Abrahams-Gessel Shafika, Denman Catalina A, Montano Carlos Mendoza, Gaziano Thomas A, Levitt Naomi, Rivera-Andrade Alvaro, Carrasco Diana Munguía, Zulu Jabu, Khanam Masuma Akter, Puoane Thandi
Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, México.
Glob Heart. 2015 Mar;10(1):39-44. doi: 10.1016/j.gheart.2014.12.009.
Community health workers (CHW) can screen for cardiovascular disease risk as well as health professionals using a noninvasive screening tool. However, this demonstrated success does not guarantee effective scaling of the intervention to a population level.
This study sought to report lessons learned from supervisors' experiences monitoring CHW and perceptions of other stakeholders regarding features for successful scaling of interventions that incorporate task-sharing with CHW.
We conducted a qualitative analysis of in-depth interviews to explore stakeholder perceptions. Data was collected through interviews of 36 supervisors and administrators at nongovernmental organizations contracted to deliver and manage primary care services using CHW, directors, and staff at the government health care clinics, and officials from the departments of health responsible for the implementation of health policy.
CHW are recognized for their value in offsetting severe human resource shortages and for their expert community knowledge. There is a lack of clear definitions for roles, expectations, and career paths for CHW. Formal evaluation and supervisory systems are highly desirable but nonexistent or poorly implemented, creating a critical deficit for effective implementation of programs using task-sharing. There is acknowledgment of environmental challenges (e.g., safety) and systemic challenges (e.g., respect from trained health professionals) that hamper the effectiveness of CHW. The government-community relationships presumed to form the basis of redesigned health care services have to be supported more explicitly and consistently on both sides in order to increase the acceptability of CHW and their effectiveness.
The criteria critical for successful scaling of CHW-led screening are consistent with evidence for scaling-up communicable disease programs. Policy makers have to commit appropriate levels of resources and political will to ensure successful scaling of this intervention.
社区卫生工作者（CHW）可以使用非侵入性筛查工具像卫生专业人员一样筛查心血管疾病风险。然而，这一已证明的成功并不能保证将该干预措施有效推广到人群层面。
本研究旨在报告从监督人员监测CHW的经验以及其他利益相关者对成功推广将任务分担与CHW相结合的干预措施的特征的看法中吸取的经验教训。
我们对深入访谈进行了定性分析，以探索利益相关者的看法。通过对36名监督人员和管理人员进行访谈收集数据，这些人员来自签约提供和管理使用CHW的初级保健服务的非政府组织、政府医疗诊所的主任和工作人员，以及负责卫生政策实施的卫生部门官员。
CHW因其在弥补严重人力资源短缺方面的价值及其专业的社区知识而得到认可。对于CHW的角色、期望和职业发展路径缺乏明确的定义。正式的评估和监督系统非常必要，但不存在或实施不力，这为有效实施使用任务分担的项目造成了严重缺陷。人们认识到环境挑战（如安全）和系统挑战（如来自受过培训的卫生专业人员的尊重）会妨碍CHW的有效性。为重新设计的医疗服务奠定基础的政府与社区关系必须在双方得到更明确和一致的支持，以提高CHW的可接受性及其有效性。
成功推广由CHW主导的筛查的关键标准与扩大传染病项目的证据一致。政策制定者必须投入适当水平的资源和政治意愿，以确保该干预措施的成功推广。
