The role of ‘hidden’ community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa
Open accessAbstract
Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with the first tier being the lessor known or 'hidden' community/village level volunteers and the second tier being formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to population, would be important for a comprehensive evaluation of child survival in these countries. We report on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise the 'hidden' contribution of volunteers. We need to better characterize the volunteers' interaction with community-based and primary care services and to better understand ways to improve the volunteer systems with the right type of investments. This is particularly important for considering the models for scale-up of CHWs in sub-Saharan Africa.
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Community-based health surveillance volunteers assist with health service delivery in some Sub-Saharan African countries, notably Ethiopia, Ghana, Mali and Niger.
“Community-based health surveillance volunteers assist with health service delivery in some Sub-Saharan African countries, notably Ethiopia, Ghana, Mali and Niger.59”
From Household air pollution and the sustainable development goals (2016) · cites this paper as [59]
The section on volunteers in Ethiopia, Mali, and Niger describes community-based volunteers who promote health, prevent disease, and refer people to health workers and facilities. Ghana is mentioned as a country included in the broader evaluation, but the copy does not establish that the volunteer arrangements described operated there. (LLM, conf=0.87)
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Cites
Achieving child survival goals: potential contribution of community health workers
Haines, A., Sanders, D., Lehmann, U., Rowe, A. K., Lawn, J. E., Jan, S., Walker, D. G., & Bhutta, Z. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60325-0 · Cited by 911 · see citing works
Self-citationProst, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A., Houweling, T., Fottrell, E., Kuddus, A., Lewycka, S., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60685-6 · Cited by 645 · see citing works
Task shifting: the answer to the human resources crisis in Africa?
Lehmann, U., Damme, W. V., Barten, F., & Sanders, D. M. (2009) · Human Resources for Health · doi:10.1186/1478-4491-7-49 · Cited by 272 · see citing works
Self-citation1 million community health workers in sub-Saharan Africa by 2015
Singh, P., & Sachs, J. D. (2013) · The Lancet · doi:10.1016/s0140-6736(12)62002-9 · Cited by 267 · see citing works
Hill, Z., Dumbaugh, M., Benton, L., Källander, K., Strachan, D., ten Asbroek, A. T., Tibenderana, J., Kirkwood, B., & Meek, S. (2014) · Global Health Action · doi:10.3402/gha.v7.24085 · Cited by 218 · see citing works
Reduction in child mortality in Niger: a Countdown to 2015 country case study
Amouzou, A., Habi, O., & Bensaïd, K. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61376-2 · Cited by 128 · see citing works
Responding to the maternal health care challenge: The Ethiopian Health Extension Program
Koblinsky, M., Tain, F., Gaym, A., Karim, A., Carnell, M. A., & Tesfaye, S. H. (2010) · Ethiopian Journal of Health Development · doi:10.4314/ejhd.v24i1.62951 · Cited by 108 · see citing works
Extension workers drive Ethiopia's primary health care
Wakabi, W. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61381-1 · Cited by 85 · see citing works
Rasanathan, K., Muñiz, M., Bakshi, S., Kumar, M. B., Solano, A., Kariuki, W., George, A. S., Sylla, M., Nefdt, R. J. C., Young, M., et al. (2014) · Journal of Global Health · doi:10.7189/jogh.04.020401 · Cited by 80 · see citing works
The community case management of pneumonia in Africa: a review of the evidence.
Druetz, T., Siekmans, K., Goossens, S., Ridde, V., & Haddad, S. (2015) · Health Policy and Planning · doi:10.1093/heapol/czt104 · Cited by 79 · see citing works
Policy challenges facing integrated community case management in S ub‐ S aharan A frica
Bennett, S., George, A. S., Rodríguez, D., Shearer, J., Diallo, B. A., Konaté, M., Dalglish, S. L., Juma, P. A., Namakhoma, I., Banda, H., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12319 · Cited by 67 · see citing works
Johnson, A., Thomson, D. R., Atwood, S., Alley, I., Beckerman, J., Koné, I., Diakité, D., Diallo, H., Traoré, B., Traoré, K., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0081304 · Cited by 41 · see citing works
Community-led Total Sanitation.
