Community case management of malaria: exploring support, capacity and motivation of community medicine distributors in Uganda.
Community case management of malaria: exploring support, capacity and motivation of community medicine distributors in Uganda.
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DOI：
10.1093/heapol/czu033
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发表时间：
2015-05
影响因子：
3.2
通讯作者：
Staedke SG
中科院分区：
文献类型：
--
作者：
Banek K;Nankabirwa J;Maiteki-Sebuguzi C;DiLiberto D;Taaka L;Chandler CI;Staedke SG
在乌干达，针对发热儿童的社区服务正在从通过家庭发热管理（HBMF）计划使用抗疟疾药物治疗发热扩展到通过综合社区病例管理（ICCM）治疗疟疾、腹泻和肺炎。为了了解可用的支持水平，以及社区卫生工作者提供这些扩展服务的能力和动机，我们采访了社区医药分销商（CMD），他们在ICCM通过前不久参与了托罗罗区的HBMF计划。方法2009年10月至2010年4月，采用方便抽样的方法，抽取100名社区医务人员进行调查。调查包括问卷，以收集有关CMD的工作经验和评估发烧病例管理的知识，并深入访谈，以讨论作为CMD的经验，包括动机，监督和与社区的关系。对所有问卷和知识评估进行了分析。为100次访谈中的每一次制作了简要联系表，并选择了35次进行完整的转录和分析。结果社区医疗机构面临着患者负担重、知识和监督有限、补偿不足、药品和供应有限以及社区成员不切实际的期望等多重挑战。CMD描述了出于利他主义的动机志愿服务;然而，他们的工作的主要好处似乎与“成为重要人物”有关，有可能为自己和家人提供社会流动性，包括与卫生工作者建立关系。在调查时，由于社区和卫生系统的支持有限，超过一半的CMD感到动力不足。结论社区卫生工作者计划依赖于社区和卫生系统的支持，以可持续地运作。当这种支持福尔斯不足时，志愿者的积极性就会减弱。如果要使形式日益复杂的社区干预成为改善获得初级卫生保健的解决办法，就需要更多地关注个人的动机，以及加强卫生系统支助的方法。
Background In Uganda, community services for febrile children are expanding from presumptive treatment of fever with anti-malarials through the home-based management of fever (HBMF) programme, to include treatment for malaria, diarrhoea and pneumonia through Integrated Community Case Management (ICCM). To understand the level of support available, and the capacity and motivation of community health workers to deliver these expanded services, we interviewed community medicine distributors (CMDs), who had been involved in the HBMF programme in Tororo district, shortly before ICCM was adopted. Methods Between October 2009 and April 2010, 100 CMDs were recruited to participate by convenience sampling. The survey included questionnaires to gather information about the CMDs’ work experience and to assess knowledge of fever case management, and in-depth interviews to discuss experiences as CMDs including motivation, supervision and relationships with the community. All questionnaires and knowledge assessments were analysed. Summary contact sheets were made for each of the 100 interviews and 35 were chosen for full transcription and analysis. Results CMDs faced multiple challenges including high patient load, limited knowledge and supervision, lack of compensation, limited drugs and supplies, and unrealistic expectations of community members. CMDs described being motivated to volunteer for altruistic reasons; however, the main benefits of their work appeared related to ‘becoming someone important’, with the potential for social mobility for self and family, including building relationships with health workers. At the time of the survey, over half of CMDs felt demotivated due to limited support from communities and the health system. Conclusions Community health worker programmes rely on the support of communities and health systems to operate sustainably. When this support falls short, motivation of volunteers can wane. If community interventions, in increasingly complex forms, are to become the solution to improving access to primary health care, greater attention to what motivates individuals, and ways to strengthen health system support are required.
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影响因子：
3
作者：
Hawkes M;Katsuva JP;Masumbuko CK
通讯作者：
Masumbuko CK
影响因子：
3
作者：
Chanda, Pascalina;Hamainza, Busiku;Pagnoni, Franco
通讯作者：
Pagnoni, Franco
影响因子：
4.5
作者：
Lehmann, Uta;Van Damme, Wim;Sanders, David
通讯作者：
Sanders, David
DOI：
10.4269/ajtmh.2012.11-0665
发表时间：
2012-11-01
影响因子：
3.3
作者：
Callaghan-Koru, Jennifer A.;Hyder, Adnan A.;Bryce, Jennifer
通讯作者：
Bryce, Jennifer
影响因子：
3.3
作者：
Kager, PA
通讯作者：
Kager, PA