COMMUNITY-BASED HEALTH-WORKERS - HEAD-START OR FALSE START TOWARDS HEALTH FOR ALL
COMMUNITY-BASED HEALTH-WORKERS - HEAD-START OR FALSE START TOWARDS HEALTH FOR ALL
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DOI：
10.1016/0277-9536(87)90168-7
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发表时间：
1987-01-01
影响因子：
5.4
通讯作者：
BURGER, SE
中科院分区：
文献类型：
--
作者：
BERMAN, PA;GWATKIN, DR;BURGER, SE
近年来，许多发展中国家建立了利用受过最低限度培训的社区卫生工作者提供卫生服务的方案。这些方案预计将通过以低成本向大量以前得不到充分服务的人提供高影响力的基本服务，提高卫生保健系统的成本效益。报告的经验与这些计划已经混合，提出了问题，社区卫生工作者是否是一个最佳的车辆，为扩大初级healthcare.This审查六个大规模的社区为基础的工作者计划表明，他们已经成功地在他们的一些目标，但不是在其他。与其他服务组织模式相比，社区卫生工作者以低成本扩大了服务提供的覆盖面和公平性。然而，它们并不总是提供可能对健康产生重大影响的服务，而且它们提供的服务质量有时很差。大规模的CHW系统需要大量增加对培训、管理、监督和后勤的支持。有证据表明，一般来说，他们的潜力还没有实现在大型例行程序。需要进一步发展这些方案，以巩固它们的成功，并确保它们作为基本保健系统的一个组成部分得到充分的支持。
Health service delivery programs using minimally-trained community-based health workers (CHWs) have been established in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care.This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforce their successes and assure that they are adequately supported as an integral component of the basic health system.