The DOI matches its Crossref record; 93 of the 95 references it cites were found in a registry or an index; 8 of the 77 sources its claims cite were checked for support.
Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”
Open accessAbstract
Background: This is the concluding paper of our 11-paper supplement, “Community health workers at the dawn of a new era”. Methods: We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. Results: CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. Conclusion: A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This concluding paper of an 11-paper supplement argues that CHWs are at the dawn of a new era as a foundation of health systems, but national CHW programmes remain constrained by inadequate financing, supplies, compensation, and supervision. It calls for sustainable domestic and donor investment, stronger political support, and rigorous monitoring, evaluation, and implementation research to achieve UHC and Health for All.
Key findings
- In 29 national CHW programme case studies, the most frequently cited challenges were lack of supplies and commodities (20 programmes), inadequate/unstable/unsustainable financing (20), low compensation of CHWs (17), and inadequate supervision (15).
- Only 2.5% of global public health donor assistance over the past decade was devoted specifically to CHW programmes, and two thirds of this was for vertical programmes related to HIV/AIDS, malaria, tuberculosis, reproductive health, or family planning.
- Modelling cited in the paper estimates that raising population coverage of evidence-based maternal-child interventions deliverable by CHWs to 90% in the 74 countries with 97% of child and maternal mortality could avert an additional 2.6 million maternal and child deaths each year.
- CHWs are increasingly recognized as critical for UHC, ending preventable child and maternal deaths, controlling HIV, tuberculosis, malaria, and noncommunicable diseases, and responding to pandemics; Brazil’s programme is cited as assigning 150–200 households per CHW for a comprehensive life-course approach.
Methods
- This is the concluding paper of the 11-paper supplement “Community health workers at the dawn of a new era”; the authors relied on their collective experience, an extensive body of CHW literature, and the other papers in the supplement to identify pressing challenges and strengthening approaches.
- The paper draws on the 2014 CHW Reference Guide, WHO guidelines on CHW programmes, and a compendium of 29 national CHW programme case studies; Table 2 summarizes challenges cited by the case study authors.
- It is a narrative synthesis/commentary rather than a new empirical study; no primary data collection or systematic review methods are described.
Limitations
- Stated: the suggestions are “not intended to be definitive,” and the authors welcome further ideas and discussion; Table 2 is not an all-encompassing list, only the most pressing challenges identified by the case study authors.
- Stated: the evidence base lacks rigorous research on CHW programme effectiveness at scale under routine conditions; large-scale randomized controlled trials cannot provide the needed evidence, and more implementation research is required.
- Evident: as a concluding commentary/synthesis, the paper presents no original empirical data or formal systematic search methods, so its conclusions rely on cited literature and expert judgment.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
Statistics
Verification
Claims the paper makes
48 Not checked yet · 25 Own interpretation · 3 Supported so far · 3 Partly supported · 1 Own method · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Evidence of the effectiveness of adequately trained and supported CHWs in providing quality health services and improving population health continues to grow [13, 20–23].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
- Not checked yetcites [20] Perry HB, editor. Engaging communities for improving mothers’ and children’s health: reviewing the evidence of effectiveness in resource-constrained settings. Edinburgh: Edinburgh University Global Health Society; 2017.
- Supportedcites [21] Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. Summary and recommendations of the Expert Panel. J Glob Health. 2017;7:010908. source
The Results section on community engagement says evidence of effectiveness continues to grow and that community-level workers have improved maternal, neonatal and child health and other health priorities. The Results recommendations call for training, support and supervision so these workers can perform appropriate health tasks; the strategies section describes community case management and treatment with appropriate medications. Together, these support the citing sentence’s broad summary. (LLM, conf=0.86)
- Not checked yetcites [22] Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;3:4015.
- Not checked yetcites [23] Glenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Trop Med Int Health. 2011;16:1044–53. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“A review of community-based PHC in improving maternal, neonatal, and child health [20] identified four strategies for which there is good evidence of effectiveness:home visitation,participatory women’s groups,community case management of childhood illness, andprovision of outreach services by mobile health teams [112].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [20] Perry HB, editor. Engaging communities for improving mothers’ and children’s health: reviewing the evidence of effectiveness in resource-constrained settings. Edinburgh: Edinburgh University Global Health Society; 2017.
- Supportedcites [112] Perry HB, Sacks E, Schleiff M, Kumapley R, Gupta S, Rassekh BM, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6 strategies used by effective projects. J Glob Health. 2017;7:010906. source
The Results identify the four intervention-delivery strategies named in the claim. The Discussion describes them as important for improving maternal, neonatal and child health in high-mortality, resource-constrained settings, and the Conclusions say the review's evidence supports their effectiveness. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“We also know that CHWs can have important impacts in the midst of humanitarian disasters [76, 77].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > How can we develop stronger CHW programming in fragile states and in the context of humanitarian disasters and epidemics/pandemics?
