Liverani Marco, Nguon Chea, Sok Ra, Kim Daro, Nou Panharith, Nguon Sokhan, Yeung Shunmay
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
National Center for Parasitology, Entomology & Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
BMC Health Serv Res. 2017 May 8;17(1):335. doi: 10.1186/s12913-017-2282-4.
There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas.
Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability.
Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment.
This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area.
在低收入和中等收入国家，扩大社区卫生工作者项目作为一种应对卫生专业人员短缺的经济有效方法，正受到越来越多的关注。然而，我们对大规模项目的接受情况以及如何改进这些项目的理解仍然有限，对于可能促进或阻碍公平获得服务的因素存在知识空白。本文考察了柬埔寨的乡村疟疾防治员（VMW）项目，这是一项针对偏远农村地区疟疾病例管理的广泛的社区干预措施。
在贡布省的六个案例村庄开展了实地调查，这些村庄具有不同的项目配置、人口规模以及与最近公共卫生设施的距离。在这些地点，对乡村疟疾防治员、村当局和居民进行了深入访谈（n = 71），以确定服务利用的促进因素和挑战。数据分析基于一个概念框架，该框架基于获得服务的五个领域：知晓度、可及性、便利性、可得性和可接受性。
在我们的研究地点，影响乡村疟疾防治员服务利用的因素包括：传播活动的性质及其覆盖不同人群的能力；村庄地形和不断变化的道路基础设施；乡村疟疾防治员参与其他社区角色和活动的情况；症状出现后对疾病类型的认知；对全面诊断和治疗的需求；对乡村疟疾防治员作为医疗服务提供者地位的认知；乡村疟疾防治员的任职时长。
本研究强调了可能影响社区卫生项目接受程度的背景因素的复杂性和多样性。与其他国家一样，柬埔寨继续利用非专业卫生工作者提供诊断和治疗服务可能对健康和经济产生巨大影响。然而，应进一步考虑不同类别居民和不同实施背景下的获得服务问题。此外，全面绘制疾病流行病学、道路基础设施和服务可及地理区域的变化情况对于为该领域的政策制定提供信息至关重要。
