Implementing comprehensive, integrated, community-based health care for vulnerable communities in South Africa: An evidence-informed model

为南非弱势社区实施全面、综合、基于社区的医疗保健：循证模型

• 批准号: MR/N015908/1
• 负责人: Jane Goudge
• 金额: $ 85.32万
• 依托单位: University of the Witwatersrand
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN015908%2F1
• 关键词: Implementing; comprehensive; integrated; community; based

In low and middle income countries across the world many poor communities have little access to health care. Providing health care is a challenge as the available national resources for health care is limited. People in these communities suffer from infectious diseases such as TB and HIV and from long term health conditions such as diabetes and high blood pressure. In poor communities many people with these conditions do not know they have them. Even if aware of their health condition, people may be unable to access the right treatment. Community Health Workers (CHWs) are local people trained to visit households in their community to identify people who are unwell, help them gain access to health care and support them in treatment. Existing CHW programmes have been successful in tackling infectious disease, as well as improving maternal and child health, but programmes usually focus on a limited range of health problems and do not cater for people with multiple problems. This project will design and evaluate a comprehensive integrated CHW programme that aims to identify and support the treatment of all types of ill health experienced in poor communities.Research has demonstrated that CHW programmes are successful if there is good programme design, management, integration with the health system, and a good 'fit' with the community. However, there is insufficient evidence on how to operationalise these attributes for a successful comprehensive, integrated CHW service. Policy makers and service providers want to know how many CHWs are needed and at what cost, how are they best supervised, what is the best balance in terms of training, scope of work and household coverage, and how can they remain responsive to their community yet integrated with the health system? We aim to identify the key features of an evidence-informed CHW service model and the lessons for scale up.South Africa is a middle income country with poor communities who have limited access to health care. The national Government is committed to strengthening primary care through the provision of community-based care by CHWs for these communities. The project will be undertaken in Sedibeng District, Gauteng Province of South Africa. Our collaborator, the District manager, is currently piloting three designs of comprehensive, integrated CHW programme, with different CHW-to-household ratios and different levels of access to supervision for the CHWs. Our objectives are to: 1) observe and interview existing CHW teams to understand how they work, and undertake a community survey to assess coverage,2) using what we learn, in consultation with local, provincial and national stakeholders and international experts, to design an evidence informed CHW model then, 3) implement the model in two communities, 4) assess the impact by undertaking a survey of the community before and 15 months after implementation, as well as observation and interviews, and 5) to inform policy, implementation and practice.The project results will inform the national roll out of these programmes by the South Africa Department of Health. By providing sufficient detail about the intervention, its context and evaluation, we expect governments internationally to be able to assess the applicability of the evidence-informed CHW model for their contexts and any adaptations needed. This will inform the use of resources for the provision of health care for poor communities, and the channeling of donor resources from high income country governments and other donor organisations, to maximise health benefit for poor communities.

在世界各地的低收入和中等收入国家，许多贫困社区几乎没有机会获得医疗保健。提供卫生保健是一项挑战，因为可用于卫生保健的国家资源有限。这些社区的人们患有结核病和艾滋病毒等传染病，以及糖尿病和高血压等长期健康问题。在贫困社区，许多患有这些疾病的人并不知道自己患有这种疾病。即使知道自己的健康状况，人们也可能无法获得正确的治疗。社区卫生工作者(CHW)是受过培训的当地人，他们被训练去拜访他们所在社区的家庭，以确定哪些人身体不适，帮助他们获得医疗保健，并支持他们接受治疗。现有的CHW方案在应对传染病以及改善孕产妇和儿童健康方面取得了成功，但方案通常侧重于有限范围的健康问题，而不是照顾有多种问题的人。这一项目将设计和评估一项综合的卫生和社会福利方案，旨在识别和支持贫困社区中所有类型的健康不良患者的治疗。研究表明，如果有良好的方案设计、管理、与卫生系统的整合以及与社区的良好“契合”，卫生和社会福利方案是成功的。然而，没有足够的证据表明如何将这些属性用于成功的全面、综合的社区卫生服务。政策制定者和服务提供者想知道需要多少CHW，费用是多少，如何对它们进行最好的监督，在培训、工作范围和家庭覆盖率方面是什么最佳平衡，以及它们如何在与卫生系统整合的情况下保持对社区的响应？我们的目标是确定循证CHW服务模式的关键特征和扩大规模的教训。南非是一个中等收入国家，社区贫穷，获得医疗保健的机会有限。国家政府致力于通过社区卫生服务机构为这些社区提供以社区为基础的护理来加强初级保健。该项目将在南非豪登省塞迪本区进行。我们的合作者，即地区经理，现正试行三个全面的综合社区福利计划，以不同的社区福利与住户比例，以及不同程度的监管途径，为社区妇女提供服务。我们的目标是：1)观察和采访现有的社区卫生工作小组，了解他们是如何工作的，并进行社区调查以评估覆盖范围；2)利用我们所学到的知识，与当地、省和国家利益攸关方和国际专家磋商，设计一个有证据的卫生工作模式；3)在两个社区实施该模式；4)通过在实施之前和15个月后对社区进行调查以及观察和访谈来评估影响；5)为政策、实施和实践提供信息。项目结果将为南非卫生部在全国推出这些计划提供信息。通过提供关于干预、其背景和评估的足够详细信息，我们期望国际上的政府能够评估循证的CHW模式在其背景下的适用性和所需的任何适应。这将有助于利用资源向贫困社区提供卫生保健，以及从高收入国家政府和其他捐助组织调拨捐助资源，以最大限度地提高贫困社区的健康效益。

项目成果

Community health workers' quality of comprehensive care: a cross-sectional observational study across three districts in South Africa.

• DOI: 10.3389/fpubh.2023.1180663
• 发表时间: 2023
• 期刊: FRONTIERS IN PUBLIC HEALTH
• 影响因子: 5.2
• 作者: Babalola, Olukemi;Levin, Jonathan;Goudge, Jane;Griffiths, Frances
• 通讯作者: Griffiths, Frances

Assessing the Utility of a Quality-of-Care Assessment Tool Used in Assessing Comprehensive Care Services Provided by Community Health Workers in South Africa.

• DOI: 10.3389/fpubh.2022.868252
• 发表时间: 2022
• 期刊: FRONTIERS IN PUBLIC HEALTH
• 影响因子: 5.2
• 作者: Babalola, Olukemi;Goudge, Jane;Levin, Jonathan;Brown, Celia;Griffiths, Frances
• 通讯作者: Griffiths, Frances

Community health workers' efforts to build health system trust in marginalised communities: a qualitative study from South Africa.

• DOI: 10.1136/bmjopen-2020-044065
• 发表时间: 2021-05-19
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Anstey Watkins J;Griffiths F;Goudge J
• 通讯作者: Goudge J

Supportive supervision from a roving nurse mentor in a community health worker programme: a process evaluation in South Africa.

• DOI: 10.1186/s12913-022-07635-w
• 发表时间: 2022-03-10
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Malatji H;Griffiths F;Goudge J
• 通讯作者: Goudge J

Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa.

• DOI: 10.1371/journal.pgph.0000881
• 发表时间: 2023
• 期刊: PLOS global public health