Health Workers' and Managers' Perceptions of the Integrated Community Case Management Program for Childhood Illness in Malawi: The Importance of Expanding Access to Child Health Services
Health Workers' and Managers' Perceptions of the Integrated Community Case Management Program for Childhood Illness in Malawi: The Importance of Expanding Access to Child Health Services
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DOI：
10.4269/ajtmh.2012.11-0665
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发表时间：
2012-11-01
影响因子：
3.3
通讯作者：
Bryce, Jennifer
中科院分区：
文献类型：
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作者：
Callaghan-Koru, Jennifer A.;Hyder, Adnan A.;Bryce, Jennifer
社区病例管理（CCM）是一种很有前途的任务转移战略，用于扩大儿童疾病的治疗，越来越多地被低收入国家采用。其成功部分取决于负责执行的人如何看待该战略。本研究采用定性的方法，探讨卫生工作者和管理人员的看法CCM提供的健康监测助理（HSAs）在该计划的第一年在马拉维。管理人员和保健服务机构一致认为，CCM通过扩大获得服务不足者的机会和减少保健设施的工作量而作出了有益的贡献。管理人员对CCM的认可程度各不相同，大多数人的认可程度有限，少数人对CCM有更强的理由。此外，HSA一致希望继续扩大其临床作用，而管理人员更愿意将CCM视为有限的任务。HSAs还报告了与CCM相关的系统限制和社区压力有关的激励因素和挫折感。CCM对HSA的动机和工作量的影响值得注意，值得进一步关注。
Community case management (CCM) is a promising task-shifting strategy for expanding treatment of childhood illness that is increasingly adopted by low-income countries. Its success depends in part on how the strategy is perceived by those responsible for its implementation. This study uses qualitative methods to explore health workers' and managers' perceptions about CCM provided by health surveillance assistants (HSAs) during the program's first year in Malawi. Managers and HSAs agreed that CCM contributed beneficially by expanding access to the underserved and reducing caseloads at health facilities. Managers differed among themselves in their endorsements of CCM, most offered constrained endorsement, and a few had stronger justifications for CCM. In addition, HSAs uniformly wanted continued expansion of their clinical role, while managers preferred to view CCM as a limited mandate. The HSAs also reported motivating factors and frustrations related to system constraints and community pressures related to CCM. The impact of CCM on motivation and workload of HSAs is noted and deserves further attention.