What the sources say
- Partly supportedcites [76] Horton A, Silwal R, Simkhada P. A survey study on the role of Female Community Health Volunteers (FCHVs) in Nepal, during and following the 2015 earthquakes. Int J Disast Risk Red. 2020;48:101583. sourceExperimental — accuracy not yet measured
The Results (section 3.2.1) report that all surveyed FCHVs provided assistance during or after Nepal’s 2015 earthquakes, most commonly first aid. Section 4.3 calls their first-aid and mental-health responses important, but explicitly says the study could not measure their effect. The paper therefore supports an important disaster-response role, not a demonstrated impact. (LLM, conf=0.82)
- Supportedcites [77] Miller NP, Ardestani FB, Dini HS, Shafique F, Zunong N. Community health workers in humanitarian settings: Scoping review. J Glob Health. 2020;10:20602. source
The Results (Emergency response activities; page not provided) describe CHWs carrying out critical work during earthquakes, floods, and disease outbreaks. The review reports that CHWs’ case finding and education campaign during a cholera outbreak were seen as key to reducing mortality, supporting the claim that they can have important impacts during humanitarian disasters. (LLM, conf=0.90)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“We know that fragile states and areas with armed conflict have higher levels of collateral mortality (especially for mothers and children) [74, 75] and that with adequate support, CHW programming is possible even when health facility functioning is compromised.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > How can we develop stronger CHW programming in fragile states and in the context of humanitarian disasters and epidemics/pandemics?
What the sources say
- Partly supportedcites [74] Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet. 2018;392:857–65. sourceExperimental — accuracy not yet measured
The Findings report higher infant mortality near armed conflict, and the Conclusions describe an indirect toll on children. The Discussion suggests possible harms to maternal health and care, but the paper does not establish higher maternal mortality or assess fragile states as a category. (LLM, conf=0.86)
- Partly supportedcites [75] Wagner Z, Heft-Neal S, Wise PH, Black RE, Burke M, Boerma T, Bhutta ZA, Bendavid E. Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood. Lancet Glob Health. 2019;7:e1622–31. sourceExperimental — accuracy not yet measured
The Results report increased mortality among women exposed to nearby armed conflict, including an 11% increase in maternal deaths. The Discussion says some deaths may be indirectly related to combat, but also identifies violence-related deaths as an important contributor. The paper measures orphanhood rather than child mortality in its own analysis, and it does not assess fragile states generally (section labels provided; page numbers unavailable). (LLM, conf=0.86)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
In the paper
“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)”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plainn = 29- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
In the paper
“Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision.”
- Also stated in: § Current challenges facing national CHW programmes · plain
“the most commonly cited challenges were (1) inadequate programme financing, (2) interruptions in the supply chain for basic supplies, commodities, and medicines, (3) inadequate remuneration of CHWs, and (4) inadequate or poor-quality supervision.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
- Rests on an assumption: The authors of the case studies correctly identified the most pressing challenges for their programmes.
- Also stated in: § Current challenges facing national CHW programmes · plain
In the paper
“Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision.”
- Also stated in: § Current challenges facing national CHW programmes · plain
“the most commonly cited challenges were (1) inadequate programme financing, (2) interruptions in the supply chain for basic supplies, commodities, and medicines, (3) inadequate remuneration of CHWs, and (4) inadequate or poor-quality supervision.”
- Also stated in: § Current challenges facing national CHW programmes · plain
“The four most frequently seen challenges concern the supply chain for key programme commodities used by CHWs, programme financing, CHW compensation, and supervision.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
- Rests on an assumption: The authors of the case studies correctly identified the most pressing challenges for their programmes.
- Also stated in: § Current challenges facing national CHW programmes · plain
In the paper
“Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision.”
- Also stated in: § Current challenges facing national CHW programmes · plain
“the most commonly cited challenges were (1) inadequate programme financing, (2) interruptions in the supply chain for basic supplies, commodities, and medicines, (3) inadequate remuneration of CHWs, and (4) inadequate or poor-quality supervision.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
- Rests on an assumption: The authors of the case studies correctly identified the most pressing challenges for their programmes.
- Also stated in: § Current challenges facing national CHW programmes · plain
In the paper
“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)”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plainn = 29- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
In the paper
“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)”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plainn = 29- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
In the paper
“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)”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plainn = 29- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
In the paper
“Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision.”
- Also stated in: § Current challenges facing national CHW programmes · plain
“the most commonly cited challenges were (1) inadequate programme financing, (2) interruptions in the supply chain for basic supplies, commodities, and medicines, (3) inadequate remuneration of CHWs, and (4) inadequate or poor-quality supervision.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
- Rests on an assumption: The authors of the case studies correctly identified the most pressing challenges for their programmes.
