Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios
Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios
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DOI：
10.4102/phcfm.v10i1.1748
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Hugo, Jannie F.
中科院分区：
文献类型：
--
作者：
Bennett, Rod;Marcus, Tessa S.;Hugo, Jannie F.
背景：通过社区卫生工作者提供以社区为基础的服务是重新定义初级卫生保健方法和做法的机会。基于最佳实践面向社区的初级保健(COPC)，开发了COPC规划工具包，以模拟在综合区域卫生系统中基于社区的层级的创建。目的：本文描述了用于确定三种情况下的劳动力数量和服务成本的方法和假设，并将它们应用于南非豪登省最贫穷的60%的人口。背景：本研究来自豪登省卫生与家庭医学部(比勒陀利亚大学)的合作伙伴关系，旨在通过基于社区的卫生团队(称为基于区的外展团队)支持信息和通信技术(ICT)的COPC。方法：建模使用全国人口普查，小地区一级的性别和收入数据、省级设施和国家疾病负担数据。服务计算考虑了多维贫困、需求调整的疾病负担和根据就业条件和地理位置调整的可用工作时间。结果：假设每个方案使用ICT，每个情景(当前做法、国家规范和全职COPC)分别需要14819名、17925名和7303名卫生人力。每种方案的总服务成本从11亿兰特到9.47亿兰特到7.83亿兰特不等。结论：建模表明，提供具有全职员工的ICT支持的COPC是最佳方案。它需要最少的劳动力，是最经济的，即使个别社区卫生工作者的雇佣成本是目前做法的两倍，而且从系统上讲是最有效的。
Background: The introduction of community-based services through community health workers is an opportunity to redefine the approach and practice of primary health care. Based on bestpractice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system.Aim: The article describes the methodologies and assumptions used to determine workforce numbers and service costs for three scenarios and applies them to the poorest 60% of the population in Gauteng, South Africa.Setting: The study derives from a Gauteng Department of Health, Family Medicine (University of Pretoria) partnership to support information and communication technology (ICT)-enabled COPC through community-based health teams (termed as ward-based outreach teams).Methods: The modelling uses national census age, gender and income data at small area level, provincial facility and national burden of disease data. Service calculations take into account multidimensional poverty, demand-adjusted burden of disease and available work time adjusted for conditions of employment and geography.Results: Assuming the use of ICT for each, a health workforce of 14 819, 17 925 and 7303 is required per scenario (current practice, national norms and full-time employed COPC), respectively. Total service costs for the respective scenarios range from R1.1 billion, through R947 million to R783 million.Conclusion: Modelling shows that delivering ICT-enabled COPC with full-time employees is the optimal scenario. It requires the smallest workforce, is the most economical, even when individual community health worker costs of employment are twice those of current practice, and is systemically the most effective.