Kawakatsu Yoshito, Sugishita Tomohiko, Tsutsui Junya, Oruenjo Kennedy, Wakhule Stephen, Kibosia Kennedy, Were Eric, Honda Sumihisa
JICA SEMAH project, Kisumu, Kenya.
Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
BMC Health Serv Res. 2015 Oct 1;15:442. doi: 10.1186/s12913-015-1117-4.
Several African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs' performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community.
This study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance.
The significant factors associated with the CHWs' performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors' better health knowledge and the number of supervisions.
A high quality of routine supervisions is one of the key interventions in sustaining a CHW's performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.
目前，一些非洲和南亚国家正在投资培养新一批社区卫生工作者（CHW），作为实现千年发展目标战略的重要组成部分。然而，一项综述得出结论，社区卫生工作者提供的服务并不能始终如一地对健康产生重大影响，而且服务质量通常较差。本研究的目的是评估肯尼亚西部社区卫生工作者的表现，并通过对个体和监督者/社区两个层面的多层次分析来描述其表现的决定因素。
本研究于2011年8月至9月在肯尼亚尼扬扎省进行了三项调查。三项调查的参与者包括所有1788名在职社区卫生工作者、他们的所有监督者，以及2560名随机抽取的有12至23个月大孩子的母亲。社区卫生工作者的表现由三个指标衡量：报告率、健康知识和家庭覆盖率。进行多层次分析以描述该表现的决定因素。
与社区卫生工作者表现相关的显著因素包括他们的婚姻状况、教育水平、家庭规模、工作经验、个人卫生习惯、接受监督的次数，以及他们的监督者更丰富的健康知识与监督次数之间的相互作用。
高质量的常规监督是维持社区卫生工作者表现的关键干预措施之一。此外，降低社区卫生工作者的流失率对于维持他们的表现以及避免替换他们的额外成本都很重要。至于新社区卫生工作者的选拔标准，良好的教育状况、有做家务的支持者以及良好的卫生习惯在选拔能够保持高绩效水平的社区卫生工作者时都很重要。
