Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana.
Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana.
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DOI：
10.9745/ghsp-d-12-00012
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Schmitt ML
中科院分区：
文献类型：
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作者：
Awoonor-Williams JK;Sory EK;Nyonator FK;Phillips JF;Wang C;Schmitt ML
最初的CHPS模式将护士部署到社区，并聘请当地领导人，大大降低了儿童死亡率和生育率。关键的推广经验：(1)将护士安置在家庭地区而不是家庭村庄，(2)针对每个地区进行独特的适应，(3)调动当地资源，(4)制定共同的项目愿景，以及(5)进行“交流”，以便发起行动的工作人员能够观察在另一个环境中工作的模式，在当地试验该方法，并根据所学到的经验教训进行推广。最初的CHPS模式将护士部署到社区，并聘请当地领导人，大大降低了儿童死亡率和生育率。关键的推广经验：(1)将护士安置在家庭地区而不是家庭村庄，(2)针对每个地区进行独特的适应，(3)调动当地资源，(4)制定共同的项目愿景，以及(5)进行“交流”，以便发起行动的工作人员能够观察在另一个环境中工作的模式，在当地试验该方法，并根据所学到的经验教训进行推广。加纳以社区为基础的卫生规划和服务(CHPS)倡议被设想为一项国家计划，将初级卫生保健服务从地区卫生中心搬迁到方便的社区地点。该倡议分4个阶段启动。首先，在3个村庄进行了试点，以制定适当的战略。其次，该方法在析因试验中进行了测试，结果表明，社区护理可以在短短3年内将儿童死亡率降低一半。然后，启动了一项复制实验，以澄清为实施第四阶段也是最后阶段--全国推广--而开展的适当活动。本文讨论了加纳上东部地区(UER)的CHPS进展情况，尽管那里的经济、生态和社会环境极其严峻，但扩大规模的步伐比该国其他9个地区快得多。UER采用了促进扩大规模的5项战略：(1)从所在地区招聘护士，以提高工人士气和文化根基，同时与村庄社区保持一定的社会距离，以确保客户的机密性，特别是在计划生育方面；(2)确定CHPS规划的优先顺序，并在管理会议上持续审查，以对倡议的方法进行必要的修改；(3)社区参与和向当地政客宣传，以筹集资源来资助启动费用；(4)卫生行政领导人对CHPS达成共同和一致的愿景，以确保适当的资源和对该倡议的承诺；以及(5)新的和先进的社区卫生计划实施者之间的知识交流访问，以促进地区内和地区之间的学习和推广。
The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct “exchanges” so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned. The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct “exchanges” so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned. Ghana's Community-Based Health Planning and Service (CHPS) initiative is envisioned to be a national program to relocate primary health care services from subdistrict health centers to convenient community locations. The initiative was launched in 4 phases. First, it was piloted in 3 villages to develop appropriate strategies. Second, the approach was tested in a factorial trial, which showed that community-based care could reduce childhood mortality by half in only 3 years. Then, a replication experiment was launched to clarify appropriate activities for implementing the fourth and final phase—national scale up. This paper discusses CHPS progress in the Upper East Region (UER) of Ghana, where the pace of scale up has been much more rapid than in the other 9 regions of the country despite exceedingly challenging economic, ecological, and social circumstances. The UER employed 5 strategies that facilitated scale up: (1) nurse recruitment from their home districts to improve worker morale and cultural grounding, balanced with some social distance from the village community to ensure client confidentiality, particularly regarding family planning use; (2) prioritization of CHPS planning and continuous review in management meetings to make necessary modifications to the initiative's approach; (3) community engagement and advocacy to local politicians to mobilize resources for financing start-up costs; (4) a shared and consistent vision about CHPS among health administration leaders to ensure appropriate resources and commitment to the initiative; and (5) knowledge exchange visits between new and advanced CHPS implementers to facilitate learning and scale up within and between districts.