Barriers to the Implementation of the Ward-Based Outreach Team Program in Mpumalanga Province: Results From Process Evaluation.
Barriers to the Implementation of the Ward-Based Outreach Team Program in Mpumalanga Province: Results From Process Evaluation.
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DOI：
10.1177/2150132720975552
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发表时间：
2020-01
影响因子：
3.6
通讯作者：
Madiba S
中科院分区：
文献类型：
--
作者：
Nelson C;Madiba S
南非采用了以病房为基础的外展队（WBOT）计划作为初级卫生保健（PHC）再造的三流方法的一个方面。初级保健的重新设计旨在将以收容为中心的治疗方法改为更具预防性和促进性的方法，以改善健康结果。自2012年开始实施以来，尚未对恩坎加拉县的WBOT执行情况进行评价。采用定性方法的过程评价方法被用来检查和描述的上下文，组织，卫生服务提供者，和程序相关的障碍被认为是影响的WBOTs 3分区在南非普马兰加省的一个卫生区的实施。本评价的框架参考了疾病控制中心开发的逻辑模型框架以及医学研究理事会过程评价指南推荐的3个评价领域。通过与直接参与实施WBOT的多个数据源进行深入访谈收集数据。使用NVivo 11进行专题分析。评估发现的主要关键障碍包括资源提供不足、缺乏监督、外展团队工作量繁重、津贴支付不足和不正常、社区卫生工作者的安全受到威胁以及接受服务的社区的文化信仰和习俗。缺乏充足的财政资源是主要挑战，并将继续对成功实施世界机器人技术构成风险。虽然这些障碍被报告为单独的背景因素，但内部和外部背景是相互依存的，相互作用，不应孤立地考虑。改善利益相关者参与WBOT计划的必要性强调了成功实施WBOT的外部环境的重要性。
South Africa adopted the ward-based outreach team (WBOT) program as one aspect of the three-stream approach to primary health care (PHC) re-engineering. PHC re-engineering seeks to modify the hospicentric and curative approach into a more preventive and promotive approach to improve health outcomes. There has not been an evaluation of the implementation of the WBOTs in Nkangala District since its inception in 2012. A process evaluation approach using qualitative methods was used to examine and describe the contextual, organizational, health provider, and program-related barriers considered to affect the implementation of the WBOTs 3 sub-districts in one of the health districts in Mpumalanga Province, South Africa. The framework for this evaluation was informed by the logic model framework developed by the Center for Disease Control as well as the 3 domains of evaluation recommended by the Medical Research Council Guidance on process evaluation. Data were collected through in-depth interviews with multiple data sources directly involved in the implementation of the WBOTs. A thematic analysis was done using NVivo 11. The key critical barriers identified by the evaluation include the inadequate provision of resources, the lack of supervision, the heavy workload for outreach teams, the inadequate and irregular payment of stipends, threats to the safety of the CHWs, and the cultural beliefs and practices of the communities who are to receive the services. The lack of adequate financial resources was the main challenge, and will continue to pose a risk to the successful implementation of the WBOTs. Although the barriers are being reported as separate contextual factors, the internal and external contexts are interdependent, interact with one each other, and should not be considered in isolation. The need to improve stakeholder engagement on the WBOT program underscores the importance of the external context in the successful implementation of WBOTs.