Revealing disparities in representation in knowledge generation and guideline development.

Background: Multidrug-resistant tuberculosis (MDR/RR-TB) is a major global health challenge, disproportionately affecting low- and lower-middle-income countries (LLMICs). The World Health Organization (WHO) generates guidance to address the problem. Here, we explore the extent to which guidance and related knowledge are generated by experts living in the most-affected countries and consider the results in the context of the movement to decolonize global health.

Confirming-and testing-bonds of trust: A mixed methods study exploring community health workers' experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya.

Amidst the COVID-19 pandemic and national responses, trust (one's belief that a system acts in one's best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust through the evolving COVID-19 crisis in Bangladesh, Haiti, and Kenya, where multi-country community health research was underway.

Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol.

Background: Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective.

The Client Empowerment in Community Health Systems Scale: Development and validation in three countries.

Background: Effectively measuring client empowerment is critical for monitoring and supporting empowerment through interventions, including via community health workers (CHWs) on the front line. Yet a comprehensive measure capturing the multidimensional aspects of client empowerment is not currently available. We aimed to develop and validate the Client Empowerment in Community Health Systems (CE-CHS) Scale in three countries.

Measuring client trust in community health workers: A multi-country validation study.

Background: Client trust in community health workers (CHWs) is integral for improving quality and equity of community health systems globally. Despite its recognized conceptual and pragmatic importance across health areas, there are no quantitative measures of trust in the context of community health services. In this multi-country study, we aimed to develop and validate a scale that assesses trust in CHWs.

"" or ""? Exploring consequences of external shocks on community health systems in Haiti.

Background: Community health systems (CHS) are integral in promoting well-being in humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti's community health workers (CHWs) as critical intermediaries have persisted throughout these contextual shocks. This study explores how shocks influence CHS functionality and resilience in Haiti.

Understanding incentive preferences of community health workers using discrete choice experiments: a multicountry protocol for Kenya, Uganda, Bangladesh and Haiti.

Introduction: There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance.

A conceptual framework for measuring community health workforce performance within primary health care systems.

Background: With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries.