Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects
Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects
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DOI：
10.1093/heapol/czn006
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发表时间：
2008-05-01
影响因子：
3.2
通讯作者：
van Rensburg, Dingie
中科院分区：
文献类型：
--
作者：
Schneider, Helen;Hlophe, Hlengiwe;van Rensburg, Dingie
在1980年代对国家社区卫生工作者方案的热情下降之后，这些方案在全球重新出现，特别是在艾滋病毒方面。本文探讨了南非的情况下，有一个快速增长的一系列外行工人（家庭为基础的照顾者，外行辅导员，DOT的支持者等）。这主要是为了应对艾滋病毒预算和方案的扩大，最近是抗逆转录病毒疗法的推出。2004年，引入了社区卫生工作者一词，作为卫生部门所有社区/非专业工作者的总括概念，并通过了一项国家社区卫生工作者政策框架。我们总结了新兴的国家CHW方案在南非，其中包括除其他外，他们的整合到一个国家的公共工程方案和使用非政府组织作为中介的主要特点。然后，我们报告在一个省，自由州的经验。在2年的时间里（2004 - 06），我们对该省首批提供艾滋病综合服务（包括抗逆转录病毒治疗）的16家基层卫生保健机构进行了三次连续访问。每次访问时，我们都对社区卫生工作者的人数和培训进行了清点，并有两次对社区卫生工作者进行了基于机构的小组访谈（分别涉及231名和182名参与者）。我们还采访了负责监督CHW的诊所护士。从这一评价中，我们得出结论，在南非卫生系统中有大量的社区卫生福利机构。然而，这一基础设施与以前的国家CHW方案有许多共同的管理挑战（稳定性、认可、志愿者与工人、与专业人员的关系），我们根据新的政策背景讨论了可持续性的前景。
After a decline in enthusiasm for national community health worker (CHW) programmes in the 1980s, these have re-emerged globally, particularly in the context of HIV. This paper examines the case of South Africa, where there has been rapid growth of a range of lay workers (home-based carers, lay counsellors, DOT supporters etc.) principally in response to an expansion in budgets and programmes for HIV, most recently the rollout of antiretroviral therapy (ART). In 2004, the term community health worker was introduced as the umbrella concept for all the community/lay workers in the health sector, and a national CHW Policy Framework was adopted. We summarize the key features of the emerging national CHW programme in South Africa, which include amongst others, their integration into a national public works programme and the use of non-governmental organizations as intermediaries. We then report on experiences in one Province, Free State. Over a period of 2 years (200406), we made serial visits on three occasions to the first 16 primary health care facilities in this Province providing comprehensive HIV services, including ART. At each of these visits, we did inventories of CHW numbers and training, and on two occasions conducted facility-based group interviews with CHWs (involving a total of 231 and 182 participants, respectively). We also interviewed clinic nurses tasked with supervising CHWs. From this evaluation we concluded that there is a significant CHW presence in the South African health system. This infrastructure, however, shares many of the managerial challenges (stability, recognition, volunteer vs. worker, relationships with professionals) associated with previous national CHW programmes, and we discuss prospects for sustainability in the light of the new policy context.