title: Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability?
abstract: OBJECTIVE
  We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs).
  
  
  METHODS
  We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization.
  
  
  RESULTS
  The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment.
  
  
  CONCLUSIONS
  Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.
authors.affiliation: Yale School of Public Health, New Haven, CT 06520-8034, USA. sarah.pallas@yale.edu
authors.forename: Sarah Wood
authors.initials: SW
authors.lastname: Pallas
authors.forename: Dilpreet
authors.initials: D
authors.lastname: Minhas
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.forename: Lauren
authors.initials: L
authors.lastname: Taylor
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D003150:Community Health Workers / Q000458:organization & administration*; D016208:Databases, Factual; D003906:Developing Countries; D006801:Humans; D011203:Poverty; D016730:Program Development / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*