Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion.
Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion.
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DOI：
10.1186/s12960-015-0074-7
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发表时间：
2015-09-07
影响因子：
4.5
通讯作者：
Pool R
中科院分区：
文献类型：
--
作者：
Turinawe EB;Rwemisisi JT;Musinguzi LK;de Groot M;Muhangi D;de Vries DH;Mafigiri DK;Pool R
自1978年《阿拉木图宣言》以来，社区卫生工作者方案受到了极大的关注，发展中国家制定了许多倡议。然而，一旦志愿者最初的热情减退，社区卫生工作方案往往会遭受很大的减员。2002年，乌干达开始实施一项名为“村保健队”的国家保健和卫生方案，但在许多社区，这些保健队的表现不佳。有人认为，贫困社区参与选择的CHW影响他们在社区和成功的嵌入。如何创造性地实施选择以维持社区卫生福利方案的问题尚未得到充分探讨。在本文中，我们的目的是研究的过程中引入的VHT战略在一个农村社区，包括VHT成员的选择，以及如何这些过程可能会影响他们的工作中的理想的自然助手模型的健康促进。作为一个更广泛的研究项目的一部分，在卢韦罗区进行了一项人种学研究。数据收集包括参与者观察、12次焦点小组讨论、14次与社区成员和VHTs成员的深入访谈以及4次关键线人访谈。在NVivo中记录、转录和编码了访谈和FGD。使用文本查询搜索进一步探讨和发展了新出现的主题。通过与其他团队成员的发现进行比较，证实了解释。VHT的选择过程造成了不信任，损害了该方案的合法性。虽然卢韦罗社区最初对该方案抱有很高的期望，但当地领导人选择志愿保健队的方式使社区大多数成员靠边站。社区成员质疑那些被选中的人的资格，不认为VHT是他们会去寻求帮助和支持的人。怨恨越来越大，结果，VHTs的运作方式使他们进一步疏远了社区。没有社区的支持，VHT很快就失去了士气，停止了工作。正如自然助手模式所建议的那样，为了使社区卫生福利方案获得和维持社区的支持，有必要利用自然存在的非正式帮助网络，吸收已经得到服务对象信任的志愿者。这样，社区将更倾向于相信志愿人员的建议，并向他们提供支持作为回报，从而增加他们在社区中服务的可持续性。
Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion. As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members. The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work. As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.