Onyango-Ouma W, Laisser R, Mbilima M, Araoye M, Pittman P, Agyepong I, Zakari M, Fonn S, Tanner M, Vlassoff C
KEDAHR Project, Division of Vector-Borne Diseases, Ministry of Health, Kisumu, Kenya.
Health Policy Plan. 2001 Sep;16 Suppl 1:24-32. doi: 10.1093/heapol/16.suppl_1.24.
This paper presents the findings of a multi-centre study assessing the impact of Health Workers for Change (HWFC) workshops in seven different primary care sites, based on the common core protocol described in this paper. The paper discusses a common methodology used by the studies, consisting of a triangulation of qualitative and quantitative methods. Such methodologies are inherently complex as they require comparisons across systems, sites and procedures. The studies were conducted in six sites in Africa and one site in Argentina. Generally, the intervention resulted either in positive change or in no change, except in the area of staff relationships where conflicts were more frequent after the intervention than before. This may reflect a willingness to confront problems or contentious issues. Implementing the HWFC workshops improved provider-client relations, facility level functioning and aspects of staff interrelationships, and had some impact at the system level. All studies indicated that overall health system development is essential for improved service provision including quality of care. The findings also indicated that this intervention complemented and could assist health sector reform efforts and can play a role in sensitizing health workers to gender issues. The paper concludes with a discussion of the robustness of the methodology used in the studies.
本文介绍了一项多中心研究的结果，该研究基于本文所述的通用核心方案，评估了“变革卫生工作者”（HWFC）研讨会在七个不同基层医疗场所的影响。本文讨论了这些研究采用的一种通用方法，该方法包括定性和定量方法的三角互证。此类方法本质上很复杂，因为它们需要对不同系统、场所和程序进行比较。这些研究在非洲的六个场所和阿根廷的一个场所开展。总体而言，除了在员工关系方面，干预后冲突比干预前更频繁外，干预要么带来了积极变化，要么没有变化。这可能反映了直面问题或有争议问题的意愿。实施HWFC研讨会改善了医患关系、机构层面的运作以及员工人际关系的各个方面，并在系统层面产生了一些影响。所有研究表明，整体卫生系统发展对于改善包括护理质量在内的服务提供至关重要。研究结果还表明，这种干预起到了补充作用，有助于卫生部门的改革努力，并且能够在提高卫生工作者对性别问题的认识方面发挥作用。本文最后讨论了研究所用方法的稳健性。
