Akintola Olagoke, Chikoko Gamuchirai
School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa.
School of Human and Social Development, Nipissing University, 100 College Drive, ON, P1B 8L7, North Bay, Canada.
Hum Resour Health. 2016 Sep 6;14(1):54. doi: 10.1186/s12960-016-0151-6.
Management and supervision of community health workers are factors that are critical to the success of community health worker programmes. Yet few studies have explored the perspectives of supervisors in these programmes. This study explored factors influencing motivations of supervisors in community health worker programmes.
We conducted qualitative interviews with 26 programme staff providing supervision to community health workers in eight community-based organizations in marginalized communities in the greater Durban area of South Africa from July 2010 to September 2011.
Findings show that all the supervisors had previous experience working in the health or social services sectors and most started out as unpaid community health workers. Most of the participants were poor women from marginalized communities. Supervisors' activities include the management and supply of material resources, mentoring and training of community health workers, record keeping and report writing. Supervisors were motivated by intrinsic factors like making a difference and community appreciation and non-monetary incentives such as promotion to supervisory positions; acquisition of management skills; participation in capacity building and the development of programmes; and support for educational advancement like salary, bonuses and medical benefits. Hygiene factors that serve to prevent dissatisfaction are salaries and financial, medical and educational benefits attached to the supervisory position. Demotivating factors identified are patients' non-adherence to health advice and alienation from decision-making. Dissatisfiers include working in crime-prevalent communities, remuneration for community health workers (CHWs), problems with material and logistical resources, job insecurity, work-related stressors and navigating the interface between CHWs and management. While participants were dissatisfied with their low remuneration, they were not demotivated but continued to be motivated by intrinsic factors. Our findings suggest that CHWs' quest for remuneration and a career path continues even after they assume supervisory positions. Supervisors continue to be motivated to work in mid-level positions within the health and social services sectors.
Global efforts to develop and increase the sustainability of CHW programmes will benefit immensely from insights gained from an exploration of supervisors' perspectives. Further, national CHW programmes should be conceptualized with the dual purpose of building the capacity of CHWs to strengthen health systems and reducing unemployment especially in marginalized communities with high unemployment and low-skilled labour force.
社区卫生工作者的管理与监督是社区卫生工作者项目取得成功的关键因素。然而，很少有研究探讨这些项目中监督者的观点。本研究探讨了影响社区卫生工作者项目中监督者积极性的因素。
2010年7月至2011年9月，我们对南非德班大都市区边缘化社区的8个社区组织中为社区卫生工作者提供监督的26名项目工作人员进行了定性访谈。
研究结果表明，所有监督者此前都有在卫生或社会服务部门工作的经验，且大多数人最初都是无薪社区卫生工作者。大多数参与者是来自边缘化社区的贫困女性。监督者的活动包括物质资源的管理与供应、对社区卫生工作者的指导与培训、记录保存和报告撰写。监督者的积极性来自于内在因素，如有所作为和社区的认可，以及非货币激励，如晋升到监督职位；获得管理技能；参与能力建设和项目开发；以及对教育进步的支持，如工资、奖金和医疗福利。有助于防止不满的卫生因素是与监督职位相关的工资以及财务、医疗和教育福利。已确定的消极因素是患者不遵守健康建议以及被排除在决策之外。不满意的因素包括在犯罪高发社区工作、社区卫生工作者的薪酬、物质和后勤资源问题（物资及后勤资源方面的问题）、工作不稳定、工作相关压力源以及在社区卫生工作者与管理层之间周旋。虽然参与者对自己的低薪酬不满意，但他们并未因此失去动力，而是继续受到内在因素的激励。我们的研究结果表明，社区卫生工作者即使担任了监督职位，仍在追求薪酬和职业发展道路。监督者继续有动力在卫生和社会服务部门担任中层职位。
全球为发展和提高社区卫生工作者项目可持续性所做的努力将从对监督者观点的探索中获得的见解中受益匪浅。此外，国家社区卫生工作者项目的概念应具有双重目的，即建设社区卫生工作者的能力以加强卫生系统，并减少失业，特别是在失业率高且劳动力技能低的边缘化社区。 （注：括号内为补充完整使表达更通顺的内容）