- Also stated in: § Current challenges facing national CHW programmes · plain
In the paper
“Each of these challenges was found to be a prominent issue for over half of the programmes documented in this set of case studies.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
In the paper
“The COVID-19 pandemic has made very clear the need for health workers on the ground who can visit homes to provide education about COVID-19, assist in identifying cases and tracing contacts, linking cases to treatment, and supporting vaccination [26].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [26] Ballard M, Bancroft E, Nesbit J, Johnson A, Holeman I, Foth J, Rogers D, Yang J, Nardella J, Olsen H, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020;5:74. source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“National community health worker (CHW) programmes face many challenges which prevent them from reaching their full potential.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Key findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
None of the sources cited for this claim have been checked yet.
In the paper
“This evidence indicates that the number of lives of mothers and their children that can be saved each year by increasing the population coverage of the evidence-based promotive, preventive, and curative interventions provided by CHWs is even greater than the number that can be saved by expanding facility-based services at PHC centres and hospitals (1.7 million versus 2.3 million) [21, 24]”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [21] Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. Summary and recommendations of the Expert Panel. J Glob Health. 2017;7:010908. source
- Not checked yetcites [24] Black RE, Levin C, Walker N, Chou D, Liu L, Temmerman M, Group DRA. Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities. Lancet. 2016; 388:2811–24. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Unless progress toward this goal accelerates, up to one third of the world’s population will still remain underserved by 2030 [15].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [15] Resolution adopted by the General Assembly on 10 October 2019: Political declaration of the high-level meeting on universal health coverage. https://undocs.org/en/A/RES/74/2.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“WHO has, for the first time, created a set of guidelines for optimizing the contribution of CHW programmes to health systems [12].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [12] WHO guideline on health policy and system support to optimize community health worker programmes. https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-eng.pdf?ua=1. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The number of CHWs in the United States is growing rapidly in response to persistent gaps in the health system [103, 104], and they are serving an important role in the COVID-19 pandemic response [29].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [29] Waters R. Community Workers Lend Human Connection To COVID-19 Response. Health Aff (Millwood). 2020;39:1112–7. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Only 2.5% of global public health donor assistance over the past decade has been devoted specifically to CHW programmes, and two thirds of this was for vertical programmes related to HIV/AIDS, malaria, tuberculosis, reproductive health, or family planning [37].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > How can we mobilize greater investments in national CHW programmes and community platforms?
What the sources say
- Not checked yetcites [37] Lu C, Palazuelos D, Luan Y, Sachs SE, Mitnick CD, Rhatigan J, Perry HB. Development assistance for community health workers in 114 low- and middle-income countries, 2007–2017. Bull World Health Organ. 2020;98:30–9. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“CHWs have the potential to identify local epidemiological priorities based on routine home visitation, including detection of disease outbreaks and registration of vital events (which can also be entered into the civil registration system), with support from mobile devices, as may be appropriate to the context [114–116].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [114] Perry H, Robison N, Chavez D, Taja O, Hilari C, Shanklin D, Wyon J. Attaining health for all through community partnerships: principles of the census-based, impact-oriented (CBIO) approach to primary health care developed in Bolivia South America. Soc Sci Med. 1999;48:1053–67. source
- Not checked yetcites [115] Vasudevan L. C G, Lewin S, Henschke N, Maayan N, Eyers J, Fonhus M, Tamrat T, Mehl G: Birth and death notification via mobile devices: a mixed methods review. Cochrane Database Syst Rev. 2020;8:74.
- Not checked yetcites [116] Odendaal W, Anstey Watkins J, Leon N, Daniels K. Health workers’ perceptions and experiences of using mHealth technologies to deliver primary health care services. Cochrane Database Syst Rev. 2020;4:987.
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“The number of CHWs in the United States is growing rapidly in response to persistent gaps in the health system [103, 104], and they are serving an important role in the COVID-19 pandemic response [29].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [103] 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;35:399–421. source
- Not checked yetcites [104] Singh P, Chokshi DA. Community health workers–a local solution to a global problem. N Engl J Med. 2013;369:894–6. source
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“The United States Government’s Fiscal Year 2021 Reconciliation Act (American Rescue Plan) provides $7.6 billion in funding to public health departments to hire 100,000 full-time employees into the public health workforce.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [105] Fact Sheet on House’s Reconciliation Package & the Biden Administration’s COVID-19 American Rescue Plan. https://welch.house.gov/sites/welch.house.gov/files/EC%20Reconciliation%20Fact%20Sheet.pdf. Accessed 11 Apr 2021
- Not checked yetcites [106] Public Health Job Corps: Responding to COVID-19, Rebuilding the Community Health Workforce. https://www.pih.org/sites/default/files/2021-02/public-health-jobs-corps-memo_05.pdf. Accessed 11 Apr 2021
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Large-scale randomized controlled trials cannot provide the needed evidence.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“At present, Ethiopia and BRAC have established exemplary programmes that address these issues in their programmes, and much can be learned by a closer analysis of how their programmes work [13, 25, 93].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are priority areas for CHW research and programme performance assessment?
