Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review.
Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review.
复制标题
DOI：
10.1093/heapol/czu126
复制
发表时间：
2015-11
影响因子：
3.2
通讯作者：
de Koning KA
中科院分区：
文献类型：
--
作者：
Kok MC;Dieleman M;Taegtmeyer M;Broerse JE;Kane SS;Ormel H;Tijm MM;de Koning KA
社区卫生工作者（chw）日益被认为是实现中低收入国家公共卫生目标所需卫生人力的一个组成部分。影响CHW性能的因素很多。我们进行了一项系统的回顾，以确定干预设计的相关因素影响健康护理人员的表现。我们系统地检索了六个数据库，以获得定量和定性研究，其中包括在中低收入国家从事促进、预防或治疗性初级卫生服务的卫生工作者。140项研究符合纳入标准，进行了质量评估和双读，以提取与CHW方案设计相关的数据。一个包含影响CHW绩效因素和CHW绩效特征（如动机和胜任力）的初步框架指导了文献检索和综述。财务和非财务激励的混合，对卫生保健人员来说是可预测的，被发现是提高绩效的有效策略，特别是那些有多重任务的卫生保健人员。基于绩效的财务激励有时会导致忽略无报酬的任务。在某些情况下，包括频繁监督和持续培训的干预设计可以提高CHW的表现。监督和培训经常被认为是促进因素，但很少有研究测试哪种方法效果最好或如何最好地实施这些方法。在社区和卫生系统中嵌入卫生工作者可以减少工作量并提高卫生工作者的可信度。明确界定卫生保健员的角色，并在卫生系统的不同层次之间引入明确的沟通程序，可加强卫生保健员的绩效。在设计社区卫生规划时，应考虑到在可比环境中提高卫生保健工作绩效的因素。需要进行更多的干预研究，为最有效的培训和监督机制建立更好的证据基础，并进行定性研究，为政策制定者制定卫生保健干预措施提供信息。
Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.