Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital.
Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital.
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DOI：
10.1186/s12960-016-0177-9
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发表时间：
2017-01-11
影响因子：
4.5
通讯作者：
Pool R
中科院分区：
文献类型：
--
作者：
Musinguzi LK;Turinawe EB;Rwemisisi JT;de Vries DH;Mafigiri DK;Muhangi D;de Groot M;Katamba A;Pool R
以社区为基础的方案，特别是社区卫生工作者，被描述为解决低收入国家卫生工作者短缺问题的具有成本效益的替代办法。通常，文献强调如何容易CHW链接和连接社区正式的医疗保健服务。在乌干达，几乎没有证据支持或反驳这种说法。本文从联结社会资本的角度出发，探讨了村卫生队作为社区卫生工作者的一个范例，在社区与正规医疗服务之间建立联系的观点。数据是通过2012年至2014年在乌干达卢韦罗区进行的民族志实地调查收集的。数据收集的主要方法是参与者观察VHT组织的活动。此外，作为更大项目的一部分，还对成年社区成员进行了总共91次深入采访和42次焦点小组讨论（FGD）。在对数据进行初步分析后，我们进行了额外的六次深入访谈和三次与VHTs的FGD和四次与社区成员的FGD。对卢韦罗当地政府工作人员、卫生工作者、当地领导人和非政府组织卫生方案工作人员进行了关键线人访谈。在数据分析过程中使用了主题分析。志愿保健队将社区与正规保健联系起来的能力受到利益攸关方对其作用的看法的影响。社区成员认为VHTs为“他人”工作并接受“他人”的指示，这使他们在正规医疗保健系统中无能为力。与VHTs的联系作用相关的挑战之一是来自政府和正规医疗保健提供者的支持。正规的卫生保健提供者认为VHT有兴趣对其服务给予特别认可，但他们不是“专家”。对于一些卫生工作者来说，VHT的引入被视为政府控制人民和掩盖其无法提供卫生服务的策略。在接受非政府组织的培训和初步支持后，VHTs从非政府组织过渡到正式的公共卫生保健结构失败。因此，VHTs被卷入权力关系，影响了他们的作用，连接社区成员与正式的医疗保健服务。我们还发现，缺乏治疗资金、交通网络差、卫生工作者的态度和多种卫生保健系统的存在等因素，都是阻碍获得正规卫生保健的因素，VHTs无法解决这些问题。正如联系社会资本框架所显示的那样，为使自愿保健小组有效地发挥社区和正规保健之间的联系作用，并利用社区以外机构的资源，必须考虑到纵向关系中的权力关系，并在公共保健提供者和他们所服务的社区之间建立伙伴关系。这将确保加强伙伴关系，提高当地人民利用垂直电力网络资源的能力。
Community-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services. Data were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis. The ability of VHTs to link communities with formal health care was affected by the stakeholders’ perception of their roles. Community members perceive VHTs as working for and under instructions of “others”, which makes them powerless in the formal health care system. One of the challenges associated with VHTs’ linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not “experts”. For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health services. Having received training and initial support from an NGO, VHTs suffered transition failure from NGO to the formal public health care structure. As a result, VHTs are entangled in power relations that affect their role of linking community members with formal health care services. We also found that factors such as lack of money for treatment, poor transport networks, the attitudes of health workers and the existence of multiple health care systems, all factors that hinder access to formal health care, cannot be addressed by the VHTs. As linking social capital framework shows, for VHTs to effectively act as links between the community and formal health care and harness the resources that exist in institutions beyond the community, it is important to take into account the power relationships embedded in vertical relationships and forge a partnership between public health providers and the communities they serve. This will ensure strengthened partnerships and the improved capacity of local people to leverage resources embedded in vertical power networks.