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Van Iseghem T, Jacobs I, Vanden Bossche D, Delobelle P, Willems S, Masquillier C, Decat P. The role of community health workers in primary healthcare in the WHO-EU region: a scoping review. Int J Equity Health 2023; 22:134. [PMID: 37474937 PMCID: PMC10357780 DOI: 10.1186/s12939-023-01944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. METHODS This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. RESULTS Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. CONCLUSION Future research projects involving CHWs should detail their involvement and elaborate on CHWs' role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.
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Affiliation(s)
- Tijs Van Iseghem
- Interuniversity Centre for Health Economics Research (ICHER), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ilka Jacobs
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dorien Vanden Bossche
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- MENT Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sara Willems
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Caroline Masquillier
- 'Family Medicine and Population Health' - FAMPOP, Faculty of Medical Sciences & 'Centre for Family, Population and Health', Faculty of Social sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Decat
- Unit Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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McAlearney AS, Menser T, Sieck CJ, Sova LN, Huerta TR. Opportunities for Community Health Worker Training to Improve Access to Health Care for Medicaid Enrollees. Popul Health Manag 2019; 23:38-46. [PMID: 31140931 DOI: 10.1089/pop.2018.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Limited access to care can negatively affect population health, which is particularly concerning for individuals of lower socioeconomic status. Shortages of US health care providers in areas that predominantly serve Medicaid enrollees contribute to a lack of access. The Ohio Medicaid Technical Assistance and Policy Program Healthcare Access Initiative was designed as a workforce development initiative to train and deploy community health workers (CHWs). The authors conducted 55 key informant interviews with preceptors, CHWs, and administrators across 5 sites with the specific aim of improving understanding of common barriers to and benefits of CHW program implementation across different CHW programs in Ohio. CHW programs reportedly act as a bridge between the patient and providers, and program benefits were reported for participants, organizations, and patients. This study found that CHW programs enabled training of health professionals that can empower participants while allowing them to also give back to their communities. Organizations employing CHWs reported being able to extend clinic services, increase utilization of community resources, and improve patient compliance through the efforts of CHWs; program impacts also led to increased patient support, patient education, and overall better care. To better integrate CHWs into health care organizations, organizations should focus on clearly defining the CHW role and ensuring adequate infrastructure to support CHW efforts.
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Affiliation(s)
- Ann Scheck McAlearney
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Cynthia J Sieck
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Lindsey N Sova
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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Tsolekile LP, Schneider H, Puoane T. The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town. Curationis 2018; 41:e1-e8. [PMID: 29781697 PMCID: PMC6091590 DOI: 10.4102/curationis.v41i1.1815] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/05/2017] [Accepted: 12/21/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood. OBJECTIVES To assess CHWs' current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town. METHODS A cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs' knowledge of hypertension and diabetes were conducted. RESULTS The vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs' roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs' knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month). CONCLUSIONS The roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.
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Mathers J, Taylor R, Parry J. The challenge of implementing peer-led interventions in a professionalized health service: a case study of the national health trainers service in England. Milbank Q 2015; 92:725-53. [PMID: 25492602 DOI: 10.1111/1468-0009.12090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Policy Points: In 2004, England's National Health Service introduced health trainer services to help individuals adopt healthier lifestyles and to redress national health inequalities. Over time these anticipated community-focused services became more NHS-focused, delivering "downstream" lifestyle interventions. At the same time, individuals' lifestyle choices were abstracted from the wider social determinants of health and the potential to address inequalities was diminished. While different service models are needed to engage hard-to-reach populations, the long-term sustainability of any new service model depends on its aligning with the established medical system's characteristics. CONTEXT In 2004, the English Public Health White Paper Choosing Health introduced "health trainers" as new members of the National Health Service (NHS) workforce. Health trainers would offer one-to-one peer-support to anyone who wished to adopt and maintain a healthier lifestyle. Choosing Health implicitly envisaged health trainers working in community settings in order to engage "hard-to-reach" individuals and other groups who often have the poorest health but who engage the least with traditional health promotion and other NHS services. METHODS During longitudinal case studies of 6 local health trainer services, we conducted in-depth interviews with key stakeholders and analyzed service activity data. FINDINGS Rather than an unproblematic and stable implementation of community-focused services according to the vision in Choosing Health, we observed substantial shifts in the case studies' configuration and delivery as the services embedded themselves in the local NHS systems. To explain these observations, we drew on a recently proposed conceptual framework to examine and understand the adoption and diffusion of innovations in health care systems. CONCLUSIONS The health trainer services have become more "medicalized" over time, and in doing so, the original theory underpinning the program has been threatened. The paradox is that policymakers and practitioners recognize the need to have a different service model for traditional NHS services if they want hard-to-reach populations to engage in preventive actions as a first step to redress health inequalities. The long-term sustainability of any new service model, however, depends on its aligning with the established medical system's (ie, the NHS's) characteristics.
