Doherty Tanya, Kroon Max, Rhoda Natasha, Sanders David
Health Systems Research Unit, South African Medical Research Council, Cape Town; and School of Public Health, University of the Western Cape, Cape Town, South Africa.
S Afr Med J. 2016 Jun 17;106(7):672-4. doi: 10.7196/SAMJ.2016.v106i7.10790.
South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more.
南非在千年发展目标时代结束时，取得了一些成功，也有一些失败。通过越来越有效的抗逆转录病毒疗法在全国范围内成功扩大了预防母婴传播艾滋病毒的服务，大幅降低了母婴传播率；然而，在同一时期，肺炎和腹泻等具有高影响力干预措施的覆盖范围似乎没有进展，而这些疾病现在是5岁以下儿童死亡的主要原因。南非在2011年开始实施一项重新设计初级卫生保健系统的战略，其中包括组建由社区卫生工作者组成的病房外展团队。在本文中，我们认为，提议的社区卫生工作者与人口的比例对于公共卫生影响来说过低，并且社区卫生工作者的作用和范围应从提供健康信息扩展到包括评估和治疗儿童疾病（特别是腹泻和疑似肺炎）。证据和经验充分表明，足够数量的社区卫生工作者能够对新生儿和幼儿死亡率产生迅速而积极的影响，尤其是当他们被允许治疗常见急性病症时。如果有更多社区卫生工作者并允许他们做更多工作，南非在儿童生存方面的平庸表现可能会得到显著改善。
