PhD defense Maryse Kok: performance of community health workers


Community health workers (CHWs) play an unique role in connecting local communities with the health sector, especially in low- and middle income countries. Access to quality health care is a prerequisite for development and it is important to know how this can be improved. KIT advisor Maryse Kok, an expert in health systems, conducted her PhD research to gain insight into how performance of Community Health Workers in low- and middle-income countries can be improved.

On Monday 23 November she defends her thesis at the VU University in Amsterdam. The defense will be preceded by a symposium on community health workers.

Renewed interest in community health workers
Community Health Workers form an essential part of the health system in low- and middle-income countries, connecting communities with the health sector. The continuing shortage of human resources for health combined with evidence that these local health workers effectively bring health care closer to communities has led to a renewed interest in CHW programmes.
Maryse Kok: “Community health workers have a great potential to increase access to health care. More tasks are shifted from higher level health workers towards local health workers, and thus responsibilities grow while community health workers receive limited training and work in poor and challenging settings . More insight is needed in how to optimize their work. That’s why I focused my research on factors influencing performance of community health workers.

The research conducted
The thesis presents research from a systematic review of the international literature, two single case studies and a qualitative comparative multiple case study about the CHW programmes of Ethiopia, Kenya, Malawi and Mozambique. The work was undertaken within REACHOUT.

Community health worker performance: a complex interaction of “software” and “hardware”
It was found that a complex mix of factors, which are highly context dependent, continuously shape and change performance. Maryse Kok: “Despite the contextual differences, we found that trust, relationships and expectations between different actors in the health system are important drivers of community health worker performance in all settings. These “software” elements interact with the programme “hardware”, such as the supervision system and communication structure. Both software and hardware elements are necessary to yield optimal CHW performance and ultimately improve the health status of poor and rural communities”.

The insights gained are relevant for policy makers, programme managers and researchers in the field of human resources for health and CHW programmes. One community health worker in Malawi nicely summarized the potential of these workers:
We are like the messengers between the health workers and the people in the community, connecting them regarding the problems they face concerning health.
The research presented in Maryse Kok’s thesis gives directions on how to optimize community health performance workers performance in resource-constrained settings, so that the benefit of CHWs’ unique position between communities and the health sector and their role in achieving universal health coverage can be enhanced.

Livestream PhD Defense Maryse Kok

The thesis defense of Maryse Kok can be followed live via the following link.

Symposium Community Health Workers
The Athena Institute of the VU University and the Royal Tropical Institute are pleased to invite their Master students, staff members and others interested to attend the symposium on Community Health Workers. The symposium aims to provide insight into the (expanding) role of Community Health Workers in health systems in low- and middle-income countries.

Date and Time: 23 Nov 2015, 9am
Venue: VU University, Auditorium (de Boelelaan 1105, Amsterdam)
Please register at:

Download the invitation