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Affiliation(s)
- Jonathan Mathers
- School of Health and Population Sciences, University of Birmingham
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Angier H, Wiggins N, Gregg J, Gold R, DeVoe J. Increasing the relevance of research to underserved communities: lessons learned from a retreat to engage community health workers with researchers. J Health Care Poor Underserved 2014; 24:840-9. [PMID: 23728049 DOI: 10.1353/hpu.2013.0086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article presents information on a community retreat developed to seek input from community health workers (CHWs) to increase the relevance of our research to underserved communities in Oregon. Retreats facilitating dialogue between researchers and CHWs could yield important insight to enhance the significance of research for communities.
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Affiliation(s)
- Heather Angier
- Oregon Health & Science University, Portland, Oregon 97239, USA.
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South J, White J, Branney P, Kinsella K. Public health skills for a lay workforce: findings on skills and attributes from a qualitative study of lay health worker roles. Public Health 2013; 127:419-26. [PMID: 23587671 DOI: 10.1016/j.puhe.2013.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 01/23/2013] [Accepted: 02/28/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To present a typology of attributes associated with lay health worker (LHW) roles drawn from a qualitative study of lay roles in the delivery of public health programmes. STUDY DESIGN Qualitative research study of case studies of public health projects. METHODS Five case studies of public health projects were undertaken, reflecting diverse roles, public health issues and populations. Semi-structured interviews and focus groups were carried out with a sample of 136 stakeholders, including commissioners, practitioners, LHWs and service users. Thematic analysis was conducted within and across cases. RESULTS Findings on the pre-eminence of social skills associated with LHW roles were consistent across all five projects. Being approachable, non-judgemental and responsive to community needs were critical attributes that enabled LHWs to undertake outreach and communicate successfully with programme recipients. Experiential knowledge and cultural understanding were also important qualities. A typology of attributes associated with LHW roles is presented. CONCLUSIONS Social skills, the ability to connect with a community, and the ability to develop respectful relationships are fundamental qualities for LHW roles. Further research would be required to produce a comprehensive map of LHW skills; however, the paper questions assumptions that lay skills are necessarily of a lower order than the professional skill set.
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Affiliation(s)
- J South
- Centre for Health Promotion Research, Leeds Metropolitan University, Leeds, UK.
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Zandee GL, Bossenbroek D, Slager D, Gordon B. Teams of Community Health Workers and Nursing Students Effect Health Promotion of Underserved Urban Neighborhoods. Public Health Nurs 2013; 30:439-47. [DOI: 10.1111/phn.12031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Dianne Slager
- Nottawaseppi Huron Band of the Potawatomi Health Center; Wyoming; Michigan
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Walton JW, Snead CA, Collinsworth AW, Schmidt KL. Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program. FAMILY & COMMUNITY HEALTH 2012; 35:161-171. [PMID: 22367263 DOI: 10.1097/fch.0b013e31824651d3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Disparities in prevalence of type 2 diabetes and complications in underserved populations have been linked to poor quality of care including lack of access to diabetes management programs. Interventions utilizing community health workers (CHWs) to assist with diabetes management have demonstrated improvements in patient outcomes. Use of CHWs may be an effective model for providing care coordination and reducing disparities, but there is limited knowledge on how to implement this model on a large scale. This article describes how an integrated health care system implemented a CHW-led diabetes self-management education program targeting Hispanic patients and reports lessons learned from the first 18 months of operation.
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Affiliation(s)
- James W Walton
- Office of Health Equity, Baylor Health Care System, Dallas, Texas 75246, USA.
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Spencer MS, Rosland AM, Kieffer EC, Sinco BR, Valerio M, Palmisano G, Anderson M, Guzman JR, Heisler M. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health 2011; 101:2253-60. [PMID: 21680932 PMCID: PMC3222418 DOI: 10.2105/ajph.2010.300106] [Citation(s) in RCA: 244] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control. METHODS We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. RESULTS Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P < .01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. CONCLUSIONS This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery.
