Exploring the use of community health workers in community-based health improvement interventions in the Caribbean

Achieving universal health coverage is the vision of world leaders in global and public health and a central element of planning for global human development currently underway by the United Nations. In the face of a growing deficit in the global health workforce, world leaders are turning their attention to developing a global strategy to ensure a health workforce prepared to meet the vast health needs of global populations. Community health workers are a cadre of health service providers that have gained renewed interest as a potentially important approach to improving access and coverage of public health and primary care services, specifically in resource poor areas where the shortage of skilled health professionals is most severe. Many countries in the Caribbean region are classified as low- to middle-income with major challenges in providing adequate access to and coverage of primary and preventative health services. A systematic search of the evidence related to the approach of using CHWs for health improvement interventions in the Caribbean region was conducted. Studies were selected for inclusion in this review based on the following criteria: 1) utilized CHWs in health improvement interventions in the Caribbean region; 2) interventions delivered by CHWs intended to promote health, manage illness, or provide support for health behaviors, 3) included a description sufficient to understand the role of the CHW in the intervention; and 4) provided information on the outcome or evaluation of the intervention (qualitative and/or quantitative). Evidence was analyzed to assess the feasibility and effectiveness of using CHWs in the Caribbean and to determine whether this approach should be considered in the strategy to meet the needs for human resources for health (HRH) in the Caribbean. The approach of using CHWs in community-based health improvement interventions in the Caribbean was found to have promising potential. The available evidence supports the feasibility and effectiveness of the use of CHWs to deliver public health and primary care services that target a number of different health problems in a variety of community settings in Caribbean countries. However, in order to draw clear conclusions about the effectiveness of CHWs in comparison to other approaches and to make recommendations for best practices in the Caribbean, more research is necessary. Given the encouraging preliminary evidence, stakeholders with an interest in improving health outcomes in the Caribbean region should consider further research on this approach as a part of the overall strategy to build the capacity of the health workforce in the Caribbean.Master of Public Healt