THE RELATIVE INFLUENCE OF THE COMMUNITY AND THE HEALTH SYSTEM ON WORK PERFORMANCE - A CASE-STUDY OF COMMUNITY-HEALTH WORKERS IN COLOMBIA
THE RELATIVE INFLUENCE OF THE COMMUNITY AND THE HEALTH SYSTEM ON WORK PERFORMANCE - A CASE-STUDY OF COMMUNITY-HEALTH WORKERS IN COLOMBIA
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DOI：
10.1016/0277-9536(90)90290-9
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发表时间：
1990-01-01
影响因子：
5.4
通讯作者：
LARSEN, DE
中科院分区：
文献类型：
--
作者：
ROBINSON, SA;LARSEN, DE
发展中国家初级卫生保健方法的一个核心组成部分是在国家卫生系统内发展和利用以社区为基础的卫生工作者。虽然使用这些一线工作人员有可能对农村社区的健康行为和健康状况产生积极影响，但有效实施卫生保健计划仍然存在挑战。据报道，高流动率、缺勤、工作质量差和卫生保健员士气低落往往与政府卫生系统的组织和管理能力薄弱有关。然而，没有系统的研究考察了工作相关因素对CHW工作绩效的影响。本文的研究考察了与社区相关的奖励和反馈因素与卫生系统相关的奖励和反馈因素对卫生保健工作者绩效的相对影响。这些数据来自1986年在哥伦比亚两个省（省）开展的一项更广泛的健康促进者研究。这项研究基于一个关注与工作相关的奖励和反馈来源的员工绩效理论模型。采用调查研究设计，随机抽取179名农村健康促进员及其护理辅助主管，了解农村健康促进工作绩效及影响因素。研究结果表明，来自社区的反馈和奖励对工作绩效（定义为工作任务的感知目标实现程度）的影响大于来自卫生系统的反馈和奖励。工作表现与反馈因素（如社区成员对HP活动的感知价值和对健康改善的直接观察）的关系比与主管反馈的关系更强。与卫生系统、与其他hp合作、书面表扬和薪水相关的奖励相比，工作表现与在社区中发挥影响力的感知奖励的关系更为密切。这些结果表明，CHW可能与社区有更强的联系和依赖，以获得奖励，反馈和表现动机，而不是通常认为的那样。作者建议建立一种卫生系统参与模式，将管理支持的重点放在工作人员-社区界面上，而不是工作人员-卫生服务界面上。本文认为，如果国家卫生系统有意识地促进和加强妇幼保健院与其社区的关系，这将对妇幼保健院的绩效产生积极影响。
A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Columbia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system. Work performance was shown to be more strongly associated with feedback factors such as the perceived value community members place on HP activities and direct observations of health improvement, than with the supervisory feedback. Work performance was also more strongly associated with the perceived reward of having influence in the community than with rewards associated with the health system, working with other HPs, written commendation and salary. These results suggest that the CHW may have stronger links to, and dependency on, the community for rewards, feedback and motivation to perform than has generally been acknowledged. The authors suggest a health system participation model that would focus management support on the worker-community interface rather than the worker-health service interface. It is argued that if the national health system were to consciously promote and strengthen the relationship between the CHW and her community, this would positively affect performance of CHWs.