Press Release

Cochrane review on lay health workers for maternal and child health and infectious diseases

New Cochrane review highlights that lay or community health workers can improve the health of children

Lay health workers may have a significant impact on people’s health, a new Cochrane systematic review shows. Lay or community health workers are members of the community who have received some training to promote health or to carry out some health care services but are not healthcare professionals. The new review concludes that lay health workers probably have an impact on breastfeeding, immunisation uptake and tuberculosis treatment results, and may reduce child illness and death. As Karen Daniels and Simon Lewin from the South African Medical Research Council, and two of the review authors, note, ‘There is now evidence from a wide range of settings to suggest that lay health workers may have beneficial impacts on a range of common health issues in primary and community care.’

The review was carried out by an international team of researchers for The Cochrane Collaboration, including from the, South African Medical Research Council, SINTEF Health Research Norway and the Norwegian Knowledge Centre for the Health Services. After searching for all relevant studies, they found 82 studies from a number of different settings. In the included studies, lay health workers worked among people in low income areas in wealthy countries, as well as among people living in poor countries. These lay health workers undertook a range of tasks including giving help and advice about issues such as child health, child illnesses, and medicine taking. In some studies, lay health workers also treated people for particular health problems.

The review shows significant results in areas that could potentially have important impacts on child health and on the achievement of key Millennium Development Goals. In particular, the use of lay health workers, compared to usual healthcare services, probably leads to an increase in the number of women who exclusively breastfeed and the number of children who have their immunization schedule up to date. The review also indicates that lay health worker programmes may decrease the number of children who suffer from fever, diarrhoea and pneumonia and the number of deaths among children under five. Lay health workers may also increase the number of parents who seek help for their sick child.

In addition to child health, the review also considers the use of lay health workers to support people receiving treatment for tuberculosis. The review concludes that the use of lay health workers, compared to people helping themselves or going to a clinic, probably leads to an increase in the number of people with tuberculosis who are cured. However, such programmes probably make little or no difference in the number of people who complete preventive treatment for tuberculosis.

This review is highly relevant to current policy debates internationally, given the growing interest in lay health workers as a way of addressing the human resource crisis in health care in many low- and middle-income countries. It also has implications for strategies to extend services to 'hard to reach' groups and areas in both wealthy and poor countries. As Simon Lewin notes, ‘Task shifting to lower levels of providers is currently much discussed. The review suggests that lay health workers could be used to deliver a range of maternal and child health services usually delivered by professionals.’

This work was funded by the Research Council of Norway.

Contact persons for more information:

• [Norway] Susan Munabi-Babigumira
  Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
  Email: SusanMunabi.Babigumira@nokc.no 
  Telephone: +47 46400471.
• [South Africa] Karen Daniels
  Health Systems Research Unit, Medical Research Council, Cape Town, South Africa. 
  Email: karen.daniels@mrc.ac.za
  Telephone: +27 21 9380454

For a summary of the review see: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004015/frame.html

For further information on the Effective Practice and Organisation of Care Group of the Cochrane Collaboration, see: http://epocoslo.cochrane.org/welcome

For further information on this programme of work on lay health workers, see: www.sintef.no/layvac

Researchers and institutions participating in the review:
Simon Lewin¹, Susan Munabi-Babigumira¹, Claire Glenton², Karen Daniels³, Xavier Bosch Capblanch⁴, Brian E van Wyk⁵, Jan Odgaard-Jensen⁶, Marit Johansen⁶, Godwin N Aja⁷, Merrick Zwarenstein⁸, Inger B. Scheel²

1. Preventive and International Health Care Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
2. Department of Global Health and Welfare, SINTEF Health Research, Oslo, Norway
3. Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
4. Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
5. School of Public Health, University of the Western Cape, Bellville, South Africa
6. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
7. Department of Health Sciences, Babcock University, Ikeja-Lagos, Nigeria
8. Combined Health Services Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada

Full reference for the review:
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE,
Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews. 2010.

Plain language summary for the review:

The effect of lay health workers on mother and child health and infectious diseases
A review of the effect of using lay health workers to improve mother and child health and to help people with infectious diseases was carried out by researchers in The Cochrane Collaboration. After searching for all relevant studies, they found 82 studies. Their findings are summarised below.

What is a lay health worker?
A lay health worker is a member of the community who has received some training to promote health or to carry out some healthcare services, but is not a healthcare professional. In the studies in this review, lay health workers carried out different tasks. These included giving help and advice about issues such as child health, child illnesses, and medicine taking. In some studies, lay health workers also treated people for particular health problems.

The studies took place in different settings. In many of the studies, lay health workers worked among people on low incomes in wealthy countries, or among people living in poor countries.

What the research says
The use of lay health workers, compared to usual healthcare services:

• probably leads to an increase in the number of women who start to breastfeed their child; who breastfeed their child at all; and who feed their child with breastmilk only;
• probably leads to an increase in the number of children who have their immunization schedule up to date;
• may lead to slightly fewer children who suffer from fever, diarrhoea and pneumonia;
• may lead to fewer deaths among children under five;
• may increase the number of parents who seek help for their sick child.

The use of lay health workers, compared to people helping themselves or going to a clinic:

• probably leads to an increase in the number of people with tuberculosis who are cured;
• probably makes little or no difference in the number of people who complete preventive treatment for tuberculosis.