Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study
复制标题
DOI：
10.1186/s12913-017-2804-0
复制
发表时间：
2017-12-20
影响因子：
2.8
通讯作者：
Kim, Young Mi
中科院分区：
文献类型：
--
作者：
Desta, Firew Ayalew;Shifa, Girma Temam;Kim, Young Mi
背景：卫生推广工作者(HEWS)是埃塞俄比亚初级卫生保健系统的一线卫生工作者。联邦卫生部正在寻求升级和增加HEWS的数量，特别是在偏远地区，并解决对HEWS职前教育和实践的担忧。本研究的目的是找出农村卫生与健康教育实践中的差距，并对其培训和实践范围提出建议。方法：采用横断面描述性任务分析的方法，评估农村卫生与健康教育实践6个月至5年的工作。从埃塞俄比亚五个地区的100个卫生站邀请了100名参与者。HEWS自我报告了62项任务：频率、关键程度(重要性)、学习任务的地方以及执行任务的能力。对每个变量计算描述性统计数据，包括频率和百分比。检查任务组合，以确定不经常执行或HEW准备不足的任务。结果：共有82名农村HEW参与研究。几乎所有的HEWS都将每一项任务评为对个人和公共健康结果至关重要的任务。平均而言，51.5%~57.4%的妇女报告在职前教育之外学习卫生和环境卫生任务、疾病预防和控制任务、家庭健康任务、健康教育和沟通任务，主要是通过在职和在职培训。超过一半的人力资源部报告说，他们很少执行某些关键任务，包括管理设施的供应、库存和维护，以及冷链系统的管理。几乎所有(95.7-97.2%)的健康教育工作者认为自己能胜任和熟练地完成所有计划领域的任务。结论：健康教育工作者在职前教育中对其工作范围内的所有工作都准备不足。许多人通过在职或在职培训学会了任务，有些任务根本没有学到。作为预期的HEW实践的一部分的一些任务不经常执行，这可能会降低健康推广计划为社区提供预防和基本治疗性医疗服务的有效性。调查结果应提醒政策制定者，有必要审查职业健康教育服务的实践范围，更新职前教育课程，并确定在职培训模块的优先顺序。
Background: Health extension workers (HEWs) are the frontline health workers for Ethiopia's primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs' pre-service education and practices. The aim of this study was to identify gaps in HEWs' practices and recommend changes in their training and scope of practice.Methods: A cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared.Results: A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%-57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7-97.2%) perceived themselves as competent and proficient in performing tasks in all program areas.Conclusion: HEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs' scope of practice, update pre-service education curricula and prioritize in-service training modules.