Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines
Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines
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DOI：
10.1186/s12913-020-05699-0
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发表时间：
2020-09-11
影响因子：
2.8
通讯作者：
Palafox, Benjamin
中科院分区：
文献类型：
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作者：
Mallari, Eunice;Lasco, Gideon;Palafox, Benjamin
背景资料：社区卫生工作者（CHW）是许多低收入和中等收入国家（LMIC）初级卫生保健（PHC）劳动力的重要骨干。菲律宾是较早采用社区卫生工作者模式提供初级保健的国家，在1980年代初启动了村卫生工作者方案，但对激励和维持村卫生工作者主要自愿参与的因素知之甚少。本研究的目的是解决这个差距，通过检查的生活经验和作用的BHWs在城市和农村sites in the Philippines.Methods：本横断面定性研究借鉴了23个半结构化的访谈与BHWs从barangays在巴伦苏埃拉市（城市）和奎松省（农村）。采用混合归纳/演绎的方法来生成主题，并根据社区动员的理论框架对其进行解释，以了解BHW方案运作的社会背景的特征如何促进或阻碍社区成员自愿成为BHW。结果：受访者确定了一系列激励因素，以寻求和维持他们的BHW的作用，包括各种财务和非财务激励，获得技术知识和技能，改善社区成员的健康和福祉，并提高自己的社会地位。此外，确保BHW有足够的支持和资源（如津贴、药品库存）履行职责，并能有助于决定他们在提供社区卫生服务中的作用，这既能增加社区参与，也能增加BHW方案的总体影响。这些发现强调了象征性的重要性，影响社区成员参与社区卫生福利方案的物质和关系因素。吸取的经验教训可有助于改善菲律宾其他地区以及其他中低收入国家目前正在制定或加强的类似方案的影响和可持续性。
Background: Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs' largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines.Methods: This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs.Results: Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one's social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme.Conclusions: These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.