Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso
Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso
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DOI：
10.1016/j.socscimed.2014.11.053
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发表时间：
2015-01-01
影响因子：
5.4
通讯作者：
Ridde, Valery
中科院分区：
文献类型：
--
作者：
Druetz, Thomas;Kadio, Kadidiatou;Ridde, Valery
在大多数撒哈拉以南非洲国家，利用社区保健工作者进行及时治疗的做法越来越受欢迎。他们的业绩是一个关键挑战，因为根据具体情况，业绩差异很大，同时又与案件管理战略的效力密切相关。是什么决定了社区卫生工作者的绩效仍在争论之中。基于现实主义的观点，最近的一项系统综述假设，几种机制与良好的绩效和成功的社区干预有关。为了对这一假设进行实证研究，并将其与现实相结合，我们在布基纳法索进行了一项研究，2010年，卫生当局实施了一项国家计划，引入了疟疾的社区病例管理。目的是评估社区卫生工作者的机制的存在，并探讨环境因素的影响。在2012年，我们进行了半结构化的采访，35个社区卫生工作者从一个研究领域建立在两个类似的卫生区（卡亚和佐尔戈）。结果表明，他们认为大多数的机制，除了被重视的卫生系统和问责制的村民成员的感觉。分析表明，药品缺货和社区卫生工作者过去的经验同时影响几种机制的存在。政府和非政府干预措施之间缺乏整合以及整体社会经济贫困也被认为影响了这些机制的存在。通过关注社区卫生工作者的代理，本研究将背景的影响重新置于绩效辩论的核心，并提出了他们在扩大抗疟疾项目中表现良好的能力的问题。(C)2014作者爱思唯尔有限公司出版
The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers' performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions. In order to empirically investigate this hypothesis and confront it with the reality, we conducted a study in Burkina Faso, where in 2010 health authorities have implemented a national program introducing community case management of malaria. The objective was to assess the presence of the mechanisms in community health workers, and explore the influence of contextual factors. In 2012, we conducted semi-structured interviews with 35 community health workers from a study area established in two similar health districts (Kaya and Zorgho). Results suggest that they perceive most of the mechanisms, except the sense of being valued by the health system and accountability to village members. Analysis shows that drug stock-outs and past experiences of community health workers simultaneously influence the presence of several mechanisms. The lack of integration between governmental and non-governmental interventions and the overall socio-economic deprivation, were also identified as influencing the mechanisms' presence. By focusing on community health workers' agency, this study puts the influence of the context back at the core of the performance debate and raises the question of their ability to perform well in scaled-up anti-malaria programs. (C) 2014 The Authors. Published by Elsevier Ltd.