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Integration of community health workers into health systems in developing countries: Opportunities and challenges
  1. Collins Otieno Asweto1,2,3,
  2. Mohamed Ali Alzain1,3,4,
  3. Sebastian Andrea1,3,
  4. Rachel Alexander5 and
  5. Wei Wang1,3,5
  1. 1. School of Public Health, Capital Medical University, Beijing, China
  2. 2. School of Health Sciences, Great Lakes University of Kisumu, Kenya
  3. 3. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
  4. 4. Community Medicine Department, Faculty of Medicine and Health Sciences, University of Dongola, Sudan
  5. 5. Systems and Intervention Research Centre for Health, School of Medical Sciences, Edith Cowan University, Perth, WA, Australia
  1. Corresponding author : Wei Wang, MD, PhD, FFPH Global Health and Genomics, School of Medical Sciences, Edith Cowan University, Joondalup WA 6027, Australia, Tel.: +61-8-63043717, Fax: +61-8-63042626, E-mail:{at}


Background Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs). It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.

Objective To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.

Methods Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.

Results CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload.

Conclusions For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound governance of community resources, promotion of inclusiveness and cohesion, engagement in participatory decision making, and mobilization of local resources for community welfare.

  • Community health workers
  • health care systems and policy
  • supportive supervision
  • developing countries

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See

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