Protective factors and stressors that influence the mental wellbeing of community health workers in South Asia and Sub-Saharan Africa: A scoping review

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Background: Community health workers (CHWs) are crucial to the achievement of Universal Health Coverage. In their roles, CHWs often experience a range of stressors that can affect their wellbeing. This scoping review aims to understand the stressors and protective factors that influence the mental wellbeing of CHWs in sub-Saharan Africa and South Asia. Methods: We reviewed English literature that we searched in MEDLINE and Scopus databases. We also conducted an online search for grey literature in Google Scholar. Our search returned 11,135 articles. After screening out duplicates and ineligible articles, we included 97 articles that met the inclusion criteria. Results: We categorized findings into interrelated domains: protective factors and stressors, which are mediated by individual characteristics. Protective factors that promote mental wellbeing of CHWs include altruism, social recognition, incentives, psychosocial support, flexibility of their work, and, training. Stressors that create anxiety and hinder mental wellbeing include: gender-based violence, harassment, delayed payment of incentives, unclear career pathways, heavy workload, unrealistic performance targets, stigma, and inadequate supervision. In the review, we developed a conceptual framework for programs and research on the mental wellbeing of CHWs in low and middle-income countries (LMICs). Conclusion: Strengthening mental wellbeing requires policy interventions such as fair remuneration, clear career pathways, capacity building, and psychosocial support. Future research may need to prioritize CHW wellbeing and advocacy for their formal integration into the health workforce to advance universal health coverage and ensure no one is left behind.