Table 1 Summary of studies addressing contextual factors and their influence on CHW performance

Community context

Socio-cultural factors

Social and cultural norms, values, practices and beliefs

Influencing health-seeking behaviour and therefore directly influencing utilization of CHW services or the ability of CHWs to reach the client

[20-32]

Positively or negatively influencing acceptance of the CHW or the CHW intervention

[33-37]

Not corresponding with CHW’s advice and therefore hindering CHW performance

[27,28,38-47]

Social class of CHW could influence relationship between CHW and client

[48,49]

Influencing level of initiative of the CHW

[33,50]

Gender roles and norms

Influencing women’s access to and uptake of CHW services

[27,33,35,40,51-55]

Preference regarding sex of the CHW influencing acceptance of the CHW

[32,40,56,57]

Influencing possibilities for interactions of female CHW with male clients and therefore hampering CHW performance

[38,48,58]

Influencing mobility of female CHW and therefore hampering CHW performance

[59,60]

Influencing choice of becoming or retaining as a CHW (for example, women seen as caring, men should be paid, women discouraged to become CHW by husband)

[21,38,51,61-67]

Disease related stigma

Influencing information provision to the CHW and health-seeking behaviour and therefore hampering CHW performance

[33,38,54,68-71]

Feeling of unsafety could lower CHW motivation and conflict could hamper the functionality of programmes

[45,72,73]

Low education and knowledge levels of clients could hinder CHW performance

[33,57,74,75]

Economic hardship could influence willingness to become CHW, health-seeking behaviour, and could lead to stress of CHWs

[55,62,64,74,76-78]

Environment

Difficult geography and large distances to cover could hamper CHW performance

[20,24,25,38,45,55,72,79-82]

Flooding could hamper mobility and thus performance of CHWs

[21,83-85]

Health system policy

CHW and human resources policy

CHW policy

Existence of CHW policy could influence CHW performance

[26,51,56,58,61,68,70,72,78,80,86-96]

Human resources policy

Human resources policies, relating to incentives and career perspectives, influence CHW performance

[59,61,62,68,78,80,97,98]

Regulatory frameworks about procedures CHWs are authorized to perform could influence their scope of work and could influence their acceptability

[20,35,37,40,53,61,72,77,79,97,99-104]

Political commitment towards CHW programmes could influence performance of CHWs

[58,72,81,92,105]

Health system practice

Embedment of CHW services with functional, well-supplied health services could enhance CHW performance

[70,82,97]

Functioning, bidirectional referral, and feedback systems enhance CHW performance

[71,106,107]

Expectations regarding career progression and incentives that are not corresponding with possibilities within health system could hinder CHW performance

[49,62,108-111]

Well defined roles of CHWs and other workers could increase CHW performance

[80,97,110]

Inadequate support of other staff or supervision could hinder CHW performance

[55,58,74,77,88,112,113]

Outcome-based payment of CHWs could hinder their performance

[29,49]

Decentralization could have an effect on performance of CHWs

[114]

User fees and income based on drug selling by CHWs could hinder their performance

[65,95,96]

Hierarchical structures and too many vertical programmes could hinder CHW performance

[29,81]