Improving local health through community health workers in Cambodia: challenges and solutions.
Improving local health through community health workers in Cambodia: challenges and solutions.
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DOI：
10.1186/s12960-017-0262-8
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发表时间：
2018-01-06
影响因子：
4.5
通讯作者：
Khatri R
中科院分区：
文献类型：
--
作者：
Ozano K;Simkhada P;Thann K;Khatri R
社区卫生志愿者（CHW）是公共卫生系统和社区之间的重要纽带。柬埔寨的“健康社区参与政策”将社区卫生工作者视为当地健康促进的关键，也是地区卫生中心与社区之间的关键纽带。然而，在柬埔寨，对社区卫生工作者面临的挑战以及确定优化其绩效所需的研究有限。本研究探讨了柬埔寨农村社区卫生工作者对实施卫生举措时面临的挑战的看法。采用定性方法来获取桔井省和蒙多基里省社区卫生工作者的经验。在蒙多基里省与社区卫生工作者进行了两次参与式焦点小组，并在桔井省进行了十次半结构化访谈。这两项研究的结果都被用来确定共同的主题。参与者是来自高棉农村和穆斯林社区的男性和女性社区卫生工作者，与七个不同的地区卫生中心有联系。调查结果表明，社区卫生工作者定期向社区提供健康促进活动。然而，系统、个人和社区参与方面的挑战阻碍了他们有效运作的能力。其中包括当地政府的领导和支持最少、专注于垂直健康计划的不定期培训、资源不足、缺乏专业身份以及实现社区成员行为改变的挑战。此外，CHW 计划的实施方式较为分散，很大程度上受到外部援助目标的影响。然而，当咨询时，社区卫生工作者展示了他们针对挑战和障碍制定切合实际的解决方案的能力。柬埔寨社区卫生工作者项目的实施分散，意味着政府所有权极少。再加上缺乏明确的核心培训计划或足够的资源，社区卫生工作者无法发挥其潜力。社区卫生工作者对于如何改善其角色以及社区成员的健康有着积极而现实的想法。社区卫生工作者有机会在支持性环境中分享学习和发展想法，这将有利于健康倡议。
Volunteer community health workers (CHWs) are an important link between the public health system and the community. The ‘Community Participation Policy for Health’ in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.
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