Effectiveness of Training and Evaluation Tools for Community Health Workers Delivering Comprehensive Care in Low- and Middle-Income Countries: A Systematic Review
1
Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
2
Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
3
Warwick Medical School, University of Warwick, Coventry, United Kingdom
4
University of Warwick Library, University of Warwick, Coventry, West Midlands, United Kingdom
5
Department of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1820
ABSTRACT
INTRODUCTION:
Low- and middle-income countries (LMICs) are increasingly expanding community health worker (CHW) roles to deliver comprehensive, multi-condition care (CC) using promotive and preventive approaches.1 While training is central to enabling these expanded roles, evidence on training effectiveness and the tools for evaluating gains in CHW knowledge and skills remains fragmented.2, 3 This review synthesises evidence on effectiveness of CHW training for CC and the utility of tools used to assess training outcomes in LMICs.
METHODS:
We conducted a systematic review of peer-reviewed studies published up to December 2023 using PubMed/MEDLINE, CINAHL, and the Cochrane Library. Searches followed the PICO/PICOS frameworks: Participants (CHWs), Intervention (training), Comparison (pre–post or no training), Outcomes (changes in knowledge and/or skills and tools for assessing these outcomes), and Study design (all). Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. A narrative synthesis was undertaken in line with PRISMA 2020 guidance.
RESULTS:
Of 30 studies (n=15 LMICs), 14 assessed training effectiveness and all reported tools for evaluating outcomes. Most studies focused on maternal and child health (MCH)-related programmes, with few evaluating broader CC packages. Training effectiveness studies demonstrated significantly improved knowledge and skills post-training (5.7–62.8 percentage points), declining 2–12 months post-training, without falling below baseline. Health professional-led training and higher CHW educational levels were associated with better outcomes. Assessments was mainly by questionnaire-based tools/observation checklists. <50% of studies reported any tool utility evidence, primarily inter-rater reliability, with minimal reporting validity or use of formal evaluation frameworks.
CONCLUSIONS:
CHWs in LMICs can be effectively trained to deliver elements of CC, particularly within MCH programmes, but evidence remains limited for full care packages. Evaluation tools show weak and inconsistent evidence of validity and reliability, highlighting the need for standardised, theory-informed frameworks for more rigorous assessment of CHW training outcomes and sustainability.
Low- and middle-income countries (LMICs) are increasingly expanding community health worker (CHW) roles to deliver comprehensive, multi-condition care (CC) using promotive and preventive approaches.1 While training is central to enabling these expanded roles, evidence on training effectiveness and the tools for evaluating gains in CHW knowledge and skills remains fragmented.2, 3 This review synthesises evidence on effectiveness of CHW training for CC and the utility of tools used to assess training outcomes in LMICs.
METHODS:
We conducted a systematic review of peer-reviewed studies published up to December 2023 using PubMed/MEDLINE, CINAHL, and the Cochrane Library. Searches followed the PICO/PICOS frameworks: Participants (CHWs), Intervention (training), Comparison (pre–post or no training), Outcomes (changes in knowledge and/or skills and tools for assessing these outcomes), and Study design (all). Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. A narrative synthesis was undertaken in line with PRISMA 2020 guidance.
RESULTS:
Of 30 studies (n=15 LMICs), 14 assessed training effectiveness and all reported tools for evaluating outcomes. Most studies focused on maternal and child health (MCH)-related programmes, with few evaluating broader CC packages. Training effectiveness studies demonstrated significantly improved knowledge and skills post-training (5.7–62.8 percentage points), declining 2–12 months post-training, without falling below baseline. Health professional-led training and higher CHW educational levels were associated with better outcomes. Assessments was mainly by questionnaire-based tools/observation checklists. <50% of studies reported any tool utility evidence, primarily inter-rater reliability, with minimal reporting validity or use of formal evaluation frameworks.
CONCLUSIONS:
CHWs in LMICs can be effectively trained to deliver elements of CC, particularly within MCH programmes, but evidence remains limited for full care packages. Evaluation tools show weak and inconsistent evidence of validity and reliability, highlighting the need for standardised, theory-informed frameworks for more rigorous assessment of CHW training outcomes and sustainability.
| eISSN: | 2654-1459 |
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