Desta Firew Ayalew, Shifa Girma Temam, Dagoye Damtew WoldeMariam, Carr Catherine, Van Roosmalen Jos, Stekelenburg Jelle, Nedi Assefa Bulcha, Kols Adrienne, Kim Young Mi
Jhpiego, Addis Ababa, Ethiopia.
Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA.
BMC Health Serv Res. 2017 Dec 20;17(1):839. doi: 10.1186/s12913-017-2804-0.
Health extension workers (HEWs) are the frontline health workers for Ethiopia's primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs' pre-service education and practices. The aim of this study was to identify gaps in HEWs' practices and recommend changes in their training and scope of practice.
A cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared.
A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%-57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7-97.2%) perceived themselves as competent and proficient in performing tasks in all program areas.
HEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs' scope of practice, update pre-service education curricula and prioritize in-service training modules.
健康推广工作者（HEWs）是埃塞俄比亚初级卫生保健系统的一线卫生工作者。联邦卫生部正寻求提升健康推广工作者的水平并增加其数量，尤其是在偏远地区，同时解决有关健康推广工作者职前教育和实践的问题。本研究的目的是找出健康推广工作者实践中的差距，并就其培训和实践范围的改变提出建议。
开展了一项横断面描述性任务分析，以评估从业六个月至五年的农村健康推广工作者的工作。从埃塞俄比亚五个地区的100个卫生站邀请了100名参与者。健康推广工作者就62项任务进行了自我报告，内容包括：频率、关键性（重要性）、任务学习地点以及执行任务的能力。对每个变量计算了描述性统计数据，包括频率和百分比。对任务组合进行了检查，以确定很少执行的任务或健康推广工作者准备不足的任务。
共有82名农村健康推广工作者参与了研究。几乎所有健康推广工作者都认为每项任务对个人和公共健康结果都至关重要。平均而言，大多数健康推广工作者（51.5%-57.4%）报告称，他们主要通过在职培训和岗位培训，在职前教育之外学习了个人卫生与环境卫生任务、疾病预防与控制任务、家庭健康任务以及健康教育与沟通任务。超过一半的健康推广工作者报告称很少执行某些关键任务，包括医疗机构的物资、库存管理与维护以及冷链系统管理。几乎所有健康推广工作者（95.7%-97.2%）都认为自己有能力且熟练执行所有项目领域的任务。
健康推广工作者在职前教育期间对其实践范围内的所有任务准备不足。许多任务是通过在职培训或岗位培训学到的，有些任务根本没有学到。一些预期的健康推广工作者实践任务很少执行，这可能会降低健康推广项目为社区提供预防和基本治疗性医疗服务的效果。研究结果应提醒政策制定者，有必要审查健康推广工作者的实践范围，更新职前教育课程，并对在职培训模块进行优先排序。
