@article{CRSIJ26000352,
                  author = {Oladiran Isaiah Olagunju, Manasseh Stephen Alangs},
                  title = {Effectiveness of Community Health Practitioner-Led Interventions in Improving Access to Primary Health Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis},
                  journal = {Cosmo Research and Science International Journal},
                  year = {2025},
                  volume = {2},
                  number = {2},
                  pages = {50-70},
                  issn = {3108-1584},
                  url = {https://cosmorsij.com/published/CRSIJ26000352.pdf},
                  abstract = {Equitable access to primary health care (PHC) remains one of the most persistent challenges confronting health systems in low- and middle-income countries (LMICs), where physician and nurse shortages, inequitable geographic distribution of facilities, and high out-of-pocket costs continue to exclude large populations from essential services. Community Health Practitioners (CHPs), a broad cadre encompassing community health extension workers, community health officers, and lay community health workers, have increasingly been deployed as a task-shifting strategy to bridge this gap. This systematic review and meta-analysis synthesised evidence on the characteristics, effectiveness and moderators of CHP-led interventions in improving access to PHC in LMICs, with particular attention to sub-national evidence from Nigeria. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, six electronic databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science, Global Health, and the Cochrane Library) were searched for studies published between 2017 and 2026. Eligible studies evaluated CHP-led interventions against usual care, no intervention, or an alternative cadre. They reported at least one dimension of PHC access, utilisation, availability, geographical accessibility, affordability, or timeliness. We used a random-effects model to pool effect estimates, and quantified heterogeneity using the I² statistic. Of 1,762 records identified, 34 studies met the inclusion criteria for narrative synthesis and 19 provided extractable quantitative data for meta-analysis. CHP-led interventions were associated with a significant improvement in overall access to PHC (pooled odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.62–2.41, I² = 76.4%), with the largest gains observed for service utilisation and geographical accessibility, and more modest, heterogeneous effects on affordability and timeliness of care. Evidence from Rivers, Bayelsa, Cross River, Abia, Oyo, and the Federal Capital Territory showed consistent, though unevenly resourced, gains in access across Nigeria's geopolitical zones. CHP-led interventions substantially improve access to PHC across LMIC settings, including diverse Nigerian contexts, but training quality, supervision intensity, and digital integration moderate their effectiveness. Scale-up requires standardised, adequately staffed and well-supervised CHP cadres, underpinned by sustained domestic financing.},
                  keywords = {Community health practitioners, community health workers, primary health care, access; task-shifting, low- and middle-income countries, Nigeria, systematic review, meta-analysis},
                  month = {September}
        }