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
- Not checked yetcites [25] Community Health Workers. https://www.exemplars.health/topics/community-health-workers. Accessed 11 Apr 2021
- Not checked yetcites [93] Hodgins S. Learning from community health worker programs, big and small. Glob Health Sci Pract. 2020;8:147–9. source
boosted- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“Based on modelling, it has been estimated that if we could raise the population coverage of current evidence-based maternal-child interventions that can be implemented at the community level by CHWs to 90% in the 74 countries with 97% of the child and maternal mortality in the world, an additional 2.6 million maternal and child deaths could be averted each year [111].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [111] Chou VB, Friberg IK, Christian M, Walker N, Perry HB. Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST). J Glob Health. 2017;7:020401. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“This has occurred even where we have robust evidence demonstrating that these tasks can be performed safely and effectively by well-trained and supervised CHWs [110].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [110] Freeman PA, Schleiff M, Sacks E, Rassekh BM, Gupta S, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 4. child health findings. J Glob Health. 2017;7:010904. source
boosteddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Only 2.5% of global public health donor assistance over the past decade has been devoted specifically to CHW programmes, and two thirds of this was for vertical programmes related to HIV/AIDS, malaria, tuberculosis, reproductive health, or family planning [37].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > How can we mobilize greater investments in national CHW programmes and community platforms?
What the sources say
- Not checked yetcites [37] Lu C, Palazuelos D, Luan Y, Sachs SE, Mitnick CD, Rhatigan J, Perry HB. Development assistance for community health workers in 114 low- and middle-income countries, 2007–2017. Bull World Health Organ. 2020;98:30–9. source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Given the great deal of evidence on the effectiveness of CHW programmes operating under ideal, small-scale and short-term conditions [20, 22], more research is needed on programmes operating at scale uunder routine conditions for the longer term.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [20] Perry HB, editor. Engaging communities for improving mothers’ and children’s health: reviewing the evidence of effectiveness in resource-constrained settings. Edinburgh: Edinburgh University Global Health Society; 2017.
- Not checked yetcites [22] Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;3:4015.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The Brazilian experience informs us that a comprehensive, life-course approach is entirely feasible providing that the number of households assigned to each CHW is reasonable (currently 150–200 in Brazil) [53].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > How can we facilitate the expansion of CHW roles beyond their traditional maternal/reproductive, child health, and nutrition role without overloading them or diminishing their effectiveness?
What the sources say
- Not checked yetcites [53] Harris M, Haines A. Brazil’s family health programme. BMJ. 2010;341:c4945. source
plainconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“The lack of inclusion of communities and community-based services in frameworks for health systems strengthening is striking [100].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [100] Sacks E, Swanson RC, Schensul JJ, Gleave A, Shelley KD, Were MK, Chowdhury AM, LeBan K, Perry HB. Community Involvement in health systems strengthening to improve global health outcomes: a review of guidelines and potential roles. Int Q Community Health Educ. 2017;37:139–49. source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“The CORE Group Polio Project coordinated the efforts of international and local national NGOs to engage communities and deploy CHWs at scale in 11 countries to address urgent needs in eradicating polio, strengthening immunization programmes more broadly, and responding to community priorities for maternal and child health [80, 83].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are the most appropriate roles for NGOs in CHW programming?
What the sources say
- Not checked yetcites [80] Losey L, Ogden E, Bisrat F, Solomon R, Newberry D, Coates E, Ward D. HIlmi L, Burrowes V, LeBan K, Perry HB: The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative. Am J Trop Med Hyg. 2019;101:4–14. source
- Not checked yetcites [83] Perry H, Solomon V, Bisrat F, Hilmi L, Stamidis K, Steinglass R, Weiss W, Losey L, Ogden E. Lessons learned from community engagement, community-based programming for polio eradication, and the CORE Group Polio Project: their relevance for ending preventable child and maternal deaths. Am J Trop Med Hyg. 2019;101:107–12. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“At the same time, we need also to recognize communities as an integral part of health systems—a key component of the health system that was initially ignored when the systems building blocks were first conceptualized by WHO in 2007 [99].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [99] Everybody's Business: Strengthening Health Systems to Improve Health Outcomes. https://www.who.int/healthsystems/strategy/everybodys_business.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“In 2019, the United Nations called on all governments to invest an additional 1% of their GDP in expanding and strengthening their PHC systems in order to achieve UHC [117].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
What the sources say
- Not checked yetcites [117] Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps. https://www.who.int/news-room/detail/22-09-2019-countries-must-invest-at-least-1-more-of-gdp-on-primary-health-care-to-eliminate-glaring-coverage-gaps. Accessed 11 Apr 2021
plaindirect- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These activities are particularly applicable in fragile and conflict-affected states where facility-based services are weak or nonfunctional.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
In the paper
“The current level of investment in CHW programmes and community health is poorly documented, but it will need to grow substantially [118].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
What the sources say
- Not checked yetcites [118] Gichaga A, Masis L, Chandra A, Palazuelos D, Wakaba N. Mind the global community health funding gap. Glob Health Sci Pract. 2021;9:S9–17. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We now know enough to conclude that—when designed appropriately to context and adequately supported—CHW programmes and community health initiatives can accelerate progress in achieving population heath goals and in reducing health disparities.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
boostedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
- Probably not a substantial claim. 32
- It may state two separate claims as one. 21
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“On a broader scale, we are in the midst of a process some are calling “the third global health transition” [31] or “a grand convergence” [32]—emerging from a demographic transition (from higher to lower death and birth rates) into an epidemiologic transition (from a high burden of maternal and child conditions and communicable diseases to noncommunicable diseases [NCDs]).”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [31] Rodin J, de Ferranti D. Universal health coverage: the third global health transition? Lancet. 2012;380:861–2. source
- Supportedcites [32] Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, Bustreo F, Evans D, Feachem RG, Frenk J, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382:1898–955. source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“As noted above, proposals have also been made to establish a permanent CHW cadre in the United Kingdom [28].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Partly supportedcites [28] Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. Lancet. 2020;395:1173–5. sourceExperimental — accuracy not yet measured
The main text (page not provided) proposes a UK CHW programme with the potential to become a long-term model of care and discusses a future scaled workforce. It frames the immediate proposal as an emergency response to COVID-19, however, and does not explicitly propose a permanent cadre. (LLM, conf=0.85)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Developing, expanding, and strengthening national CHW programmes represent promising approaches to accelerating progress in achieving the global health goals of Universal Health Coverage, ending preventable child and maternal deaths, and achieving “Health for All”.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Key implications
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Similar proposals are emerging in the United States [29, 30].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [29] Waters R. Community Workers Lend Human Connection To COVID-19 Response. Health Aff (Millwood). 2020;39:1112–7. source
- Not checked yetcites [30] Goldfield NI, Crittenden R, Fox D, McDonough J, Nichols L, Lee Rosenthal E. COVID-19 crisis creates opportunities for community-centered population health: community health workers at the center. J Ambul Care Manage. 2020;43:184–90. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is growing recognition of the need for fair remuneration for full- and part-time CHWs.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CHWs need to be understood as the foundation of PHC as well as an increasingly important component of health systems in settings where delivery or equity gaps are present.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, it is fair to say, particularly in resource-constrained, high-mortality settings, there can be no PHC without CHWs.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“For example, the pandemic has led to a call for the creation of a CHW cadre in the United Kingdom that would continue, for the foreseeable future, to link all households with a CHW who can assist in addressing health needs in the household [28].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [28] Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. Lancet. 2020;395:1173–5. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Countries that have been making the strongest gains in population health outcomes have strong CHW programmes; Bangladesh, Brazil, Ethiopia, Nepal, and Rwanda are prominent examples [25].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [25] Community Health Workers. https://www.exemplars.health/topics/community-health-workers. Accessed 11 Apr 2021
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CHWs can also play a critical role in responding to current and future pandemics.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“As a result, Ethiopia became a global leader in attaining the Millennium Development Goals for maternal and child health, HIV/AIDS, malaria, and tuberculosis [16, 17] and in accelerating progress in achieving UHC [17].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [16] Assefa Y, Tesfaye D, Damme WV, Hill PS. Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia. Lancet. 2018;392:1473–81. source
- Not checked yetcites [17] Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W. Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Global Health. 2019;15:24. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The result is that the pandemic has led to calls throughout the world for CHWs to receive the proper respect and status that they deserve, not to mention the personal protective equipment they need to safely carry out their duties [27].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
What the sources say
- Not checked yetcites [27] Community health workers are crucial to pandemic response. How to support them. https://theconversation.com/community-health-workers-are-crucial-to-pandemic-response-how-to-support-them-134908. Accessed 11 Apr 2021
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is a steady but persistently increasing professionalization of CHW roles.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The lack of national political support and sustainable funding (from both domestic and donor sources) for national CHW programmes is perhaps the most critical challenge facing these programmes.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Key findings
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
- Rests on an assumption: The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
- Rests on an assumption: The authors of the case studies correctly identified the most pressing challenges for their programmes.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A comprehensive approach is needed since the effectiveness of the whole programme is dependent on how well each component of the system is functioning; addressing one component without consideration of the other components is not likely to improve programme effectiveness.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A role also remains for voluntary CHWs, who can make important contributions as long as they are not be expected to work more than a few hours per week or perform the role of regular full- or part-time workers.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For these reasons, we argue that CHWs are now at the dawn of a new era.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is also an emerging dual cadre of CHWs in which professionalized CHWs are supervising lower tiers of CHWs, who are often volunteers responsible for a small number of households.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CHWs are increasingly being recognized as a critical resource for achieving national and global health goals.”
