Phiri Sydney Chauwa, Prust Margaret Lippitt, Chibawe Caroline Phiri, Misapa Ronald, van den Broek Jan Willem, Wilmink Nikhil
Clinton Health Access Initiative, Lusaka, Zambia.
, 175 Kudu Road, Kabulonga, Lusaka, Zambia.
Hum Resour Health. 2017 Jun 24;15(1):40. doi: 10.1186/s12960-017-0214-3.
In 2010 a public sector cadre of community health workers called Community Health Assistants (CHAs) was created in Zambia through the National Community Health Worker Strategy to expand access to health services. This cadre continues to be scaled up to meet the growing demands of Zambia's rural population. We summarize factors that have facilitated the scale-up of the CHA program into a nationwide CHW cadre and the challenges of introducing and institutionalizing the cadre within the Zambian health system.
Semi-structured, individual interviews were held across 5 districts with 16 CHAs and 6 CHA supervisors, and 10 focus group discussions were held with 93 community members. Audio recordings of interviews and focus group discussions were transcribed and thematically coded using Dedoose web-based software.
The study showed that the CHAs play a critical role in providing a wide range of services at the community level, as described by supervisors and community members. Some challenges still remain, that may inhibit the CHAs ability to provide health services effectively. In particular, the respondents highlighted infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system.
The study shows that in order to optimize the impact of CHAs or other community health workers, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting. The Ministry of Health with support from partners are currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017-2021. This study contributes to the evidence base on the introduction of formalized community health worker cadres in developing countries.
2010年，赞比亚通过《国家社区卫生工作者战略》设立了名为社区卫生助理（CHA）的公共部门社区卫生工作者队伍，以扩大卫生服务的可及性。这一队伍仍在不断扩大，以满足赞比亚农村人口日益增长的需求。我们总结了促进将社区卫生助理项目扩大为全国性社区卫生工作者队伍的因素，以及在赞比亚卫生系统中引入该队伍并使其制度化所面临的挑战。
在5个地区对16名社区卫生助理和6名社区卫生助理监督员进行了半结构化的个人访谈，并与93名社区成员进行了10次焦点小组讨论。访谈和焦点小组讨论的录音被转录，并使用基于网络的Dedoose软件进行主题编码。
研究表明，如监督员和社区成员所述，社区卫生助理在社区层面提供广泛服务方面发挥着关键作用。一些挑战仍然存在，可能会抑制社区卫生助理有效提供卫生服务的能力。特别是，受访者强调监督不频繁、缺乏外展服务的医疗和非医疗用品以及移动数据报告系统存在的问题。
研究表明，为了优化社区卫生助理或其他社区卫生工作者的影响，关键的卫生系统支持结构需要有效运作，如监督、社区监测系统、用品和报告。卫生部在合作伙伴的支持下，目前正在通过全国范围的监督员和社区数据培训来应对这些挑战，并倡导将初级卫生保健作为2017 - 2021年新的《国家卫生战略计划》中的一个特定重点领域。这项研究为发展中国家引入正规化社区卫生工作者队伍的证据基础做出了贡献。
