How a Technical Agency Helped Scale Up a Community Health Worker Program: An Exploratory Study in Chhattisgarh State, India
How a Technical Agency Helped Scale Up a Community Health Worker Program: An Exploratory Study in Chhattisgarh State, India
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DOI：
10.1080/23288604.2016.1148802
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发表时间：
2016-01-01
影响因子：
4.1
通讯作者：
Sheikh, Kabir
中科院分区：
文献类型：
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作者：
Nambiar, Devaki;Sheikh, Kabir
印度全民保健覆盖的目标强调了社区卫生行动需要扩大规模。恰蒂斯加尔邦的米塔宁项目是少数几个在社区项目中取得成功的项目之一，该项目在整个州的规模上进行设计和维护(覆盖近2000万人)。对扩大干预措施的评估通常会检查人群的健康结果，较少强调项目的成功或失败。为了解决这一知识差距，我们进行了一项定性研究，以探索国家卫生资源中心(SHRC)这一国家技术机构在2002年开始的十年期间扩大恰蒂斯加尔邦米塔宁卫生工作者计划的作用。我们与政策/项目开发者、促进者和培训者、社区卫生工作者以及公民社会的代表进行了观察、政策文献回顾、深度访谈和焦点小组讨论。数据分析遵循定性数据分析的归纳方法，数据以民间理论的形式组织，包括相互关联的背景、机制和结果，反映了人权委员会在扩大该州社区健康行动方面的经验。第一种民间理论将新国家形成的有利背景与人权委员会的多元化和多利益攸关方治理机制以及避免公开的政治赞助方案联系起来，通过多次行政和政治过渡促进方案的可持续性。第二种民间理论阐述了注重公平的机制，如将方案与当地重要的、针对边缘化社区的跨部门议程联系起来，以及关注女性一线工人的职业发展轨迹，如何在土著部落少数群体和妇女被广泛排除在社会和政治主流之外的更广泛的背景下，为这些工人组织和要求谋生权利创造了空间。这些探索性的发现表明，人权委员会的多元化治理结构，加上一套独特的背景战略，如何有助于该方案的长盛不衰以及女性社区卫生工作者的职业成长和机会，为其他低收入和中等收入国家的决策者提供了经验教训。
India's goal of universal health coverage underscores the need for scale in community action for health. Among the few successes in community programs is Chhattisgarh's Mitanin Program, designed and maintained at the scale of the entire state (covering almost 20 million). Evaluations of scaled-up interventions typically examine population health outcomes, placing less emphasis on how programs succeed or fail. To address this knowledge gap, we undertook a qualitative research study to explore the role of the State Health Resource Centre (SHRC), a state technical agency, in scaling up Chhattisgarh's Mitanin health worker program over a ten-year period commencing in 2002. We undertook observation, policy documentary review, in-depth interviews, and focus group discussions with policy/program developers, facilitators and trainers, community health workers, and representatives of civil society. Data analysis followed an inductive approach of qualitative data analysis and data were thematically organized in the form of folk theories including interlinked contexts, mechanisms, and outcomes reflecting the experience of the SHRC in scaling up community action for health in the state. The first folk theory links the enabling context of the formation of a new state with mechanisms of pluralistic and multistakeholder governance of the SHRC and avoidance of overt political patronage of the program, contributing to the sustainability of the program through multiple administrative and political transitions. The second folk theory elaborates how equity-focused mechanisms such as linking the program to locally important, intersectoral agendas for marginalized communities and attentiveness to career trajectories of female frontline workers created space for these workers to organize and demand livelihood rights against a broader context where the indigenous tribal minority and women are widely excluded from the social and political mainstream. These exploratory findings illustrate how the pluralistic governance structure of the SHRC, coupled with a set of unique contextual strategies, contributed to the longevity of the program and professional growth and opportunities for female community health workers, with lessons for other low- and middle-income country decision makers.