Mutalemwa P, Kisinza W N, Kisoka W J, Kilima S, Njau J, Tenu F, Nkya T, Magesa S M
Tabora Medical Research Centre, P. O. Box 482, Tabora, Tanzania.
Tanzan J Health Res. 2009 Jul;11(3):116-25. doi: 10.4314/thrb.v11i3.47697.
The Community Directed Intervention (CDI) is currently used for Ivermectin distribution for the treatment of onchocerciasis in Africa. This study was carried out to determine the extent to which the CDI process can be used for the delivery of other health interventions with different degrees of complexity. The study was conducted in five districts of Kilosa, Muheza, Lushoto, Korogwe and Ulanga in Tanzania and involved communities, health facility and district healthcare providers. Implementation of CDI across these health interventions involved addressing six major processes, namely, stakeholder processes, health system dynamics, engaging communities, empowering communities, engaging CDI implementers and broader system effects. Community and health systems changes were triggered, such that the inherent value of community involvement and empowerment could be internalized by communities and health workers, leading to a more receptive health system. The CDI process was accepted at the community levels as many were willing and ready to adopt the approach. Health workers at community levels were readily available and supportive of the process. Additionally, noted were the verified willingness and ability of community implementers to deliver multiple interventions; confirmed efficiency of CDI leading to cost savings at health systems level; increasing interest of the health system in CDI; interest of health workers in the process of integrated planning. However, there were factors that may have a negative influence on the CDI process. Drug and supply policy for CDI process was lacking at the national and district levels and the presence of parallel community-based programmes that provide financial incentives for community members to run them discouraged Community-directed distributors who in most cases are volunteers. In conclusion, the results have clearly and evidently demonstrated the potential of CDI approach for effectively and efficiently control of other diseases such as malaria, tuberculosis and childhood illnesses. The study has provided unique information on the feasibility and effectiveness of integrated delivery of interventions at the community level.
社区定向干预（CDI）目前用于在非洲分发伊维菌素以治疗盘尾丝虫病。开展这项研究是为了确定CDI流程在多大程度上可用于提供其他不同复杂程度的卫生干预措施。该研究在坦桑尼亚的基洛萨、穆赫扎、卢绍托、科罗韦和乌朗加五个地区进行，涉及社区、卫生设施和地区医疗服务提供者。在这些卫生干预措施中实施CDI涉及六个主要流程，即利益相关者流程、卫生系统动态、社区参与、社区赋权、CDI实施者参与以及更广泛的系统影响。引发了社区和卫生系统的变革，使社区参与和赋权的内在价值能够被社区和卫生工作者内化，从而形成一个更具接受性的卫生系统。CDI流程在社区层面得到了认可，因为许多人愿意并准备采用这种方法。社区层面的卫生工作者随时可用并支持这一流程。此外，还注意到社区实施者有经过核实的意愿和能力来提供多种干预措施；CDI的效率得到证实，可在卫生系统层面节省成本；卫生系统对CDI的兴趣增加；卫生工作者对综合规划过程感兴趣。然而，有些因素可能会对CDI流程产生负面影响。国家和地区层面缺乏针对CDI流程的药品和供应政策，并且存在一些平行的社区项目，这些项目为社区成员提供经济激励以运营它们，这使得大多数情况下作为志愿者的社区定向分发者感到气馁。总之，结果清楚且明显地表明了CDI方法在有效和高效控制其他疾病（如疟疾、结核病和儿童疾病）方面的潜力。该研究提供了关于在社区层面综合提供干预措施的可行性和有效性的独特信息。
