Evaluating health service delivery frameworks for assessing community health worker performance in LMICs: a mixed-method systematic review protocol

BACKGROUND: Community health workers (CHWs) are essential to delivering primary healthcare, particularly in low- and middle-income countries (LMICs), where they extend critical services to underserved populations. Despite global recognition of their role in advancing Universal Health Coverage (UHC), efforts to comprehensively evaluate CHW performance through standardized, context-sensitive frameworks remain limited. Current frameworks vary widely in scope, methodology, and applicability, often lacking in comprehensive domains, indicators, and validation processes. This mixed-method systematic review aims to identify, analyze, and synthesize existing performance assessment frameworks for CHWs, focusing on their components, contextual applicability, strengths, and limitations in LMIC settings. METHODS: This mixed-method systematic review (MMSR) has been prepared according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. Three electronic databases PubMed, Web of Science, and Scopus using a string of keywords shall be used to capture qualitative, quantitative, and mixed-method studies published in English between 2015 and 2025. Eligible studies will focus on frameworks evaluating CHW performance in LMICs. Screening and selection will be conducted in Covidence software by two independent reviewers with a third reviewer resolving any discrepancies. The included studies will be assessed for quality using the Mixed Methods Appraisal Tool (MMAT). A convergent segregated approach will be applied for quantitative and qualitative synthesis followed by their integration of evidence in accordance with the Joanna Briggs Institute (JBI) guidelines. The review has been registered in the PROSPERO database. DISCUSSION: This review is expected to yield a comprehensive understanding of the frameworks used to assess CHW performance in LMICs, including common domains and indicators, variations across contexts, and gaps in current performance evaluation strategies. Findings will inform policymakers, program implementers, and researchers on the development or adaptation of more effective, evidence-based, and context-sensitive performance assessment frameworks for CHWs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024616947.