Factors affecting the work performance and engagement of community health workers in maternal and child health services delivery: A systematic review in low- and middle-income Asian countries

Background: Despite their vital contributions, community health workers (CHWs) often face a complex range of factors that diminish their work performance and engagement. This in turn, affects their ability to effectively deliver maternal and child health (MCH) services and long-term commitment. Methods: A systematic review was conducted to identify factors that influence the work performance and engagement of CHWs delivering MCH services in Asia. We searched PubMed, EMBASE and Scopus from inception until August 2023. Findings were categorized according to the socioecological model. Findings: A total of 32 studies were included. At the personal level, sociodemographic characteristics, skills, and personal motivations were most influential. Interpersonal dynamics, including family and collegial relationships, played a critical role in sustaining job commitment. Organizational factors such as training opportunities, work environment, and access to resources were also significant. At the community level, social dynamics and safety consideration were emphasized for improving work performance. Finally, at the health system level, funding mechanisms and prevailing policies were found to shape long-term commitment. Several recommendations, including digital health solutions, were proposed as promising strategies to address these multilevel challenges. Interpretation: This study illustrates that CHWs’ performance and engagement are shaped by a range of interconnected factors across multiple levels. Fundamental issues limiting CHWs from functioning at work mainly revolved around not knowing enough, not having enough and not empowered enough . To enhance their work performance and engagement, future research should focus on exploring the potential of digital health solutions to address these foundational challenges. Funding: Nil