- Also stated in: § Results · plain
“These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
- Also stated in: § Results · plain
In the paper
“BRAC’s2 CHW health programmes in Bangladesh reach over 100 million people and another 20 million people in other countries [88].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are the most appropriate roles for NGOs in CHW programming?
What the sources say
- Not checked yetcites [88] Chowdhury A, Perry H. NGO Contributions to Community Health and Primary Health Care: Case Studies on BRAC (Bangladesh) and the Comprehensive Rural Health Project, Jamkhed (India). In Oxford Research Encyclopedia, Global Public Health. New York: Oxford University Press USA; 2020.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“An expansion of the six WHO building blocks has been proposed that highlights community-based service delivery as well as community mobilizing and organization, with attention to nontraditional health system components such as social capital, inter-sectoral partnerships, local governance, equitable financing, community information and data systems, and household production of health [101].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [101] Sacks E, Morrow M, Story WT, Shelley KD, Shanklin D, Rahimtoola M, Rosales A, Ibe O, Sarriot E. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ Glob Health. 2018;3:e001384. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“NGOs sometimes operate their own CHW programmes separate from government CHW programmes, while others are working hard to assist the government in strengthening government CHW programmes [89].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are the most appropriate roles for NGOs in CHW programming?
What the sources say
- Not checked yetcites [89] Walker PR, Downey S, Crigler L, LeBan K. CHW “Principles of Practice”: Guiding principles for non-governmental organizations and their partners for coordinated national scale-up of community health worker programs. Washington: CORE Group/World Vision International; 2013. p. 21.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Evidence needs to come from comprehensive, critical programme case studies and from investigations not only on what works but also on what conditions are required for such programmes to perform well (including health system requirements) [13].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Follow the recommendations of the 2018 WHO guidelines and focus research on (1) CHW selection, education, and certification, (2) management and supervision, and (3) integration into and support by health systems and communities [12].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are priority areas for CHW research and programme performance assessment?
What the sources say
- Not checked yetcites [12] WHO guideline on health policy and system support to optimize community health worker programmes. https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-eng.pdf?ua=1. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“In its guidelines for health policy and system support to optimize CHW programmes, WHO noted that although there is a rich body of literature on CHW programming, there is a striking lack of rigorous research on CHW programme effectiveness that can provide practical guidance on programme implementation [12].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [12] WHO guideline on health policy and system support to optimize community health worker programmes. https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-eng.pdf?ua=1. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There are unprecedented new technologies, tools, and programmatic approaches which offer the prospect of increasing the effectiveness of CHWs, provided they are giving appropriate training and support.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
In the paper
“Hazel et al. [109] have documented the disappointing results of evaluations of CHW programmes that employed integrated community case management (iCCM) for childhood illness in Burkina Faso, Ethiopia, and Malawi regarding the quality of care provided by CHWs, the low utilization of their services, the low population coverage of CHW services, and the absence of a demonstrated impact on mortality.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [109] Hazel E, Bryce J. IIP-JHU ICCM Evaluation Working Group: On bathwater, babies, and designing programs for impact: evaluations of the integrated community case management strategy in Burkina Faso, Ethiopia, and Malawi. Am J Trop Med Hyg. 2016;94:568–70. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The global experience and the scientific evidence are unequivocal: CHWs are among the most cost-effective and the most rapidly implementable approaches to improve the health of underserved populations.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each case study has at least one author who has personal in-country experience with the programme described, and each follows a common format to facilitate comparisons across cases.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
plainn = 29- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Community case management of childhood illness, using proactive frequent home visitation, has shown promising results as a strategy for reducing under-five mortality in Mali and for improving access to care in Senegal, in which CHWs are well supplied with the medicines they need [43, 44].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
What the sources say
- Not checked yetcites [43] Johnson AD, Thiero O, Whidden C, Poudiougou B, Diakite D, Traore F, Samake S, Kone D, Cisse I, Kayentao K. Proactive community case management and child survival in periurban Mali. BMJ Glob Health. 2018;3:e000634. source
- Not checked yetcites [44] Gaye S, Kibler J, Ndiaye JL, Diouf MB, Linn A, Gueye AB, Fall FB, Ndiop M, Diallo I, Cisse M, et al. Proactive community case management in Senegal 2014–2016: a case study in maximizing the impact of community case management of malaria. Malar J. 2020;19:166. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“NGOs have been global leaders in community health research and innovative program development [90].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are the most appropriate roles for NGOs in CHW programming?
What the sources say
- Not checked yetcites [90] Ballard M, Schwarz R. Employing practitioner expertise in optimizing community healthcare systems. Healthcare (Amst). 2019;7:100334. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The findings, summarized in Table 2, provide a realistic, grounded view of the constraints under which such programmes are currently functioning.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Current challenges facing national CHW programmes
What the sources say
- Not checked yetcites [13] Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. [https://pdf.usaid.gov/pdf_docs/PA00WKKN.pdf. Accessed 11 Apr 2021
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CHW programmes rely on support from their nearest facilities, and without adequately functioning facilities, patients referred by CHWs will not be able to receive proper care, thereby undermining CHW programme functioning.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Discussion > Change our mental models, giving greater recognition to CHWs and communities as central components of health systems
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“NGOs have been global leaders in pioneering the development and implementation of programmes, in community engagement, and in the research and development components of community-based PHC [87, 88].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > How can national CHW programmes be strengthened? > What are the most appropriate roles for NGOs in CHW programming?
