The Role of Community Health Workers in Advancing Universal Health Coverage: A Systematic Review of Effects on Service Coverage, Utilization, and Health Equity

Abstract

Background: Community health workers (CHWs) are increasingly positioned as a practical strategy for advancing universal health coverage (UHC), especially in underserved populations. Yet evidence on their contributions across service coverage, utilization, equity, and implementation remains dispersed across disease areas and study designs.

Objective: To synthesize evidence on how CHWs contribute to UHC through service expansion, improved utilization, selected health outcomes, and health equity, and to identify implementation factors that shape effectiveness.

Methods: We conducted a systematic review using PRISMA-informed methods. Four databases (SciSpace, Google Scholar, PubMed, and ArXiv) were searched with structured terms related to CHWs, UHC, service delivery, equity, and health systems. After deduplication and reranking, 260 unique records were screened. Fourteen studies informed the qualitative synthesis. Findings were synthesized narratively by service area, equity dimension, and implementation context.

Results: CHWs performed diverse roles including home-based promotion and referral, integrated community case management, HIV and TB service support, noncommunicable disease screening and follow-up, psychosocial intervention delivery, and system navigation. Evidence showed improved maternal service utilization, increased appropriate treatment of childhood illness, gains in HIV and TB indicators, better chronic disease follow-up, and reductions in mental health symptoms. Equity-focused reviews found that CHW programmes were commonly equitable or pro-equitable, largely through reduced geographic, financial, and sociocultural barriers. Persistent constraints included weak supervision, inadequate remuneration, variable training quality, commodity stockouts, and poor referral linkages.

Conclusion: CHWs make meaningful contributions to UHC and health equity, but their impact depends on sustained supervision, fair compensation, continuous training, reliable supplies, and stronger integration into formal health systems.