Producing effective knowledge agents in a pluralistic environment: What future for community health workers?
Producing effective knowledge agents in a pluralistic environment: What future for community health workers?
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DOI：
10.1016/j.socscimed.2008.01.046
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发表时间：
2008-05-01
影响因子：
5.4
通讯作者：
Chowdhury, A. Mushtaque R.
中科院分区：
文献类型：
--
作者：
Standing, H.;Chowdhury, A. Mushtaque R.
本文关注的是贫困人口如何能够获得信任，合格的知识和服务，在日益多元化的卫生系统，不受管制的市场占主导地位的健康知识和服务。这里的“不受管制”一词来自关于低收入国家市场发展的文献，指的是国家缺乏对正式法律和规章的执行。我们通过过去几十年来社区卫生工作者不断变化的角色和命运来探讨这个问题，并询问他们在未来可以发挥什么样的作用。在许多情况下，社区保健人员被用来填补缺乏更熟练人员的服务缺口。它们还在广泛的社区发展中发挥了更具变革性的作用。我们探讨了自1980年代以来方案减少的原因。利用孟加拉国的具体经验，该文件考虑了可以从过去的成功和失败中吸取什么教训，以及需要改变什么来迎接21世纪世纪卫生系统的挑战。这些挑战是在多元化环境中建立信誉和合法性以及制定可持续生计战略的挑战。文章最后讨论了四个潜在的模式，以社区为基础的卫生代理人不一定是排他性的：一个通用代理人，是密切联系在一起的一个有信誉的监督机构;一个专家干部工作与特定的健康状况;一个专家倡导者;和一个动员者或促进者谁可以调解用户和健康市场之间。(C)2008爱思唯尔有限公司保留所有权利。
This paper is concerned with how poor populations can obtain access to trusted, competent knowledge and services in increasingly pluralistic health systems where unregulated markets for health knowledge and services dominate. The term "unregulated" here derives from the literature on the development of markets in low income countries and refers to the lack of state enforcement of formal laws and regulations. We approach this question of access through the changing roles and fortunes of community health workers over the last few decades and ask what kind of role they can be expected to play in the future. Community based health agents have been used in many settings as a way of filling gaps in service provision where more skilled personnel are not available. They have also fulfilled a more transformative role in broad based community development.We explore the reasons for the decline of programmes from the 1980s onwards. Using the specific experience of Bangladesh, the paper considers what lessons can be learned from past successes and failures and what needs to change to meet the challenges of 21st century health systems. These challenges are those of establishing credibility and legitimacy in a pluralistic environment and creating a sustainable livelihood strategy. The article concludes with a discussion of four potential models of community based health agents which are not necessarily exclusive: a generic agent that is closely linked to a reputable supervisory agency; a specialist cadre working with particular health conditions; an expert advocate; and a mobiliser or facilitator who can mediate between users and health markets. (C) 2008 Elsevier Ltd. All rights reserved.