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Community health workers in low, middle, and high income countries: an overview of their history, recent evolution, and current effectiveness.

Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health, 2014. doi: 10.1146/annurev-publhealth-032013-182354
Abstract / Summary: 
Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.
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The evidence cited here conclusively demonstrates that CHWs can be effective in improving population health in low-, middle-, and high-income countries. Unfortunately, they are still often considered as second-class, temporary solutions. However, the evidence increasingly demonstrates that they are now essential elements of population-based programs that improve health outcomes, even in high-income countries. When CHWs are appropriately selected, trained, and supervised, and when they are provided with appropriate supplies, medicines, and equipment, CHWs can improve key health-related behaviors, extend the accessibility of key services, and strengthen linkages between communities and health services. The evidence cited here indicates that CHWs should become an integral part of health systems as they strive to improve their quality, coverage, and impact on population health.

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Perry HB, Zulliger R, Rogers MM

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