Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia.
Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia.
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DOI：
10.1186/s12913-017-2282-4
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发表时间：
2017-05-08
影响因子：
2.8
通讯作者：
Yeung S
中科院分区：
文献类型：
--
作者：
Liverani M;Nguon C;Sok R;Kim D;Nou P;Nguon S;Yeung S
人们越来越有兴趣在低收入和中等收入国家扩大社区保健工作者方案，将其作为解决保健专业人员短缺问题的一种具有成本效益的办法。然而，我们对大规模方案的接受情况以及如何改进这些方案的了解仍然有限，对可能促进或阻碍公平获得服务的因素存在知识差距。本文探讨了柬埔寨乡村疟疾工作者（VMW）计划的案例，这是一项广泛的基于社区的干预措施，用于管理偏远农村地区的疟疾病例。在贡布省的六个村庄进行了实地调查，这些村庄的特点是不同的方案配置、人口规模和到最近的公共卫生设施的距离。在这些地点，深入采访（n = 71）与VMW，村政府和居民进行了识别的促进者和服务利用的挑战。数据分析的基础上获得服务的五个领域的概念框架：认识，可及性，住宿，可用性和可接受性。在我们的研究地点中，影响使用VMW服务的因素包括：传播活动的性质及其到达不同人群的能力;村庄地形和不断变化的道路基础设施; VMW参与其他社区角色和活动;症状出现后对疾病类型的看法;全面诊断和护理的需要;对VMW作为医疗提供者的地位的看法; VMW任命的长度。这项研究强调了复杂性和多样性的背景因素，可能会影响社区卫生计划的吸收。与其他国家一样，柬埔寨继续使用非专业保健工作者提供诊断和治疗服务，有可能产生巨大的保健和经济影响。然而，应进一步考虑不同类别居民和不同执行情况下的获取问题。此外，全面绘制疾病流行病学、道路基础设施和获得服务的地理位置的变化图，对于为这一领域的政策制定提供信息至关重要。本文的在线版本（doi：10.1186/s12913-017-2282-4）包含补充材料，可供授权用户使用。
There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas. Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability. Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment. This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area. The online version of this article (doi:10.1186/s12913-017-2282-4) contains supplementary material, which is available to authorized users.