Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium.
Hum Resour Health. 2009 Apr 9;7:31. doi: 10.1186/1478-4491-7-31.
Low-income countries with high HIV/AIDS burdens in sub-Saharan Africa must deal with severe shortages of qualified human resources for health. This situation has triggered the renewed interest in community health workers, as they may play an important role in scaling-up antiretroviral treatment for HIV/AIDS by taking over a number of tasks from the professional health workers. Currently, a wide variety of community health workers are active in many antiretroviral treatment delivery sites. This article investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. Based on a desk review of multi-purpose community health worker programmes for primary health care and of recent experiences with antiretroviral treatment-related community health workers, we developed an analytic framework of 10 criteria: eight conditions for successful large-scale antiretroviral treatment-related community health worker programmes and two antiretroviral treatment-specific opportunities. Our appraisal of six community health worker programmes, which we identified during field work in Ethiopia, Malawi and Uganda in 2007, shows that while some lessons from the past have been learnt, others are not being sufficiently considered and antiretroviral treatment-specific opportunities are not being sufficiently seized.In particular, all programmes have learnt the lesson that without adequate remuneration, community health workers cannot be retained in the long term. Yet we contend that the apparently insufficient attention to issues such as quality supervision and continuous training will lead to decreasing quality of the programmes over time. The life experience of people living with HIV/AIDS is still a relatively neglected asset, even though it may give antiretroviral treatment-related community health worker programmes better chances of success than their predecessors and may be crucially important for adherence and retention in large-scale antiretroviral treatment programmes. Community health workers as a community-based extension of health services are essential for antiretroviral treatment scale-up and comprehensive primary health care. The renewed attention to community health workers is thus very welcome, but the scale-up of community health worker programmes runs a high risk of neglecting the necessary quality criteria if it is not aligned with broader health systems strengthening. To achieve universal access to antiretroviral treatment, this is of paramount importance and should receive urgent attention.
撒哈拉以南非洲艾滋病毒/艾滋病负担沉重的低收入国家，其卫生人力资源严重短缺。这种情况再次引发了人们对社区卫生工作者的兴趣，因为他们可以通过从专业卫生工作者那里接管一些任务，在扩大艾滋病毒/艾滋病抗逆转录病毒治疗方面发挥重要作用。目前，在许多抗逆转录病毒治疗提供点，有各种各样的社区卫生工作者在活跃工作。本文调查了目前针对抗逆转录病毒治疗的社区卫生工作者方案，是否考虑到了过去初级卫生保健中社区卫生工作者方案的经验教训，以及在何种程度上抓住了新的抗逆转录病毒治疗特定机会。我们根据对多用途社区卫生工作者初级卫生保健方案和最近与抗逆转录病毒治疗相关的社区卫生工作者经验的案头审查，制定了一个包含 10 个标准的分析框架：8 个成功开展大规模抗逆转录病毒治疗相关社区卫生工作者方案的条件和 2 个抗逆转录病毒治疗特定机会。我们在 2007 年对埃塞俄比亚、马拉维和乌干达的实地工作中确定了六个社区卫生工作者方案，并对其进行了评估，结果表明，虽然从过去吸取了一些经验教训，但其他经验教训没有得到充分考虑，抗逆转录病毒治疗特定机会也没有得到充分利用。特别是，所有方案都吸取了一个教训，即没有足够的报酬，社区卫生工作者就无法长期留任。然而，我们认为，对质量监督和持续培训等问题的明显关注不足，将导致方案质量随时间推移而下降。艾滋病毒感染者/艾滋病患者的生活经验仍然是一个相对被忽视的资产，尽管它可能使抗逆转录病毒治疗相关的社区卫生工作者方案比其前身更有成功的机会，而且对大规模抗逆转录病毒治疗方案的依从性和保留率至关重要。社区卫生工作者作为卫生服务的社区延伸，对于扩大抗逆转录病毒治疗和综合初级卫生保健至关重要。因此，再次关注社区卫生工作者是非常受欢迎的，但如果不与更广泛的卫生系统加强相结合，扩大社区卫生工作者方案就有可能忽视必要的质量标准，从而带来很高的风险。为了实现普及抗逆转录病毒治疗，这一点至关重要，应该引起紧急关注。