What the sources say
- Not checked yetcites [87] Perry HB, Rohde J. The Jamkhed comprehensive rural health project and the Alma-Ata vision of primary health care. Am J Public Health. 2019;22:e1–6.
- Not checked yetcites [88] Chowdhury A, Perry H. NGO Contributions to Community Health and Primary Health Care: Case Studies on BRAC (Bangladesh) and the Comprehensive Rural Health Project, Jamkhed (India). In Oxford Research Encyclopedia, Global Public Health. New York: Oxford University Press USA; 2020.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The potential for CHWs and for community engagement, more broadly, to serve as an integral component of PHC exceeds what can be achieved by facility-based care alone. This is true not only for ending preventable child and maternal deaths, but also for better controlling NCDs.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, there are now calls throughout the world for CHWs to be appropriately supported (and protected) to enable them to play a key frontline role against the pandemic and then, moving forward, a key part of the foundation of health systems.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: In many countries, CHWs are the frontline of defence against the COVID-19 pandemic.
None of the sources cited for this claim have been checked yet.
In the paper
“Calls are being made for the establishment of a national CHW cadre in the United Kingdom [28] and for a community health corps in the United States [29, 30] to carry out similar functions—to assist in controlling the COVID-19 pandemic but also to strengthen the health system moving forward and to be able to be better prepared for future pandemics.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
What the sources say
- Not checked yetcites [28] Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. Lancet. 2020;395:1173–5. source
- Not checked yetcites [29] Waters R. Community Workers Lend Human Connection To COVID-19 Response. Health Aff (Millwood). 2020;39:1112–7. source
- Not checked yetcites [30] Goldfield NI, Crittenden R, Fox D, McDonough J, Nichols L, Lee Rosenthal E. COVID-19 crisis creates opportunities for community-centered population health: community health workers at the center. J Ambul Care Manage. 2020;43:184–90. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By enabling national CHW programmes to reach their full potential, they in turn can lead the way toward accelerating progress in reducing inequities in health and achieving health for all.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
- Rests on an assumption: In many countries, CHWs are the frontline of defence against the COVID-19 pandemic.
In the paper
“With the availability of local data, local forums for sharing data, and local multi-sectoral stakeholder engagement, [such technical] solutions will work better and deliver more” [119].”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
What the sources say
- Not checked yetcites [119] Sherry M, Ghaffar A, Bishai D. Community platforms for health inferventions. In: Jamison D, Gelband H, Horton S, Jha P, Laxminarayan R, Mock C, Nugent R, editors. Disease control priorities: improving health and reducing poverty. Washington: The World Bank; 2018. p. 267–83.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A strong commitment by governments to community health initiatives, including CHW programming, will give a major boot at this critical moment will encourage donors and technical support organizations to follow suit.”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
In the paper
“without initiatives to help community health platforms flourish around the world, the health gains promised by [specific evidence-based technical] interventions will cost more and deliver less….”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Conclusion
What the sources say
- Not checked yetcites [119] Sherry M, Ghaffar A, Bishai D. Community platforms for health inferventions. In: Jamison D, Gelband H, Horton S, Jha P, Laxminarayan R, Mock C, Nugent R, editors. Disease control priorities: improving health and reducing poverty. Washington: The World Bank; 2018. p. 267–83.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
The paper relies on this without support.
The 29 case studies in the compendium are representative enough of national CHW programmes generally that the challenges they report reflect the challenges facing national CHW programmes broadly.
“The studies look at a mix of CHW types, from the more professionalized end of the spectrum to less formalized volunteer CHW programmes. The programmes described are drawn from diverse regions and from both low-income and middle-income countries.”
The paper relies on this without support.
The authors of the case studies correctly identified the most pressing challenges for their programmes.
“What Table 2 provides is a listing of those that were considered by the authors of the case studies to be the most pressing challenges for that programme.”
The paper relies on this without support.
With adequate support, CHW programming is possible even when health facility functioning is compromised.
“We know that fragile states and areas with armed conflict have higher levels of collateral mortality (especially for mothers and children) [74, 75] and that with adequate support, CHW programming is possible even when health facility functioning is compromised.”
The paper relies on this without support.
NGOs and their donors have sometimes undercut government leadership, pressured governments to pursue fragmented, disease-specific projects, and instituted approaches damaging to national health systems in the longer term.
“However, NGOs and their donors have sometimes undercut government leadership, pressured governments to pursue fragmented, disease-specific projects, and have instituted approaches that have been damaging to national health systems in the longer term.”
