abstract: 'Addressing urban health challenges in low- and middle-income countries

  (LMICs) has been hampered by lack of evidence on effective mechanisms

  for delivering health services to the poor. The urban disadvantaged

  experience poor health outcomes (often worse than rural counterparts)

  and face service barriers. While community health workers (CHWs) have

  been extensively employed in rural communities to address inequities,

  little attention has been given to understanding the roles of CHWs in

  urban contexts. This study is the first to systematically examine urban

  CHW roles in LMICs. It aims to understand their roles vis-a-vis other

  health providers and raise considerations for informing future scope of

  practice and service delivery models. We developed a framework that

  presents seven key roles performed by urban CHWs and position these

  roles against a continuum of technical to political functions. Our

  scoping review included publications from four databases (MEDLINE,

  EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource

  hubs. We included all peer-reviewed, CHW studies situated in

  urban/peri-urban, LMIC contexts. We identify roles (un)commonly

  performed by urban CHWs, present the range of evidence available on CHW

  effectiveness in performing each role and identify considerations for

  informing future roles. Of 856 articles, 160 met the inclusion criteria.

  Programmes spanned 34 LMICs. Studies most commonly reported evidence on

  CHWs roles related to health education, outreach and elements of direct

  service provision. We found little overlap in roles between CHWs and

  other providers, with some exceptions. Reported roles were biased

  towards home visiting and individual-capacity building, and not

  well-oriented to reach men/youth/working women, support community

  empowerment or link with social services. Urban-specific adaptations to

  roles, such as peer outreach to high-risk, stigmatized communities, were

  limited. Innovation in urban CHW roles and a better understanding of the

  unique opportunities presented by urban settings is needed to fully

  capitalize on their potential.'
affiliation: 'Ludwick, T (Corresponding Author), Univ Melbourne, Melbourne Sch Populat
  \& Global Hlth, Nossal Inst Global Hlth, 333 Exhibit St, Melbourne, Vic 3004, Australia.

  Ludwick, Teralynn; McPake, Barbara, Univ Melbourne, Melbourne Sch Populat \& Global
  Hlth, Nossal Inst Global Hlth, 333 Exhibit St, Melbourne, Vic 3004, Australia.

  Morgan, Alison; Kane, Sumit, Univ Melbourne, Melbourne Sch Populat \& Global Hlth,
  Nossal Inst Global Hlth, Maternal Sexual \& Reprod Hlth Unit, Melbourne, Vic, Australia.

  Kelaher, Margaret, Univ Melbourne, Ctr Hlth Policy, Melbourne Sch Populat \& Global
  Hlth, Melbourne, Vic, Australia.'
author: Ludwick, Teralynn and Morgan, Alison and Kane, Sumit and Kelaher, Margaret
  and McPake, Barbara
author-email: teralynn.ludwick@unimelb.edu.au
author_list:
- family: Ludwick
  given: Teralynn
- family: Morgan
  given: Alison
- family: Kane
  given: Sumit
- family: Kelaher
  given: Margaret
- family: McPake
  given: Barbara
da: '2023-09-28'
doi: 10.1093/heapol/czaa049
eissn: 1460-2237
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: 'Urban health; community health; human resources; low- and middle-income

  countries; health inequalities; review'
keywords-plus: 'SOUTH-AFRICA; COST-EFFECTIVENESS; SMOKING-CESSATION; RANDOMIZED-TRIAL;

  PEER EDUCATION; CHILD HEALTH; NEWBORN CARE; HOME VISITS; CAPE-TOWN;

  INTERVENTION'
language: English
month: OCT
number: '8'
number-of-cited-references: '131'
orcid-numbers: 'McPake, Barbara/0000-0002-9904-1077

  Ludwick, Teralynn/0000-0003-4160-7354

  Kane, Sumit/0000-0002-4858-7344

  Morgan, Alison/0000-0001-5380-1619'
pages: 1039-1052
papis_id: e471994528e3475c435997c026f2f354
ref: Ludwick2020distinctiveroles
researcherid-numbers: 'McPake, Barbara/AAE-8655-2021

  Ludwick, Teralynn/AAZ-3458-2020

  '
tags:
- review
times-cited: '11'
title: 'The distinctive roles of urban community health workers in low- and middle-income
  countries: a scoping review of the literature'
type: Review
unique-id: WOS:000593028300016
usage-count-last-180-days: '1'
usage-count-since-2013: '9'
volume: '35'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2020'