Mapping common job demands and job resources for large-scale community health worker programs in Southern Africa
1
School of Public Health, University of the Western Cape, Cape Town, South Africa
2
SAMRC/UWC Health Services to Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3511
ABSTRACT
INTRODUCTION:
Countries in the Southern Africa Development Community (SADC) have adopted various large-scale community health worker (CHW) program models in which CHWs serve as intermediaries between communities and the formal health system. This structure enables CHWs to impact community health but presents challenges in governance, management, and funding that shape the nature of their work. It is critical to understand the characteristics of work for individuals employed in large-scale CHW programs, given the importance of these programs in SADC countries’ national primary health care strategies.
METHODS:
A scoping review aligned with PRISMA guidelines (Page et al. 2021) was undertaken to identify common job demands and job resources associated with working in large-scale CHW programs in SADC. The review was grounded in the Job Demands-resources model (Demerouti et al. 2001), which categorizes characteristics of work that require sustained effort and entail physical or psychological costs as job demands, and characteristics that facilitate the achievement of work goals, promote personal growth, or mitigate demands as job resources.
RESULTS:
A search of five databases (CHW Central, CINHAL, PubMed, SCOPUS, and the World Health Organization) identified 3,330 unique studies for initial screening and 865 studies for full-text review. Data were extracted from 162 studies exploring CHW programs in 12 countries. Studies highlighted a range of common job demands, including role confusion, insufficient organizational policies, and issues of violence and aggression at work. A lack of job resources, including insufficient remuneration, training, equipment, medications, supplies, and inadequate supervision, was observed across most country programs.
CONCLUSIONS:
Despite unique program configurations, large-scale CHW programs in SADC face common and concerning imbalances between job demands and job resources. Additional research is needed to determine whether this imbalance affects CHWs' health and motivation, as well as their ability to provide health services and improve the lives of their communities.
Countries in the Southern Africa Development Community (SADC) have adopted various large-scale community health worker (CHW) program models in which CHWs serve as intermediaries between communities and the formal health system. This structure enables CHWs to impact community health but presents challenges in governance, management, and funding that shape the nature of their work. It is critical to understand the characteristics of work for individuals employed in large-scale CHW programs, given the importance of these programs in SADC countries’ national primary health care strategies.
METHODS:
A scoping review aligned with PRISMA guidelines (Page et al. 2021) was undertaken to identify common job demands and job resources associated with working in large-scale CHW programs in SADC. The review was grounded in the Job Demands-resources model (Demerouti et al. 2001), which categorizes characteristics of work that require sustained effort and entail physical or psychological costs as job demands, and characteristics that facilitate the achievement of work goals, promote personal growth, or mitigate demands as job resources.
RESULTS:
A search of five databases (CHW Central, CINHAL, PubMed, SCOPUS, and the World Health Organization) identified 3,330 unique studies for initial screening and 865 studies for full-text review. Data were extracted from 162 studies exploring CHW programs in 12 countries. Studies highlighted a range of common job demands, including role confusion, insufficient organizational policies, and issues of violence and aggression at work. A lack of job resources, including insufficient remuneration, training, equipment, medications, supplies, and inadequate supervision, was observed across most country programs.
CONCLUSIONS:
Despite unique program configurations, large-scale CHW programs in SADC face common and concerning imbalances between job demands and job resources. Additional research is needed to determine whether this imbalance affects CHWs' health and motivation, as well as their ability to provide health services and improve the lives of their communities.
| eISSN: | 2654-1459 |
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