The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

Schaaf, Marta, Warthin, Caitlin, Freedman, Lynne, and Topp, Stephanie M. (2020) The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability. BMJ Global Health, 5 (6). e002296.

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This paper is a critical interpretive synthesis of community health workers (CHWs) and accountability in low-income and middle-income countries. The guiding questions were: What factors promote or undermine CHWs as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? We conducted an iterative search that included articles addressing the core issue of CHWs and accountability, and articles addressing ancillary issues that emerged in the initial search, such as 'CHWs and equity.' CHWs are intended to comprise a 'bridge' between community members and the formal health system. This bridge function is described in three key ways: service extender, cultural broker, social change agent. We identified several factors that shape the bridging function CHWs play, and thus, their role in fomenting health system accountability to communities, including the local political context, extent and nature of CHW interactions with other community-based structures, health system treatment of CHWs, community perceptions of CHWs, and extent and type of CHW unionisation and collectivisation. Synthesising these findings, we elaborated several analytic propositions relating to the self-reinforcing nature of the factors shaping CHWs' bridging function; the roles of local and national governance; and the human resource and material capacity of the health system. Importantly, community embeddedness, as defined by acceptability, social connections and expertise, is a crucial attribute of CHW ability to foment local government accountability to communities.

Item ID: 63620
Item Type: Article (Research - C1)
ISSN: 2059-7908
Copyright Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Date Deposited: 13 Jul 2020 23:13
FoR Codes: 44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 20%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450404 Aboriginal and Torres Strait Islander cultural determinants of health @ 80%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920413 Social Structure and Health @ 20%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 80%
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