Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries
Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries
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DOI：
10.1080/17441690903334232
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发表时间：
2011-01-01
影响因子：
3.3
通讯作者：
Scott, K.
中科院分区：
文献类型：
--
作者：
Campbell, C.;Scott, K.
本文探讨了社区卫生工作者 (CHW) 计划的潜力，正如 2008 年世界卫生组织 (WHO) 文件《任务转移》中提出的那样，旨在解决卫生工作者短缺问题，为艾滋病毒/艾滋病预防和治疗以及低收入国家的各项千年发展目标做出贡献。它通过对以往社区卫生工作者经验取得成功的因素进行文献回顾，对世界卫生组织的提案进行了审查。世界卫生组织考虑了从过去的社区卫生工作者计划中吸取的五个关键经验教训（需要强有力的管理、适当的选择、适当的培训、足够的保留结构以及与其他医护人员的良好关系）。然而，它忽略了强调第六个教训的重要性，即社区卫生工作者的“社区嵌入”，这对于过去社区卫生工作者计划的成功至关重要。我们毫不怀疑，世界卫生组织的计划将增加能够执行医疗任务的工人数量。然而，我们认为，如果没有社区嵌入，社区卫生工作者将无法成功执行世界卫生组织分配给他们的面向社会的任务，例如健康教育和咨询。我们将世界卫生组织对社区嵌入性的忽视置于更广泛的全球公共卫生趋势的背景下，即从以社区为中心的初级医疗保健转向以生物医学为重点的选择性医疗保健。
This paper examines the potential of community health worker (CHW) programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to tackle health worker shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous CHW experiences. The WHO has taken account of five key lessons learnt from past CHW programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the 'community embeddedness' of CHWs, found to be of critical importance to the success of past CHW programmes. We have no doubt that the WHO plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness, CHWs will be unable to successfully perform the socially oriented tasks assigned to them by the WHO, such as health education and counselling. We locate the WHO's neglect of community embeddedness within the context of a broader global public health trend away from community-focused primary healthcare towards biomedically focused selective healthcare.