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Community-based health workers: Head start or false start towards health for all?


  • Berman, Peter A.
  • Gwatkin, Davidson R.
  • Burger, Susan E.


Health service delivery programs using minimally-trained community-based health workers (CHWs) have been established in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforce their successes and assure that they are adequately supported as an integral component of the basic health system.

Suggested Citation

  • Berman, Peter A. & Gwatkin, Davidson R. & Burger, Susan E., 1987. "Community-based health workers: Head start or false start towards health for all?," Social Science & Medicine, Elsevier, vol. 25(5), pages 443-459, January.
  • Handle: RePEc:eee:socmed:v:25:y:1987:i:5:p:443-459

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    References listed on IDEAS

    1. Temin, Peter, 1983. "Costs and benefits in switching drugs from Rx to OTC," Journal of Health Economics, Elsevier, vol. 2(3), pages 187-205, December.
    2. Foster, S. D., 1990. "Improving the supply and use of essential drugs in sub-Saharan Africa," Policy Research Working Paper Series 456, The World Bank.
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    Cited by:

    1. Mitsunaga, Tisha & Hedt-Gauthier, Bethany & Ngizwenayo, Elias & Farmer, Didi Bertrand & Karamaga, Adolphe & Drobac, Peter & Basinga, Paulin & Hirschhorn, Lisa & Ngabo, Fidele & Mugeni, Cathy, 2013. "Utilizing community health worker data for program management and evaluation: Systems for data quality assessments and baseline results from Rwanda," Social Science & Medicine, Elsevier, vol. 85(C), pages 87-92.
    2. Riviere-Cinnamond, Ana, 2004. "A Public Choice Approach to the Economic Analysis of Animal Healthcare Systems," PPLPI Working Papers 23786, Food and Agriculture Organization of the United Nations, Pro-Poor Livestock Policy Initiative.
    3. Berman, Peter, 1995. "Health sector reform: making health development sustainable," Health Policy, Elsevier, vol. 32(1-3), pages 13-28.
    4. Kim, Younoh & Radoias, Vlad, 2016. "Education, individual time preferences, and asymptomatic disease detection," Social Science & Medicine, Elsevier, vol. 150(C), pages 15-22.
    5. Thomas Porter & Jane Chuma & Catherine Molyneux, 2009. "Barriers to managing chronic illness among urban households in coastal Kenya," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 271-290.
    6. Kash, Bita Arbab & May, Marlynn Lee & Tai-Seale, Ming, 2007. "Community health worker training and certification programs in the United States: Findings from a national survey," Health Policy, Elsevier, vol. 80(1), pages 32-42, January.
    7. Standing, H. & Chowdhury, A. Mushtaque R., 2008. "Producing effective knowledge agents in a pluralistic environment: What future for community health workers?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2096-2107, May.
    8. Druetz, Thomas & Kadio, Kadidiatou & Haddad, Slim & Kouanda, Seni & Ridde, Valéry, 2015. "Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso," Social Science & Medicine, Elsevier, vol. 124(C), pages 232-240.
    9. Stekelenburg, Jelle & Kyanamina, Sindele Simasiku & Wolffers, Ivan, 2003. "Poor performance of community health workers in Kalabo District, Zambia," Health Policy, Elsevier, vol. 65(2), pages 109-118, August.
    10. Riviere-Cinnamond, Ana, 2005. "Animal Health Policy and Practice: Scaling-up Community-based Animal Health Systems, Lessons from Human Health," PPLPI Working Papers 23775, Food and Agriculture Organization of the United Nations, Pro-Poor Livestock Policy Initiative.
    11. Naydene de Lange & Claudia Mitchell, 2012. "Community Health Workers Working the Digital Archive: A Case for Looking at Participatory Archiving in Studying Stigma in the Context of HIV and AIDS," Sociological Research Online, Sociological Research Online, vol. 17(1), pages 1-7.


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