Bongartz, P. (2007) · Cited by 24 · see citing works
Special Issue: Maternal and newborn health.
Fantahun, M. (2010) · Ethiopian Journal of Health Development · Cited by 9 · see citing works
Reduction in child mortality in Niger
Hercot, D., Doherty, T., Hongoro, C., Damme, W. V., & Sanders, D. M. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60010-0 · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 5
- [10]Doherty T Daviaud E Oliphant N Zamasiya T Community case management of childhood illness in Africa Do people centered delivery platforms contribute to the goal of universal access? 2014 Third Health Systems Global Conference 29 September–3 October 2014 Cape Town, South Africa
- [11]Oliver K Young M Oliphant N Diaz T Kim J Review of systematic challenges to the scale-up of integrated community case management: emerging lessons & recommendations from the Catalytic Initiative (CI/IHSS) 2012 New York UNICEF
- [17]Taylor H Mid term review of progress: Catalytic Initiative Mission Report 2010 New York UNICEF
- [18]Bennett S George A Rodriguez D Shearer J Diallo B Konate M Policy challenges facing integrated community case management in Sub-Saharan Africa Trop Med Int Health 2014 19 872 82 24750516 PMC4282431
- [28]World Health Organization Essential nutrition actions: improving maternal-newborn-infant and young child health and nutrition 2012 Geneva WHO 25473713
Cited by
Sorted by citations
Bitton, A., Fifield, J., Ratcliffe, H., Karlage, A., Wang, H., Veillard, J. H., Schwarz, D., & Hirschhorn, L. R. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2019-001551 · Cited by 205 · see citing works
Quansah, R., Semple, S. E., Ochieng, C., Juvekar, S. K., Armah, F. A., Luginaah, I., & Emina, J. B. O. (2017) · Environment International · doi:10.1016/j.envint.2017.03.010 · Cited by 203 · see citing works
Household air pollution and the sustainable development goals
Amegah, A. K., & Jaakkola, J. J. (2016) · Bulletin of the World Health Organization · doi:10.2471/blt.15.155812 · Cited by 179 · see citing works
From Community Health Workers to Community Health Systems: Time to Widen the Horizon?
Schneider, H. M., & Lehmann, U. (2016) · Health Systems & Reform · doi:10.1080/23288604.2016.1166307 · Cited by 165 · see citing works
LeBan, K., Kok, M. C., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00756-4 · Cited by 137 · see citing works
Community health workers at the dawn of a new era: 5. Roles and tasks
Glenton, C., Javadi, D., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00748-4 · Cited by 126 · see citing works
Hodgins, S., Kok, M. C., Musoke, D., Lewin, S. A., Crigler, L., LeBan, K., & Perry, H. B. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-021-00752-8 · Cited by 104 · see citing works
Labour conditions in dual-cadre community health worker programmes: a systematic review
Ballard, M., Olaniran, A., Iberico, M., Rogers, A., Thapa, A., Cook, J., Aranda, Z., French, M., Olsen, H. E., Haughton, J., et al. (2023) · The Lancet Global Health · doi:10.1016/s2214-109x(23)00357-1 · Cited by 50 · see citing works
Community-Based Interventions for Newborns in Ethiopia (COMBINE): Cost-effectiveness analysis
Mathewos, B., Owen, H., Sitrin, D., Cousens, S. N., Degefie, T., Wall, S. N., Bekele, A., Lawn, J. E., & Daviaud, E. (2017) · Health Policy and Planning · doi:10.1093/heapol/czx054 · Cited by 50 · see citing works
