Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa.
Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa.
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DOI：
10.1371/journal.pgph.0000881
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发表时间：
2023
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由于卫生工作者的数量不足，而且有证据表明社区卫生工作者(CHW)的好处，社区卫生工作者正被部署向服务不足的社区提供卫生保健服务。在这篇文章中，我们探索2009至2011年间推出的南非CHW方案在多大程度上符合社区需求，融入医疗体系和社区结构，并根据以社区为导向的初级卫生保健原则实施。使用案例研究方法，我们研究了位于南非豪登省和姆普马兰加省半城市和农村地区的七个初级医疗机构的CHW团队。我们通过深入访谈的方式收集数据，这些访谈涉及设施经理、社区卫生服务监督员、社区代表和关键信息提供人，以及社区卫生服务中心的焦点小组和观察。以社区为导向的卫生干预措施的实施仍然很复杂。在不同地点，努力将利益攸关方(例如，政治领导人)的意见纳入社区卫生和妇女方案的执行工作。然而，许多居民更关心获得住房的机会，而不是医疗服务。调查发现，卫生福利院的服务总体上是全面的，但培训、监督和指导效率低下限制了其有效性。一些网站介绍的多学科护理方法，有助于提高一些社区卫生工作者关于复杂健康主题的知识和技能。在南非这样一个资源有限的环境中，面向社区的初级卫生保健服务的推出至关重要。然而，重大的社会经济问题扰乱了社区参与和有效提供服务。各国政府需要为培训、监督、用品和薪酬提供足够的资金，以帮助克服这些障碍。
Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services’ were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.