Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti
Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti
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DOI：
10.1097/01.aids.0000366084.75945.c9
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发表时间：
2010-01-01
期刊：
影响因子：
3.8
通讯作者：
Ivers, Louise C.
中科院分区：
文献类型：
--
作者：
Jerome, Gregory;Ivers, Louise C.
背景：海地是面临医疗保健人力资源严重短缺的国家之一。在海地农村，在扩大艾滋病毒服务的过程中，需要每天长期坚持用药治疗艾滋病毒和结核病，这最初是招募社区卫生工作者的驱动因素。随着时间的推移，他们的作用变得更加广泛。这项定性研究评估了社区卫生工作者在海地农村地区艾滋病和非艾滋病相关服务中在整个卫生系统中的作用，并调查了其工作面临的挑战和促进因素。方法：我们采用定性方法，包括焦点小组讨论和小组访谈，在海地农村的四个地点。根据标准的人种学方法对462名CHW的数据进行了主题和内容分析。结果：CHW为广泛的初级卫生服务和非艾滋病毒相关活动做出了贡献。来自社区的认可、地位、对为他人福祉作出贡献的满足感和报酬是促进他们履行工作的因素。挑战包括没有足够的材料来应对实地的障碍，在他们的活动中缺乏诊断和治疗角色，高工作量，以及对持续培训和更高工资的渴望。结论：最初聘请CHW进行艾滋病毒护理是海地农村卫生系统的重要组成部分，无论是艾滋病毒相关服务还是初级卫生保健服务。社区卫生和妇女方案在建设卫生人力能力方面具有重要潜力，从而有助于加强整个卫生系统。必须注意适当的报酬、培训和提供材料。(C)2010年Wolters Kluwer Health垂直酒吧Lippincott Williams&Wilkins
Background: Haiti is among the countries facing serious shortages in human resources for healthcare. In rural Haiti, the need for daily, long-term adherence to medication for HIV and TB was initially the driving factor for recruitment of community health workers (CHW) during scale-up of HIV services. Their role became broader over time. This qualitative study evaluated the role of CHW in the health system as a whole in both HIV and non-HIV-related services in rural Haiti and investigated the challenges and facilitating factors for their work.Methods: We used qualitative methods including focus group discussions and group interviews in four sites in rural Haiti. Data from 462 CHW were analysed for themes and content according to standard ethnographic methods.Results: CHW contributed to a wide range of primary health services and non-HIV-related activities. Recognition from the community, status, satisfaction of contributing to the well-being of others and remuneration were facilitating factors to performing their work. Challenges included insufficient materials to cope with the obstacles on the ground, lack of diagnostic and treatment roles in their activities, high work load, and desire for ongoing training and a higher salary.Conclusion: CHW initially hired for HIV care represent an important part of the health system in rural Haiti in both HIV-related and primary healthcare services. CHW programmes have important potential for building capacity in the health workforce and thereby contributing to strengthening of the health system as a whole. Attention must be paid to adequate remuneration, training and provision of materials. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins