Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines
Background: Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out. Ob...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-06-01
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| Series: | Health Services Insights |
| Online Access: | https://doi.org/10.1177/11786329251352658 |
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| author | Warren Dodd Laura Jane Brubacher Monica Bustos Melinda Kelly Mijares Krisha Lim-Mar Lincoln Lau |
| author_facet | Warren Dodd Laura Jane Brubacher Monica Bustos Melinda Kelly Mijares Krisha Lim-Mar Lincoln Lau |
| author_sort | Warren Dodd |
| collection | DOAJ |
| description | Background: Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out. Objectives: (1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out. Methods: In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council’s framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828). Results: CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation. Conclusion: This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process. |
| format | Article |
| id | doaj-art-7a8d8e76428a4e42856d13f69e6ad4e1 |
| institution | Kabale University |
| issn | 1178-6329 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Health Services Insights |
| spelling | doaj-art-7a8d8e76428a4e42856d13f69e6ad4e12025-08-20T03:27:58ZengSAGE PublishingHealth Services Insights1178-63292025-06-011810.1177/11786329251352658Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the PhilippinesWarren Dodd0Laura Jane Brubacher1Monica Bustos2Melinda Kelly Mijares3Krisha Lim-Mar4Lincoln Lau5School of Public Health Sciences, University of Waterloo, ON, CanadaSchool of Public Health Sciences, University of Waterloo, ON, CanadaSchool of Public Health Sciences, University of Waterloo, ON, CanadaInternational Care Ministries, Metro Manila, PhilippinesInternational Care Ministries, Metro Manila, PhilippinesDalla Lana School of Public Health, University of Toronto, ON, CanadaBackground: Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out. Objectives: (1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out. Methods: In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council’s framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828). Results: CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation. Conclusion: This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process.https://doi.org/10.1177/11786329251352658 |
| spellingShingle | Warren Dodd Laura Jane Brubacher Monica Bustos Melinda Kelly Mijares Krisha Lim-Mar Lincoln Lau Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines Health Services Insights |
| title | Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines |
| title_full | Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines |
| title_fullStr | Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines |
| title_full_unstemmed | Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines |
| title_short | Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines |
| title_sort | amplifying community health worker voices to examine the implementation and scaling of a community health program a qualitative study in the philippines |
| url | https://doi.org/10.1177/11786329251352658 |
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