The 10th European Congress on Tropical Medicine and International Health will take place in Antwerp, Belgium from the 16-20 October. We are delighted that REACHOUT will be represented at the conference by Maryse Kok who will give a presentation on the performance of community health workers and their intermediary position within complex adaptive health systems.

Community health workers are increasingly recognized as an integral component of the health workforce needed to achieve universal health coverage in low- and middle-income countries. They have a unique intermediary position between communities and professionals in the health sector. Their performance is shaped by transactional processes between these different actors.

In her talk Maryse will analyse the multiple factors that influence community health worker performance and develop a framework on their performance. This is based on evidence from a systematic review that included 140 studies related to community health workers working in promotional, preventive or curative primary health services. Empirical data came from a multi-country study on community health worker performance in Ethiopia, Kenya, Malawi and Mozambique, in which focus group discussions and interviews were undertaken with community health workers, their supervisors, managers and community members.

The framework on performance demonstrates that programme design, health system and broader context are most important to performance. Influencing factors can be divided into ‘hardware’ and ‘software’. Hardware elements, such as supervision systems and accountability structures, continuously influence software elements: the ideas and interest, relationships and power, values and norms of the actors involved.

The framework touches upon interesting considerations for policy, practice and research. The realization that hardware and software elements are both needed and need to strengthen each other, calls for the incorporation of programme or intervention elements facilitating this process. For example, the introduction of a supervision system should reflect and take into account power relations and values and norms of the people involved, including those in the community. Health systems research should take into account the software elements, as effective systems thrive on these elements, and performance, in particular community health worker performance, correlates with the strength and nature of relationships between all actors. 

If you are at the conference please do come along and say hello.

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