Effectiveness of Community Health Workers in Low-Income Countries: A Meta-Analysis
Henry Perry, Rose Zulliger, Michael Rogers
The Lancet Global Health · 2014 · DOI: 10.1016/S2214-109X(14)70258-0
Countries: Multiple LMICs
What Was Studied
A meta-analysis of 36 randomised controlled trials and quasi-experimental studies examining the effectiveness of community health workers (CHWs) in improving maternal, neonatal, and child health outcomes in low- and middle-income countries.
What They Found
CHW programmes reduced neonatal mortality by 24% (RR 0.76, 95% CI 0.68-0.84) and under-five mortality by 16% when they included home visits, health education, and basic treatment. Key success factors: (1) regular supervision and mentoring, (2) clearly defined scope of work, (3) community trust and selection, (4) adequate supply chain for medicines and commodities, (5) fair compensation or incentives. Volunteer-only programmes showed lower retention and effectiveness compared to salaried CHWs.
What This Means for Nepal
Nepal's FCHV programme has been effective but faces challenges: FCHVs are unpaid volunteers with growing workloads and declining motivation. This evidence suggests Nepal should consider transitioning FCHVs to paid positions with clearer roles, regular supervision, and better supply chains. The 24% neonatal mortality reduction is achievable but requires consistent support systems that Nepal's current programme structure may not fully provide.
Contextualisation
Nepal's Female Community Health Volunteer (FCHV) programme is one of the world's largest community health worker networks. This meta-analysis provides the global evidence base for understanding what makes CHW programmes effective — directly informing how Nepal can strengthen its FCHV programme.