be the key to achieving improvements in complementary feeding and child care practices in developing countries.


  • This study highlights the importance of proactive home visits, which our friends over at Muso have been championing for years. Watch this space for a ground breaking study on their experience of proactive Community Case Management, coming soon!

Read the full study here.