背景:社区卫生工作者计划有可能为全民健康覆盖做出重要贡献。然而,全球CHWs经常继续在医疗保健系统的外围运作,被视为非必要干部。这导致劳动力经常被剥夺权力和支持不足。本文提供了在南非农村地区进行的一项研究的证据,为了更好地理解CHW优先级的问题,一体化,和赋权。
方法:我们应用了基于赋权理论的分析透镜,并对一项cRCT子研究中出现的定性数据进行了二次分析,该研究评估了大规模CHW计划中CHW支持性监督的有效性。cRCT于2017年至2022年进行,39例CHW被纳入研究。
结果:我们在结构授权的四个领域组织了我们的发现;信息,资源,支持,和机会,并将这些领域映射到心理授权领域。我们的研究结果表明,CHW仍在医疗保健系统的外围发挥作用。如果没有足够的优先级,国家和地区政府的高度支持,以及在培训等计划领域的足够投资,设备,和支持性监督-CHW干部很可能会继续被视为非正式的医护人员。
结论:CHW赋权可能是将当前卫生系统转变为全民覆盖的杠杆;然而,只有在有足够的高级别优先次序和投资的情况下,这个过程才能发生。
BACKGROUND: Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment.
METHODS: We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study.
RESULTS: We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains-such as training, equipment, and supportive supervision-it is likely that the CHW cadre will continue to be seen as informal health care workers.
CONCLUSIONS: CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment.