Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries
Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries
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DOI：
10.1080/17441692.2016.1174722
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Dieleman, Marjolein
中科院分区：
文献类型：
--
作者：
Kok, Maryse C.;Ormel, Hermen;Dieleman, Marjolein
社区卫生工作者在社区和卫生部门之间具有独特的地位。员工与双方的关系强弱会影响他们的动机和表现。这项定性比较研究的目的是了解在撒哈拉以南非洲不同环境中，卫生保健员、社区和卫生部门之间的关系如何形成的异同。该研究表明，信任和卫生保健工作者与其社区和卫生部门行动者的关系之间存在复杂的相互影响。影响人际关系的机制是（不）联系感、（不）熟悉感和服务于相同目标的感觉，以及对获得的支持、尊重、能力、诚实、公平和认可的感知。有时，卫生保健员与卫生部门之间的关系有限，导致卫生保健员与社区之间的关系较弱。确定了这些机制所处的更广泛的背景（例如社会经济情况）和方案背景（例如与任务转移、志愿服务和监督有关）。决策者和规划管理人员应该考虑到更广泛的背景，并可以调整卫生保健工作者规划，以便它们触发在卫生保健工作者、社区和卫生系统其他行动者之间建立信任关系的机制。这有助于卫生保健工作者表现良好，并对其独特的中介地位所提供的机会作出反应。
Community health workers (CHWs) have a unique position between communities and the health sector. The strength of CHWs' relationships with both sides influences their motivation and performance. This qualitative comparative study aimed at understanding similarities and differences in how relationships between CHWs, communities and the health sector were shaped in different Sub-Saharan African settings. The study demonstrates a complex interplay of influences on trust and CHWs' relationships with their communities and actors in the health sector. Mechanisms influencing relationships were feelings of (dis)connectedness, (un)familiarity and serving the same goals, and perceptions of received support, respect, competence, honesty, fairness and recognition. Sometimes, constrained relationships between CHWs and the health sector resulted in weaker relationships between CHWs and communities. The broader context (such as the socio-economic situation) and programme context (related to, for example, task-shifting, volunteering and supervision) in which these mechanisms took place were identified. Policy-makers and programme managers should take into account the broader context and could adjust CHW programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system. This can contribute to enabling CHWs to perform well and responding to the opportunities offered by their unique intermediary position.