Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs.
Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs.
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DOI：
10.9745/ghsp-d-13-00140
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发表时间：
2014-02
期刊：
影响因子：
--
通讯作者：
Weaver M
中科院分区：
文献类型：
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作者：
Brunie A;Wamala-Mucheri P;Otterness C;Akol A;Chen M;Bufumbo L;Weaver M
在乌干达，使用志愿者的社区卫生计划应侧重于加强支持系统，以解决运输和缺货问题，并改善与卫生结构的联系，同时加强努力认可、地位和新技能的获取。在乌干达，使用志愿者的社区卫生计划应侧重于加强支持系统，以解决运输和缺货问题，并改善与卫生结构的联系，同时加强努力认可、地位和新技能的获取。面对全球卫生工作者短缺的情况，社区卫生工作者 (CHW) 是为服务不足的人群提供重要的卫生保健服务的战略。在乌干达，基于社区的项目经常利用志愿社区卫生工作者在农村地区推广包括计划生育在内的服务。本研究考察了乌干达 3 个计划生育项目中与社区卫生工作者动机和活动水平相关的因素。数据收集于 2011 年 7 月至 8 月期间，来源包括对 183 名活跃社区卫生工作者的调查、对 43 名活跃社区卫生工作者和 5 名前社区卫生工作者的深度访谈 (IDI) 以及服务统计记录。调查包括离散选择实验（DCE），以得出社区卫生工作者对选定项目投入的偏好。服务统计数据显示，在数据收集之前的 3 个月内，每个接受调查的社区卫生工作者平均拜访了计划生育客户 56 次。在调查中，新技能和知识、对社区的感知影响以及地位的提高是社区卫生工作者报告的工作的主要积极方面；与运输有关的主要挑战。多变量分析确定了社区卫生工作者高度活跃与不活跃（就客户拜访次数而言）的 2 个相关因素：遇到供应问题以及不与同事合作。 DCE 的结果显示，提供包括 T 恤、徽章和自行车在内的包裹是社区卫生工作者首选的项目输入，其次是手机（无通话时间）。 IDI 数据强化并补充了这些定量发现。社会声望、社会责任和对其他机会的渴望是重要的动力，而主要挑战则与运输和商品缺货有关。社区卫生工作者想要获得更好的补偿有着复杂的动机，包括抵消时间和交通成本、养家糊口以及对自己的努力感到赞赏。乌干达和其他地方的志愿者社区卫生工作者计划需要仔细考虑财务和非财务投入的适当组合，以获得最佳结果。
In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills. In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills. In the face of global health worker shortages, community health workers (CHWs) are an important health care delivery strategy for underserved populations. In Uganda, community-based programs often use volunteer CHWs to extend services, including family planning, in rural areas. This study examined factors related to CHW motivation and level of activity in 3 family planning programs in Uganda. Data were collected between July and August 2011, and sources comprised 183 surveys with active CHWs, in-depth interviews (IDIs) with 43 active CHWs and 5 former CHWs, and service statistics records. Surveys included a discrete choice experiment (DCE) to elicit CHW preferences for selected program inputs. Service statistics indicated an average of 56 visits with family planning clients per surveyed CHW over the 3-month period prior to data collection. In the survey, new skills and knowledge, perceived impact on the community, and enhanced status were the main positive aspects of the job reported by CHWs; the main challenges related to transportation. Multivariate analyses identified 2 correlates of CHWs being highly vs. less active (in terms of number of client visits): experiencing problems with supplies and not collaborating with peers. DCE results showed that provision of a package including a T-shirt, badge, and bicycle was the program input CHWs preferred, followed by a mobile phone (without airtime). IDI data reinforced and supplemented these quantitative findings. Social prestige, social responsibility, and aspirations for other opportunities were important motivators, while main challenges related to transportation and commodity stockouts. CHWs had complex motivations for wanting better compensation, including offsetting time and transportation costs, providing for their families, and feeling appreciated for their efforts. Volunteer CHW programs in Uganda and elsewhere need to carefully consider appropriate combinations of financial and nonfinancial inputs for optimal results.