Exploring providers' perspectives of a community based TB approach in Southern Ethiopia: implication for community based approaches.
Exploring providers' perspectives of a community based TB approach in Southern Ethiopia: implication for community based approaches.
复制标题
探索埃塞俄比亚南部社区结核病方法的提供者的观点：对基于社区的方法的影响。
DOI：
10.1186/s12913-015-1149-9
复制
发表时间：
2015-11-09
影响因子：
2.8
通讯作者：
Theobald S
中科院分区：
文献类型：
--
作者：
Datiko DG;Yassin MA;Tulloch O;Asnake G;Tesema T;Jamal H;Markos P;Cuevas LE;Theobald S
人们越来越关注贴近社区的服务提供者在支持全民健康覆盖方面的作用，但问题仍然是支持和激励这些服务提供者的最佳方法，以及他们可以提供的最佳一揽子服务和所需的支持。我们报告的经验，不同的卫生服务提供者参与社区为基础的干预，以支持获得结核病的诊断和治疗在埃塞俄比亚南部。这项研究的目的是探讨保健服务提供者在埃塞俄比亚南部提供社区结核病一揽子服务的经验，并为社区方案吸取经验教训。采用了定性方法。方法包括深入访谈（IDIs，n= 37）与所有的健康提供者群体：社区健康促进员（CHP），健康推广工作者（HEW），地区监督员和实验室技术人员进行了详细了解的经验提供者在社区为基础的结核病包。作为补充，还进行了干部特定焦点小组讨论（n= 3）。我们使用框架方法进行定性分析。讨论的关键主题是社区干预措施对弱势群体获得结核病诊断、护理和治疗的积极影响。提供者发现来自社区的积极反馈和对社区的明显影响非常鼓舞人心。与激励和业绩有关的其他主题包括监督和支持;学习新技能;团队解决问题/应对挑战和激励措施。在埃塞俄比亚卫生推广方案的背景下，卫生保健工作者在监督员、实验室技术员和卫生保健中心的额外培训和适当支持下，成功地承担了新的任务（收集痰液和准备涂片）。各类提供者的动机是，基于社区的干预措施对贫穷和弱势社区和家庭产生了显著影响。通过在基于社区的干预措施和更广泛的全国保健推广方案内建立的结构和程序，卫生保健工作者在基于社区的干预措施中的作用得到了支持和促进。在以社区为基础的办法中，有必要制定与具体情况相结合的战略，以支持、维持和激励这一关键骨干力量，他们在将卫生系统与农村社区联系起来方面发挥着关键作用。
There is increasing interest in the role of close-to-community providers in supporting universal health coverage, but questions remain about the best approaches to supporting and motivating these providers, and the optimal package they can deliver indifferent contexts and support required. We report on the experiences of different health providers involved in a community based intervention to support access to tuberculosis diagnosis and treatment in Southern Ethiopia. The aim of the study is to explore the experiences of health providers in delivering a community-based tuberculosis package in southern Ethiopia and to draw lessons for community-based programmes. A qualitative methodology was used. Methods included in-depth interviews (IDIs, n= 37) with all health provider groups: Community health promoters (CHPs), health extension workers (HEWs), district supervisors and laboratory technicians were undertaken to obtain a detailed understanding of the experiences of providers in the community based tuberculosis package. These were complemented with cadre specific focus group discussions (n= 3). We used the framework approach for qualitative analysis. The key theme that emerged was the positive impact the community-based intervention had on vulnerable groups’ access to diagnosis, care and treatment for tuberculosis. Providers found the positive feedback from, and visible impact on, communities very motivating. Other themes related to motivation and performance included supervision and support; learning new skills; team problem solving/ addressing challenges and incentives. Against the backdrop of the Ethiopian Health Extension Programme (HEP), HEWs were successfully able to take on new tasks (collecting sputum and preparing smears) with additional training and appropriate support from supervisors, laboratory technicians and CHPs. All categories of providers were motivated by the high visible impact of the community-based intervention on poor and vulnerable communities and households. HEWs role in the community-based intervention was supported and facilitated through the structures and processes established within the community-based intervention and the broader nation-wide Health Extension Programme. Within community based approaches there is need to develop context embedded strategies to support, sustain and motivate this critical cadre who play a pivotal role in linking health systems and rural communities.