Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature

Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature

MacRae M C; Fazal O; O'Donovan J

BMJ Global Health

2020

children; palliative care; India; methods; Developing Countries; Asia; health care; recommendations; Chordata; eukaryotes; Hominidae; Homo; human diseases; mammals; man; primates; vertebrates; animals; Commonwealth of Nations; sustainability; methodology; systematic reviews; allied health occupations; community health; effects; grey literature; guidelines; health services; health workers; literature reviews; medical auxiliaries; Newly Industrialized Countries; NICS; non-conventional literature; South Asia; techniques; Third World; threshold countries; Underdeveloped Countries; workers

Background: Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach. Methods: We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature. Findings: 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care. Conclusion: Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.

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