In a paper published in the journal Health Systems and Reform, Schneider and Lehmann look at health interventions outside of the formal health system from a systems perspective.

The authors call this system of health care delivery, often centered around community health workers, as acommunity health system and define it as “a set of local actors, relationships, and processes engaged in producing, advocating for, and supporting health in communities and households outside of, but existing in relationship to, formal health structures.”

After several decades of experience with CHWs led health interventions, the authors argue that the focus now is on sustaining and scaling CHW programsrather than just measuring outcomes. They also see a great role for community health systems in ensuring universal health coverage and achieving sustainable development goals in low and middle income countries.

In order to successfully do so, the authors point that the major challenge is for community health systems needs to integrate with the formal heath system while embedding themselves in the community. The authors point out systems oriented community health interventions can be successfully implemented by mapping out all the actors that constitute the community health system and understand local social and cultural context.

In another paper in the same journal, Kok and colleagues offer a comparative analysis of (CHW) programs in 4 sub-saharan countries– Kenya, Ethiopia, Malawi, and Mozambique. The authors conclude that strong and trusting relationships form an important determinant of the performance of community health workers.