TITLE:
Integration of Community Health Workers into Primary Health Care Systems in a Conflict-Affected Setting: A Mixed-Methods Study in Tiko Health District, Cameroon
AUTHORS:
Smith Afanji, Celestin Nana, Martin Ayim, Marcelus U. Ajonina
KEYWORDS:
Community Health Workers, Primary Health Care, Community Integration, Health Systems, Conflict-Affected Settings, Cameroon, Universal Health Coverage
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.8,
August
24,
2026
ABSTRACT: Background: Community Health Workers (CHWs) are essential for strengthening primary health care (PHC), particularly in fragile and conflict-affected settings where shortages of trained health personnel limit access to essential services. Although Cameroon has adopted community-based health strategies, evidence on the integration of CHWs into the formal health system remains limited. Objective: This study assessed the integration of Community Health Workers into the primary health care system in the conflict-affected Tiko Health District of Cameroon. Methods: A convergent mixed-methods cross-sectional study was conducted among 464 participants, comprising 415 household heads, 40 Community Health Workers (CHWs), and 9 purposively selected key informants. Household heads and CHWs were selected using a multistage sampling approach, while key informants were purposively recruited based on their responsibilities in community health governance and service delivery. Quantitative data were collected using structured questionnaires and analyzed using descriptive statistics, Chi-square tests, Fisher’s exact tests where appropriate, and multivariable logistic regression. Qualitative data were obtained through key informant interviews, analyzed thematically, and integrated with quantitative findings during interpretation. Results: Awareness of CHW services was high among household heads (96.9%) and CHWs (100.0%), while positive perceptions of CHWs were reported by 96.7% and 97.5%, respectively. Community trust in CHWs remained high, and respondents consistently recognized their contributions to health education, disease surveillance, maternal and child health, immunization support, and commodity distribution. The principal barriers to effective integration included inadequate financing, limited refresher training, weak supervision, and poor awareness of national CHW policies. Community trust, supportive PHC structures, continuous capacity building, digital reporting systems, and support from development partners were identified as major facilitators. Residence, educational level, and the conflict context were independently associated with perceived CHW integration (p Conclusion: Community Health Workers are well integrated into PHC service delivery in the Tiko Health District and remain indispensable for sustaining essential health services in conflict-affected communities. Strengthening institutional support through sustainable financing, supportive supervision, continuous capacity building, and formal integration into national health systems is essential for improving program sustainability and advancing Universal Health Coverage in Cameroon.