Voices from the field: Perspectives from community health workers on health care delivery in rural KwaZulu-Natal, South Africa.
Voices from the field: Perspectives from community health workers on health care delivery in rural KwaZulu-Natal, South Africa.
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DOI：
10.1086/521122
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发表时间：
2007-12-01
影响因子：
6.4
通讯作者：
Carpenter, Stephen
中科院分区：
文献类型：
--
作者：
Suri, Arjun;Gan, Kevin;Carpenter, Stephen
背景资料。作为南非正规卫生保健部门(诊所、医生和护士)和家庭之间的主要纽带，社区卫生工作者(CHW)为农村卫生保健提供障碍提供了一个重要的视角。一份包含30个问题的书面问卷，评估了CHW对人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)、结核病(TB)和潜在的CHW计划改进的看法，调查对象是南非夸祖鲁-纳塔尔外西部地区的120名CHW。对社区卫生工作人员、社区卫生服务项目管理者、地区诊所的医生和护士也进行了访谈。社区卫生组织认为结核病、艾滋病毒/艾滋病和贫困是社区面临的最大挑战，并建议污名、否认和缺乏教育是未能完成结核病治疗和避免艾滋病毒咨询和检测的主要原因。此外，由于缺乏行政监督和与工作相关的基本用品，对该项目的支持和监测不足。这些结果表明，社区卫生工作者认识到需要艾滋病毒/艾滋病和结核病相关的干预措施，但无法提供与这一需要相称的应对措施。为了充分使现有的CHW计划能够有效地抗击艾滋病毒/艾滋病和结核病的共同流行，夸祖鲁-纳塔尔必须在监督和合作方面取得实质性进展。
Background. As the primary link between the formal health care sector (clinics, physicians, and nurses) and the household level in South Africa, community health workers (CHWs) provide a critical perspective on barriers that exist in rural health care delivery.Methods. A 30-question written questionnaire assessing CHW perspectives on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and potential CHW program improvement was administered to 120 CHWs in the Outer West Region of KwaZulu-Natal, South Africa. Interviews with CHWs, administrators of the CHW program, physicians, and nurses from district clinics were also conducted.Results. CHWs identify TB, HIV/AIDS, and poverty as the greatest challenges facing the community and suggest stigma, denial, and lack of education as the primary reasons for failure to complete TB treatment and avoidance of HIV counseling and testing. Additionally, the results highlight inadequate support and monitoring for the program as a result of a lack of administrative supervision and of basic work-related supplies.Conclusions. These results suggest that CHWs recognize the need for HIV/AIDS- and TB-related interventions but are unable to provide a response commensurate to this need. To fully enable the existing CHW program to effectively fight the HIV/AIDS and TB coepidemics, substantial improvements in supervision and collaboration must be made in KwaZulu-Natal.