Advancing Maternal and Child Health in Economically Disadvantaged Settings: The Role of Community Health Workers

Abstract

Maternal and child health (MCH) remains a major public health priority, particularly in low-income settings where access to essential healthcare services is often limited. Although global efforts have contributed to reductions in maternal and child mortality, substantial disparities continue to exist due to socioeconomic inequalities, weak healthcare infrastructure, and underutilization of available services. In such contexts, Community Health Workers (CHWs) have emerged as an important strategy for strengthening primary healthcare systems and improving health outcomes. This narrative review examines the role of CHWs in promoting maternal and child health services and identifies key challenges influencing their performance in low-income settings. CHWs function as a vital link between healthcare systems and communities by providing accessible and culturally appropriate services. Their roles include promoting antenatal care, facilitating institutional deliveries, supporting postnatal care, improving immunization coverage, enhancing child nutrition, and managing common childhood illnesses. Through home visits, health education, and community engagement, CHWs contribute to improved awareness and encourage positive health-seeking behaviors. Evidence indicates that CHW interventions are associated with increased utilization of maternal health services, including early antenatal registration and skilled birth attendance. Their involvement in promoting institutional deliveries has contributed to reductions in maternal and neonatal complications. During the postnatal period, CHWs support breastfeeding practices, monitor maternal recovery, and provide guidance on newborn care. In child health, they play a significant role in improving immunization coverage, identifying malnutrition, and managing common childhood conditions such as diarrheal diseases and respiratory infections. These contributions are particularly important in underserved populations with limited access to formal healthcare services. However, the effectiveness of CHW programs is influenced by several systemic and operational challenges. Factors such as inadequate training, heavy workload, limited financial incentives, and weak supervisory mechanisms can affect their performance and reduce program effectiveness. Additionally, issues related to role clarity, resource availability, and integration with formal healthcare systems further impact service delivery. Strengthening CHW programs requires a comprehensive approach that includes continuous training, supportive supervision, adequate remuneration, and strong policy support. Better integration of CHWs within formal healthcare systems and improved coordination with other healthcare providers can enhance service delivery and accountability. In conclusion, CHWs play a crucial role in improving maternal and child health outcomes in low-income settings. Strengthening their capacity and addressing systemic challenges are essential for achieving sustainable improvements in healthcare delivery and advancing public health goals.