Community health extension program of Ethiopia, 2003-2018: successes and challenges toward universal coverage for primary healthcare services
Community health extension program of Ethiopia, 2003-2018: successes and challenges toward universal coverage for primary healthcare services
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DOI：
10.1186/s12992-019-0470-1
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发表时间：
2019-03-26
影响因子：
10.8
通讯作者：
Van Damme, Wim
中科院分区：
文献类型：
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作者：
Assefa, Yibeltal;Gelaw, Yalemzewod Assefa;Van Damme, Wim
背景埃塞俄比亚自2003年以来一直在实施社区健康推广计划（HEP）。我们的目的是评估随着时间的推移，HEP的成功和挑战，并制定一个框架，可能有助于实现该计划向全民初级医疗服务。MethodsWe进行了系统的回顾和综合的文献HEP在埃塞俄比亚之间的2003年和2018年。在PubMed、Embase和Google scholar数据库中完成文献检索。使用医学主题词（MeSH）和与综述目的相关的文本词制定文献检索策略。我们使用了三个阶段的筛选过程来选择出版物。由三名审查员使用预先准备的数据提取表进行数据提取。我们进行了一个解释性的（而不是聚合）综合研究。FindingsThe HEP使埃塞俄比亚能够实现显着改善孕产妇和儿童健康，传染病，个人卫生和环境卫生，知识和医疗保健寻求。HEP是一个学习型组织，适应社区需求。该计划也是动态的，足以在卫生中心和社区之间转移任务。社区一直是成功推行健康教育计划的主要参与者。尽管取得了这些成功，但该方案目前仍面临有待解决的挑战。这些挑战涉及卫生推广工作者的生产力和效率;卫生推广工作者的工作和生活条件;卫生站的能力;以及健康的社会决定因素。这就需要采取系统的办法，使更广泛的卫生系统、社区和负责健康的社会决定因素的部门参与其中。我们制定了一个框架，可能有助于在HEP.ConclusionThe HEP的实施，使埃塞俄比亚实现显着改善。然而，仍有若干挑战有待解决。该框架可用于改善社区卫生计划，以实现初级卫生保健服务的普遍覆盖。
BackgroundEthiopia has been implementing a community health extension program (HEP) since 2003. We aimed to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services.MethodsWe conducted a systematic review and synthesis of the literature on the HEP in Ethiopia between 2003 and 2018. Literature search was accomplished in PubMed, Embase and Google scholar databases. Literature search strategies were developed using medical subject headings (MeSH) and text words related to the aim of the review. We used a three-stage screening process to select the publications. Data extraction was conducted by three reviewers using pre-prepared data extraction form. We conducted an interpretive (not aggregative) synthesis of studies.FindingsThe HEP enabled Ethiopia to achieve significant improvements in maternal and child health, communicable diseases, hygiene and sanitation, knowledge and health care seeking. The HEP has been a learning organization that adapts itself to community demands. The program is also dynamic enough to shift tasks between health centers and community. The community has been a key player in the successful implementation of the HEP. In spite of these successes, the program is currently facing challenges that remain to be addressed. These challenges are related to productivity and efficiency of health extension workers (HEWs); working and living conditions of HEWs; capacity of health posts; and, social determinants of health. These require a systemic approach that involves the wider health system, community, and sectors responsible for social determinants of health. We developed a framework that may assist in the implementation of the HEP.ConclusionThe HEP has enabled Ethiopia to achieve significant improvements. However, several challenges remain to be addressed. The framework can be utilized to improve community health programs toward universal coverage for primary healthcare services.