Self-citationReñosa, M. D. C., Dalglish, S. L., Bärnighausen, K., & McMahon, S. A. (2020) · Global Health Action · doi:10.1080/16549716.2020.1732669 · Cited by 47 · see citing works
Angwenyi, V., Aantjes, C., Kondowe, K., Mutchiyeni, J. Z., Kajumi, M., Criel, B., Lazarus, J. V., Quinlan, T., & Bunders, J. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000996 · Cited by 39 · see citing works
Molla, Y., Rawlins, B. J., Makanga, P. T., Cunningham, M., Hernández‐Ávila, J. E., Ruktanonchai, C. W., Singh, K., Alford, S., Thompson, M., Dwivedi, V., et al. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-1199-y · Cited by 32 · see citing works
Besada, D., Kerber, K. J., Leon, N., Sanders, D. M., Daviaud, E., Rohde, S. S., Rohde, J. E., Damme, W. V., Kinney, M. V., Manda, S., et al. (2016) · PLoS ONE · doi:10.1371/journal.pone.0146945 · Cited by 31 · see citing works
Self-citationNdu, M. N., Andoniou, E., McNally, S., Olea‐Popelka, F. J., Tippett, M., & Nouvet, É. (2022) · Global Health Action · doi:10.1080/16549716.2022.2138117 · Cited by 29 · see citing works
HPV vaccination strategies targeting hard-to-reach populations: Out-of-school girls in LMICs
Bonner, K., Banura, C., & Basta, N. E. (2017) · Vaccine · doi:10.1016/j.vaccine.2017.11.038 · Cited by 26 · see citing works
Woldeamanuel, B. T. (2020) · Journal of Environmental and Public Health · doi:10.1155/2020/8076259 · Cited by 26 · see citing works
More, N. S., Waingankar, A., Ramani, S., Chanani, S., D'Souza, V., Pantvaidya, S., Fernandez, A., & Jayaraman, A. (2018) · Global Health Science and Practice · doi:10.9745/ghsp-d-17-00182 · Cited by 25 · see citing works
Indonesian antenatal nutrition education: A qualitative study of healthcare professional views
Rahmawati, W., van der Pligt, P., Worsley, A. F., & Willcox, J. C. (2021) · Women s Health · doi:10.1177/17455065211066077 · Cited by 22 · see citing works
Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys
Doherty, T., Rohde, S. S., Besada, D., Kerber, K. J., Manda, S., Loveday, M., Nsibande, D. F., Daviaud, E., Kinney, M. V., Zembe‐Mkabile, W., et al. (2016) · Journal of Global Health · doi:10.7189/jogh.06.020401 · Cited by 21 · see citing works
Self-citationCommunity-Based Stunting Intervention Strategies: Literature Review
Kusumawardani, L. H., Rasdiyanah, R., Rachmawati, U., Jauhar, M., & Rohana, I. G. A. P. D. (2020) · Dunia keperawatan Jurnal keperawatan dan kesehatan · doi:10.20527/dk.v8i2.8555 · Cited by 19 · see citing works
Mambulu, F. N., Eyles, J. D., & Ditlopo, P. (2018) · Health & Social Care in the Community · doi:10.1111/hsc.12595 · Cited by 18 · see citing works
Nsibande, D. F., Loveday, M., Daniels, K., Sanders, D. M., Doherty, T., & Zembe‐Mkabile, W. (2018) · African Health Sciences · doi:10.4314/ahs.v18i1.24 · Cited by 17 · see citing works
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Deserranno, E., Nansamba, A., & Qian, N. (2020) · National Bureau of Economic Research · doi:10.3386/w26928 · Cited by 15 · see citing works
Asegedew, B., Tessema, F., Perry, H. B., & Bisrat, F. (2019) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.18-1000 · Cited by 14 · see citing works
Rahmawati, W., van der Pligt, P., Willcox, J. C., & Worsley, A. F. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002317 · Cited by 14 · see citing works
Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?
