Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?
Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?
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DOI：
10.15171/ijhpm.2018.53
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发表时间：
2018-10-01
影响因子：
3.5
通讯作者：
Baum, Fran
中科院分区：
文献类型：
--
作者：
Javanparast, Sara;Windle, Alice;Baum, Fran
背景：在低收入和中等收入国家，社区卫生工作者（CHWs）被证明是非常有效的，有许多成功的大规模项目的例子。人们对在高收入国家部署卫生保健项目越来越感兴趣，以解决处于不利地位的人口群体在医疗保健获取和结果方面的不平等。这项研究首次考察了澳大利亚卫生保健项目的范围和潜在价值，以及将卫生保健项目纳入卫生系统所面临的挑战。探讨卫生保健中心改善卫生公平的潜力。方法：检索学术文献和灰色文献，以检查现有CHW在澳大利亚初级卫生保健系统中的作用。对包括政策制定者、项目经理和从业人员在内的11人进行了半结构化的电话访谈，以加深对政策和实践的理解。结果：澳大利亚关于卫生工作者的文献很少，但结合访谈数据表明，卫生工作者发挥了广泛的作用，包括教育、宣传和基本临床服务，并与各种处于不利地位的社区合作。卫生保健员使用了许多（在某种程度上是不一致的）术语，反映了卫生保健员采用的各种策略、他们所服务的社区的特点以及他们所处理的卫生问题。在澳大利亚，土著卫生工作者的作用得到了比较充分的认识、理解和记录，有证据表明他们为克服文化障碍和改善获得卫生服务的机会作出了贡献。少数民族卫生工作者协助解决语言障碍，提高服务的文化适宜性。卫生保健员被广泛认为是被广泛接受和有价值的，作为通往社区的可信赖的“桥梁”，促进获得卫生服务。在“健康”被认为包括对社会决定因素的行动和服务模式等级较低的情况下，它们最有效。短期的资助模式以及缺乏专业资格和认可是卫生工作者面临的挑战。结论：卫生保健中心在澳大利亚初级卫生保健（PHC）的各种情况下发挥着一系列作用，其共同的、有价值的目的是促进边缘化社区获得服务和信息。卫生保健中心提供了一个很有希望的机会，可以提高弱势社区获得初级保健服务的公平性，特别是在慢性病不断增加的情况下。
Background: Community Health Workers (CHWs) are proven to be highly effective in low-and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored.Methods: Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policy-makers, program managers and practitioners, to develop an understanding of policy and practice.Results: Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted 'bridge' to communities. They work best where 'health' is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter.Conclusion: CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.