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Affiliation(s)
- Michael S Spencer
- University of Michigan, School of Social Work, Ann Arbor, MI 48109-1106, USA.
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Gilkey M, Garcia CC, Rush C. Professionalization and the experience-based expert: strengthening partnerships between health educators and community health workers. Health Promot Pract 2011; 12:178-82. [PMID: 21427271 DOI: 10.1177/1524839910394175] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The recent inclusion of community health workers (CHWs) in the U.S. Department of Labor's 2010 Standard Occupational Classification System provides an opportunity for health educators to reflect on their relationship with CHWs. The authors discuss the ways that health educators and CHWs differ in their orientation toward professionalization and employ the concept of the "experience-based expert" to highlight what they believe to be the unique contributions of CHWs. Finally, considerations important for health educators and CHWs as they work to advance supportive and complementary practices are discussed.
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Affiliation(s)
- Melissa Gilkey
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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South J, Meah A, Branney PE. 'Think differently and be prepared to demonstrate trust': findings from public hearings, England, on supporting lay people in public health roles. Health Promot Int 2011; 27:284-94. [PMID: 21511725 DOI: 10.1093/heapro/dar022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery.
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Affiliation(s)
- Jane South
- Centre for Health Promotion Research, Leeds Metropolitan University, Queen Square House, Leeds LS2 8NU, UK.
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Stone JR, Parham GP. An ethical framework for community health workers and related institutions. FAMILY & COMMUNITY HEALTH 2007; 30:351-63. [PMID: 17873641 DOI: 10.1097/01.fch.0000290547.40952.f9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The aim of this article is to provide practical ethical guidance and to foster further critical reflection on ethical issues in the work, education, and training of community health workers. The analysis includes implications for associated institutions. We first summarize the roles of community health workers and some evaluations of their work. After next highlighting ethical elements from the literature, we then give a justification for the ethical framework that follows. The article then provides a detailed discussion of a set of basic ethical principles for the field of community health work. Among the principles, we argue that the following 3 should have a foundational role: equal and substantial respect, justice, and care. Among these, respect is most fundamental.
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Affiliation(s)
- John R Stone
- Center for Health Policy and Ethics, Creighton University Medical Center, Omaha, Neb 68178, USA.
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Thyne SM, Rising JP, Legion V, Love MB. The Yes We Can Urban Asthma Partnership: a medical/social model for childhood asthma management. J Asthma 2007; 43:667-73. [PMID: 17092847 DOI: 10.1080/02770900600925288] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pediatric asthma programs have struggled to integrate children's medical and social needs. We developed and piloted an integrated team model for asthma care for low-income children through the Yes We Can Urban Asthma Partnership. Program evaluation demonstrated increases in prescribing controller medications (p <0.05), use of action plans (p<0.001), and the use of mattress covers (p<0.001); and decrease in asthma symptoms (p<0.01). Additional changes occurred within the local system of asthma care to support ongoing efforts to improve asthma management. We conclude that pediatric asthma programs can effectively target the social and medical needs of children in a sustainable manner.
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Affiliation(s)
- Shannon M Thyne
- Department of Pediatrics, University of California, San Francisco, California 94110, USA.
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Abstract
BACKGROUND Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. We tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset. METHODS We did cross-country multiple regression analyses with maternal mortality rate, infant mortality rate, and under-five mortality rate as dependent variables. Aggregate density of human resources for health was an independent variable in one set of regressions; doctor and nurse densities separately were used in another set. We controlled for the effects of income, female adult literacy, and absolute income poverty. FINDINGS Density of human resources for health is significant in accounting for maternal mortality rate, infant mortality rate, and under-five mortality rate (with elasticities ranging from -0.474 to -0.212, all p values < or = 0.0036). The elasticities of the three mortality rates with respect to doctor density ranged from -0.386 to -0.174 (all p values < or = 0.0029). Nurse density was not associated except in the maternal mortality rate regression without income poverty (p=0.0443). INTERPRETATION In addition to other determinants, the density of human resources for health is important in accounting for the variation in rates of maternal mortality, infant mortality, and under-five mortality across countries. The effect of this density in reducing maternal mortality is greater than in reducing child mortality, possibly because qualified medical personnel can better address the illnesses that put mothers at risk. Investment in human resources for health must be considered as part of a strategy to achieve the Millennium Development Goals of improving maternal health and reducing child mortality.
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Affiliation(s)
- Sudhir Anand
- University of Oxford, Department of Economics, Oxford, UK.
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