The paper relies on this without support.
In Afghanistan and South Sudan, among other countries, the government contracts with NGOs to run its national CHW programme.
“In Afghanistan and South Sudan, among other countries, the government contracts with NGOs to run its national CHW programme.”
The paper relies on this without support.
Ethiopia and Brazil are struggling with task overload, burnout, and career (de)motivation for CHWs.
“Ethiopia and Brazil are struggling with these issues and provide a good example of how these issues might be addressed.”
The paper relies on this without support.
Research on CHWs in urban settings is quite limited at present.
“Build the evidence base on the role of CHWs in urban settings. Research in the area is quite limited at present.”
The paper relies on this without support.
Lack of mutual support among health workers has hindered effectiveness of CHW programmes.
“We need to build mutual support and collaboration among health workers, the lack of which has hindered effectiveness of CHW programmes.”
The paper relies on this without support.
In many countries, professional associations of nurses and physicians have opposed the introduction of CHW programmes as well as efforts to delegate authority to CHWs to manage dispensing medication.
“In many countries, professional associations of nurses and physicians have opposed the introduction of CHW programmes as well as efforts to delegate authority to CHWs to manage dispensing medication (e.g., childhood pneumonia and malaria).”
The paper relies on this without support.
CHW programmes and community health initiatives more broadly remain relatively underdeveloped areas of endeavour in global public health in terms of the number of professionals working to advance the field, investments in expanding the evidence base, and investigations into factors affecting implementation effectiveness at scale.
“At the same time, it is necessary to recognize that CHW programmes and community health initiatives more broadly remain relatively underdeveloped areas of endeavour in global public health in terms of (1) the number of professionals working to advance the field, (2) investments in expanding the evidence base, and (3) investigations into the factors affecting implementation effectiveness at scale.”
The paper relies on this without support.
There is a lack of evidence to guide implementation, and there is a lack of implementation because of a lack of evidence; there is also plenty of evidence that is not being acted upon.
“Too often we find ourselves faced with a dilemma—there is a lack of evidence to guide implementation, and there is a lack of implementation because of a lack of evidence. But there is also plenty of evidence that is not being acted upon.”
The paper relies on this without support.
UHC will be required to achieve the SDGs.
“UHC will be required to achieve the SDGs.”
The paper relies on this without support.
In many countries, CHWs are the frontline of defence against the COVID-19 pandemic.
“Furthermore, in many countries, CHWs are the frontline of defence against the COVID-19 pandemic.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
“even greater than the number that can be saved by expanding facility-based services at PHC centres and hospitals”
§ Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” > Background
“(1.7 million versus 2.3 million)”
Citations
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Research works printed but not linked: 7
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- Damtew Z, Lemma S, Zulliger R, Moges A, Teklu A, Perry H. Ethiopia’s Health Extension Program. In: Perry H, editor. Health for the People: National Community Health Programs from Afghanistan to Zimbabwe. Washingon: USAID/Maternal and Child Survival Program; 2020. p. 75–86.
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Sorted by citations
The Lancet Commission on lessons for the future from the COVID-19 pandemic
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Self-citationSchleiff, M., Aitken, I. W., Alam, M. A., Damtew, Z. A., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00757-3 · Cited by 164
Self-citationCommunity health workers at the dawn of a new era
Zulu, J. M., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00761-7 · Cited by 128
Self-citationCommunity health workers at the dawn of a new era: 5. Roles and tasks
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Self-citationKodali, P. B. (2023) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s366759 · Cited by 126
Metadata
- Authors
- Perry, H. B., Chowdhury, M., Were, M., LeBan, K., Crigler, L., Lewin, S., Musoke, D., Kok, M., Scott, K., Ballard, M., & Hodgins, S.
- Affiliations
- Johns Hopkins University (US)
- BRAC University (BD)
- Hillsborough Community College (US)
- South African Medical Research Council (ZA)
- Makerere University (UG)
- Royal Tropical Institute (NL)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Perry, Henry B.
- ORCID
- Venue
- Health Research Policy and Systems
- Published
- 2021-10
- Volume
- 19
- Issue
- S3
- Pages
- 111-111
- ISSN
- 1478-4505 (ISSN-L)
- PMC
- PMC8506098
- OpenAlex
- W3206264955
- Semantic Scholar
- de9aa5b44cdad5b043194169404c6d0e21af5e19
- Cited by
- 129
- References
- 95
- Citations by year
- 2026: 27 · 2025: 28 · 2024: 25 · 2023: 29 · 2022: 10 · 2021: 10
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Health Research Policy and Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Greater South Information System
- Funders
- Bill and Melinda Gates Foundation (ID OPP 1197181)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- community health workers, health care financing, universal health coverage, Sustainable Development Goals, health for all, pandemic preparedness, monitoring and evaluation, implementation research, global health goals
- MeSH terms
- Child, Community Health Workers, Humans, Motivation, Global Health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
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Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
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