Abstract
Background: Community health workers (CHWs) are trained members of the community who play a crucial role in bridging gaps between health and social care systems. They leverage community networks, cultural competence and knowledge of care systems to enhance service delivery. Working in partnership with health care providers, such as nurses, CHWs address health challenges, that are often intensified by health inequities. The positive impact of CHWs has been demonstrated in areas such as: disease prevention (e.g., vaccination, hand washing),1,2 enhancing provider-patient communication/trust,1-3 ensuring treatment adherence,2-4 linking individuals to health/social services,1,2,4 managing chronic diseases,4 cancer screening,4 and enhancing maternal-child health.1,5
In India, Community Health Workers (CHWs) function within well-established, formalized structures, including the Accredited Social Health Activists (ASHAs), Anganwadi Workers, and Female Health Workers. This structured approach serves as an exemplary model, as CHWs have significantly enhanced population and community health, particularly in underserved areas with limited healthcare resources and access challenges. Our team identified an opportunity for other countries to learn from India’s successful CHW implementation model, drawing insights that could inform both policy development and practical applications internationally
Approach: Our team is a partnership between India (Jamia-Hamdard University) and Canada (Dalhousie University), with a shared primary goal to describe strategies to strengthen CHW capacity to enhance health systems and promote healthcare equity amid health human workforce challenges in India. Our secondary goal was to explore how the CHW role can help strengthen the health human workforce in other countries (e.g., Canada) particularly with equity seeking populations.
In phase one (of three), we completed semi-structured interviews (60 mins) in Hindi with 12 CHWs, six community members, and two community leaders near New Delhi, India. Interviews were translated into English and analyzed using content analysis. The thematic summary informed the phase 2 scoping review (JBI methodology) to identify strategies for developing and implementing the CHW role. As this work was funded by Research Nova Scotia, we included considerations for integration in high-income contexts (e.g., Canada).
Results: We present the thematic findings from 20 interviews, alongside preliminary results from the JBI scoping review. This research describes how CHWs in India enact their roles, addressing critical service gaps shaped by local contexts and cultural factors. In this context, CHWs act as extensions of healthcare services, bridging gaps between health and social care systems. They play pivotal roles in health education, by addressing stigma and misinformation; and provide essential support and advocacy to help patients access appropriate care.1-3,5 Based on these insights, we have developed recommendations to inform CHW role descriptions and guide implementation strategies adaptable to the Canadian context.
Implications: This co-developed project was supported by partnership between universities in India and Canda. We learned about effective CHW role enactment and implementation in the Indian context and have considered strategies to adapt this role to Canadian context. Our next steps are to host a policy workshop in Halifax, Nova Scotia to bring together Canadian and Indian partners to develop strategies to enhance CHW capacity.