School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland.
PLoS One. 2014 Apr 15;9(4):e94948. doi: 10.1371/journal.pone.0094948. eCollection 2014.
Given country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs.
A mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation.
We identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems.
There is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined competencies and methods for assessing competencies and supervision are considered best practices but remain a gap.
鉴于各国在培训社区卫生工作者（CHW）方面的需求，以加速实现千年发展目标中关于性健康和生殖健康以及孕产妇、新生儿、儿童和青少年健康（SR/MNCAH）方面的目标，联合国卫生机构对 CHW 在 SR/MNCAH 不同领域的现有培训资源包进行了综合分析，以确定差距和机遇，并为协调发展 CHW 能力的方法提供信息。
通过在线检索和关键知情人获取的文件，对 CHW 的培训资源包进行了映射。根据健康主题对材料进行分类，并使用商定的参数进行分析。后续的专家咨询为前进的道路提供了信息。
我们确定了 31 个相关的资源包。它们涵盖了 SR/MNCAH 连续体的不同组成部分，广度（综合套餐）和深度（重点套餐）不一，包括计划生育、产前和分娩护理（主要是产后出血）、新生儿护理和儿童护理以及 HIV。没有或有限涵盖与安全堕胎、青少年健康和基于性别的暴力相关的干预措施。没有培训套餐涵盖根据世界卫生组织指南可以由 CHW 提供的一系列基于证据的干预措施。差距包括对学员能力的评估、支持性监督和套餐影响评估方面的不足。许多套餐代表个别方案的努力，而不是国家方案的材料，这可能反映出它们在国家卫生系统中的整合程度较弱。
有大量针对 CHW 的 SR/MNCAH 培训套餐，这反映了加强 CHW 能力的兴趣。这为政府和合作伙伴提供了一个协同应对的机会，以解决差距，并确保 CHW 提供基于证据的综合干预套餐。具有明确能力和评估能力以及监督方法的套餐被认为是最佳实践，但仍存在差距。
