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Table 2 Challenges cited by authors of 29 case studies of national CHW programmes [13]

From: Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”

Type of challenge Number of national programmes for which this challenge was mentioned Countries in which they challenge was mentioned and name of CHW cadre involved
Lack of supplies and commodities 20 Ethiopia (HEW, WDA); India (ANM, AWW, ASHA, VHG); Kenya (CHW); Liberia (CHA, CHSS); Malawi (CHW); Mozambique (APE); Niger (ASC, RV); Rwanda (Binome, ASM); Sierra Leone (CHW); South Africa (WBPHCOT); Zambia (CHA, CBV); Zimbabwe (VHW)
Inadequate, unstable, or unsustainable financing 20 Brazil (ASC Agent); Ghana (CHO, CHV); Indonesia (Kader); Liberia (CHA, CHSS); Malawi (CHW); Mozambique (APE); Myanmar (AMW, CHW, MV, TBV, TBA), Pakistan (LHW); Rwanda (Binome, ASM); Sierra Leone (CHW); South Africa (WBPHCOT); Tanzania (CHW); Zimbabwe (VHW)
Low compensation of CHWs 17 Brazil (CHW); Ghana (CHO, CHV); India (ANM, AWW, ASHA, VHG); Iran (B, MS), Kenya (CHV); Malawi (CHW); Mozambique (APE); Pakistan (LHW); South Africa (WBPHCOT), Zambia (CHW, CBV); Zimbabwe ( VHW)
Inadequate supervision 15 Brazil (ASC-agent); Ethiopia (HEW, WDA); India (ANM, AWW, SAHA, VHG); Mozambique (APE); Niger (ASC, RV); Rwanda (Binome; ASM); South Africa (WBPHCOT); Zambia (CH-assistant, CBV)
Management challenges 11 Brazil (ASC-agent); Ghana (CHO, CHV). Iran (B, MS); Kenya (CHV); Malawi (CHW); Nigeria (CHW, CHIPS, CDD); Tanzania (CHW)
Overall shortage of human resources 10 Indonesia (Kader); Liberia (CHA, CHSS); Kenya (CHV), Madagascar (AC, ACN); Malawi (CHW); Niger (ASC, RV), Pakistan (LHW)
Weak linkage with the formal health system 10 Brazil (ASC-agent); Ethiopia (HEW, WDA); Kenya (CHW), Malawi (CHW). Myanmar (AMW, CHW, MV, TBV, TBA)
Unavailability of health facilities 9 India (ANM, AWW, ASHA, VHG); Iran (B, MS); Malawi (CHW), Niger (ASC, RV)
Deficient training 8 Brazil (ASC-agent); Ethiopia (HEW, WDA); India (ANM, AWW, ASHA, VHG); Mozambique (APE)
Low level of community involvement 7 India (ANM, AWW, ASHA, VHG); Thailand (VHV); Kenya (CHV); Malawi (CHW)
Inappropriate workload 7 Ethiopia (HEW, WDA); Rwanda (Binome, ASM); Malawi (CHW); Zambia (CHA, CBV)
Role constraints 6 Nepal (FCHV); Nigeria (CHEW, CHIP, CDD, CHA); Zambia (CHA, CBV)
Limited career progression 6 Bangladesh (FWA, HA, CHCP); Ethiopia (HEW, WDA); Mozambique (APE)
Fragmented (vertical) programming 5 Myanmar (AMW, CHW, MV, TBV, TBA)
Low quality of services 5 Bangladesh (FWA, HA, CHCP), Kenya (CHV); Tanzania (CHW)
Violence and sexual harassment against CHWs 4 India (ANM, AWW, ASHA, VHG)
Increased health needs 4 Bangladesh (SS, SK); Madagascar (AC, ACN)
Discrimination 4 Bangladesh (SS, SK); Iran (B, MS)
Programme inefficiencies 4 Afghanistan (CHW); Ethiopia (HEW, WDA), Kenya (CHV)
Lack of political support for the CHW programme 3 Indonesia (Kader), Kenya (CHV); South Africa (WBPHCOT)
Limited educational background of CHWs 2 South Africa (WBPHCOT); Thailand (VHV)
High turnover of CHWs 2 Brazil (CH-agent); Kenya (CHV)
  1. AWW: aganwadi worker; AC: agent communautaire; ACN: agent communautaire nutritional; AMW: auxiliary midwife; ANM: auxiliary nurse midwife; APE: agent polivalente elementares; ASC: agent de santé communautaire; ASHA: accredited social health activist; ASM: agent de santé maternelle; B: behvarzs; CBV: community-based volunteer; CDD: community-directed distributor; CHA: community health agent; CHCP: community healthcare provider; CHEW: community health extension worker; CHIP: community health influencer and promoter; CHO: community health officer; CHSS: community health service supervisor; CHW: community health worker; CHV: community health volunteer; FWA: family welfare assistant; FCHV: female community health volunteer; HA: health assistant; HEW: health extension worker; LHW: lady health worker; MS: moraghebe-salamat; MV: malaria volunteer; RV: relais volunteer; SK: shasthya korbi; SS: shasthya shebika TBA: traditional birth attendant; TBV: traditional birth volunteer; VHG: village health guide; VHV: village health volunteer; WBPHCOT: ward-based primary healthcare outreach team; WDA: Women’s Development Army; VHW: village health worker