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Community health workers and adolescent health and well-being across sub-Saharan Africa: A systematic review

Yangxu Lin, Oluwatoni Adesina, Broline Sagini Asuma, Jenny Chen-Charles, Satvika Chalasani, Lucie Cluver, Rosalie Aduayi Diop, William E. Rudgard

2025

Abstract Introduction Adolescence represents a pivotal stage of development. Community health workers (CHWs) may constitute a valuable approach to addressing adolescent health challenges in sub-Saharan Africa (SSA). This review systematically synthesised evidence on the effectiveness of CHW-led interventions to improve adolescent health and well-being in SSA. Methods We searched 12 databases and 19 grey literature sources for relevant studies published between January 2014 and October 2024. Interventions were classified by settings (community or school) and by delivery (lay or paraprofessional, peer- or adult-led). Vote-counting and meta-analyses were conducted, alongside risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments. Results Fifty studies were included spanning across 11 countries and 21 outcomes. All outcomes were summarised narratively. Meta-analyses showed moderate-certainty evidence for reducing post-traumatic stress (PTS), low-certainty evidence for reducing depression and improving human immunodeficiency virus (HIV) viral suppression, and very low-certainty evidence for increasing modern contraceptive use. No clear effects were observed for HIV and sexual health knowledge or adolescent pregnancy, all with very low certainty. Conclusion CHW-led programmes show promise for improving adolescent mental health and HIV suppression outcomes and may support contraceptive use in SSA. However, future research is needed on other adolescent health domains. Implications and Contribution Drawing on 50 studies, this systematic review consolidates evidence on community health workers’ role in supporting adolescent health across Africa. It shows clear potential to improve mental health, HIV, and modern contraceptive use, while exposing evidence gaps in other domains and setting priorities for future investment and research.

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International regulation without international government: Improving IO performance through orchestration

Kenneth W. Abbott, Duncan Snidal

The Review of International Organizations·2010·218 citations

International organizations (IOs) have been widely criticized as ineffective. Yet scholars and practitioners assessing IO performance frequently focus on traditional modes of governance such as treaties and inter-state dispute-resolution mechanisms. When they observe poor performance, moreover, they often prescribe a strengthening of those same activities. We call this reliance on traditional state-based mechanisms “International Old Governance” (IOG). A better way to understand and improve IO performance is to consider the full range of ways in which IOs can and do operate—including, increasingly, by reaching out to private actors and institutions, collaborating with them, and supporting and shaping their activities. Such actions are helping to develop an intricate global network of public, private and mixed institutions and norms, partially orchestrated by IOs, that we call “Transnational New Governance” (TNG). With proper orchestration by IOs, TNG can ameliorate both “state failure”—the inadequacies of IOG—and “market failure”—the problems that result when the creation and evolution of norm-setting institutions is highly decentralized. Orchestration thus provides a significant way for IOs to improve their regulatory performance. Some IOs already engage actively with private actors and institutions—we provide a range of illustrations, highlighting the activities of the UN Environment Programme (UNEP). Yet there remains a significant “orchestration deficit” that provides real opportunities for IOs. We draw on the lessons of existing IO activities to suggest additional possibilities for improving IO performance.

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Polycentric systems for coping with collective action and global environmental change

Elinor Ostrom

Global Environmental Change·2010·1618 citations

The 20th anniversary issue of Global Environmental Change provides an important opportunity to address the core questions involved in addressing “global environmental” problems—especially those related to climate change. Climate change is a global collective-action problem since all of us face the likelihood of extremely adverse outcomes that could be reduced if many participants take expensive actions. Conventional collective-action theory predicts that these problems will not be solved unless an external authority determines appropriate actions to be taken, monitors behavior, and imposes sanctions. Debating about global efforts to solve climate-change problems, however, has yet not led to an effective global treaty. Fortunately, many activities can be undertaken by multiple units at diverse scales that cumulatively make a difference. I argue that instead of focusing only on global efforts (which are indeed a necessary part of the long-term solution), it is better to encourage polycentric efforts to reduce the risks associated with the emission of greenhouse gases. Polycentric approaches facilitate achieving benefits at multiple scales as well as experimentation and learning from experience with diverse policies.

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THE CHALLENGES OF THE ANTHROPOCENE: FROM INTERNATIONAL ENVIRONMENTAL POLITICS TO GLOBAL GOVERNANCE

MATÍAS FRANCHINI, EDUARDO VIOLA, ANA FLÁVIA BARROS-PLATIAU

Ambiente & Sociedade·2017·22 citations

This article proposes a reflection on the challenges of global environmental policy in the Anthropocene. Firstly, the inconsistency between the institutions of international environmental policy and the progressive degradation of the planetary boundaries is highlighted. Secondly, it is stated that, since the transition to Anthropocene requires the conscious construction of a new space of safe operation for humanity, it is necessary to radically modify the institutional structure of cooperation, based on international regimes: the transition from environmental politics to global governance. The fundamental milestone of this path is the overcoming of the international system of conservative hegemony, that is, the abandonment of the sovereignist tendencies - egotistical and short-term - on the part of its actors, particularly the great powers. Finally, a series of premises for the governance of the Anthropocene is proposed from the point of view of International Relations, with the post-sovereign transition as the main pillar.

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Geology of mankind

Crutzen, Paul J.

Nature·2002

Mankind's growing influence on the environment was recognized as long ago as 1873, when the Italian geologist Antonio Stoppani spoke about a “new telluric force which in power and universality may be compared to the greater forces of earth,” referring to the “anthropozoic era”. And in 1926, V. I. Vernadsky acknowledged the increasing impact of mankind: “The direction in which the processes of evolution must proceed, namely towards increasing consciousness and thought, and forms having greater and greater influence on their surroundings.” Teilhard de Chardin and Vernadsky used the term 'noösphere' — the 'world of thought' — to mark the growing role of human brain-power in shaping its own future and environment. So far, these effects have largely been caused by only 25% of the world population. The consequences are, among others, acid precipitation, photochemical 'smog' and climate warming. Hence, according to the latest estimates by the Intergovernmental Panel on Climate Change (IPCC), the Earth will warm by 1.4–5.8 °C during this century.

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Including Exclusion in European Memory? Politics of Remembrance at the House of European History

Veronika Settele

Journal of Contemporary European Studies·2015·20 citations

Politicians and scholars agree that a shared historical consciousness could help foster a common European identity, something which is currently lagging behind economic and political integration in the EU. To this end, a flagship of the European remembrance scene is to be opened to the public in Brussels in 2015: the House of European History (HEH). Here, we see that European institutions can play an important role in developing historical narratives that more accurately reflect European political and social reality today than the national paradigms originated from the 19th century. My article investigates the role of ‘marginal voices’ in the HEH's depiction of European history, looking at the issues of colonialism and migration and the manner in which they are dealt with. At the same time, I probe whether the HEH offers counter-narratives to the prevailing picture of European integration as a success story. An examination of the various concepts underlying the museum's approach reveals major difficulties to include exclusion in the official memory. Although a primary aim of the curators is to portray diversity and to offer multiple perspectives, the concept of diversity employed is rather limited, rooted in the structure of the project.

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