The Case for CHWs: What Evidence Exists?

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A CHW talking to a girl of school age.The following evidence exists supporting the use of CHWs in the health care industry:

  • Professional literature contains:
    • Summaries of data on CHWs
    • Systematic reviews of literature on CHW effectiveness
  • Shortcomings of existing evidence:
    • Many evaluations go unpublished
    • Wide-ranging CHW roles make drawing overarching conclusions difficult


Seeing research and evaluation as a topic for policy might be surprising, but policymakers and others are looking for evidence-based policy initiatives. A frequent theme in this e-learning series has been the diversity of roles and activities performed by CHWs. Evidence is generally associated with one specific role, function, or intervention, making it extremely challenging to paint an overall picture of the impact of CHWs.

In this portion of Session 4, we will look at some key points about research and evaluation: What evidence is now available? How good is it? How can we use unpublished data from employers to bolster this evidence base?

Many commentators have focused on a small number of compelling studies describing the impact of CHW services, and over the last 15 to 20 years, a number of systematic reviews of formal studies of CHW effectiveness have been published. These reviews, however, have highlighted the challenges in drawing broad conclusions from published data.

Also, the published studies cover only a limited range of programs, most of which were created by researchers for the purpose of testing the efficacy of a particular intervention. Funders of pilot or demonstration projects typically require formal evaluations, but the results of these evaluations do not always find their way into professional journals. Again, these studies and unpublished reports cover a wide range of interventions involving dozens of different health issues and conditions, making it difficult to draw overarching conclusions.