Doherty, T., Kroon, M., Rhoda, N. R., & Sanders, D. M. (2016) · South African Medical Journal · doi:10.7196/samj.2016.v106i7.10790 · Cited by 14 · see citing works
Self-citationMunshi, S., Christofides, N. J., & Eyles, J. D. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2019-001564 · Cited by 14 · see citing works
Angwenyi, V., Bunders, J., Criel, B., Lazarus, J. V., & Aantjes, C. (2020) · Health & Social Care in the Community · doi:10.1111/hsc.13094 · Cited by 13 · see citing works
Amurwon, J., Hajdu, F., Bukenya, D., & Seeley, J. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2666-5 · Cited by 11 · see citing works
Rethinking the scale up of Integrated Management of Childhood Illness
Patel, S. K., Zambruni, J. P., Palazuelos, D., Legesse, H., Ndiaye, N. F., Detjen, A., & Aboubaker, S. (2018) · BMJ · doi:10.1136/bmj.k2993 · Cited by 11 · see citing works
dos Santos, A., & Lotter, C. B. (2017) · Muziki · doi:10.1080/18125980.2017.1385412 · Cited by 4 · see citing works
Landa, S., Sanoussi, E. Y., Mahamane, E., Mahamadou, K. O. B., Salzberg, A. A., & Anderson, D. M. (2025) · PLOS Water · doi:10.1371/journal.pwat.0000330 · Cited by 2 · see citing works
Volunteering in Health Care Context: A Concept Analysis Using Rodger’s Evolutionary Approach
A’la, M. Z., Nuntaboot, K., & Rungreangkulkij, S. (2020) · Nurse Media Journal of Nursing · doi:10.14710/nmjn.v10i3.30782 · Cited by 3 · see citing works
Cheshmehzangi, A. (2022) · Urban sustainability · doi:10.1007/978-981-19-3167-3_6 · Cited by 2 · see citing works
Mbewe, S., & Phiri, J. (2023) · OALib · doi:10.4236/oalib.1110932 · Cited by 2 · see citing works
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Self-citationTong, K.-W. (2020) · Springer eBooks · doi:10.1007/978-981-15-2521-6_16 · Cited by 1 · see citing works
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Lange, O., Mehra, D., de Pee, S., & Bloem, M. W. (2017) · Springer eBooks · doi:10.1007/978-3-319-43739-2_28
Fauzi, L., Rahayu, S., Anggorowati, L., & Rizki, N. D. A. (2018) · International Seminar of Public Health and Education (ISPHE) · doi:10.2991/isphe-18.2018.53
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Sanders, D., Ceukelaire, W. D., & Hutton, B. (2023) · doi:10.1093/oso/9780192858450.003.0007
Self-citationZanchetta, M. S., Santos, W. S., Silva, L. D. S. A., & Lucchese, S. P. (2023) · Springer eBooks · doi:10.1007/978-3-030-87624-1_26-1
Baatiema, L., Sedzro, K. M., Amon, S., Hotopf, I., Basit, K., AKATOTI, W., Aikins, M., Raven, J., & Akweongo, P. (2025) · Research Square · doi:10.21203/rs.3.rs-7685937/v1
Ryneveld, M. V., & Schneider, H. (2026) · Health Policy and Planning · doi:10.1093/heapol/czag024
- Authors
- Leon, N., Sanders, D., Van Damme, W., Besada, D., Daviaud, E., Oliphant, N. P., Berzal, R., Mason, J., & Doherty, T.
- Affiliations
- South African Medical Research Council (ZA)
- University of the Western Cape (ZA)
- United Nations Children's Fund (US)
- United Nations Children's Fund Niger (NE)
- Tulane University (US)
- Corresponding author
- Leon, Natalie
- ORCID
- Venue
- Global Health Action
- Publisher
- Informa UK Limited
- Published
- 2015-03-12
- Volume
- 8
- Issue
- 1
- Pages
- 27214
- ISSN
- 1654-9716 (ISSN-L)
- 1654-9880
- PMC
- PMC4359271
- OpenAlex
- W2077196209
- Cited by
- 43
- References
- 15
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 6 · 2017: 8 · 2016: 5
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Global Health Action (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UWC Research Repository (University of the Western Cape) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- community health workers, child survival, primary care, sub-Saharan Africa, Ethiopia, Mali, Niger
- MeSH terms
- Adult, Child, Child Health Services, Child, Preschool, Community Health Workers, Community Health Services, Cooperative Behavior, Developing Countries, Ethiopia, Female, Humans, Infant, Infant, Newborn, Male, Mali, Middle Aged, Niger, Volunteers, Professional Role
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