Public Health Institute, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2ET, UK.
Public Health Institute, Liverpool John Moores University, Henry Cotton Building, 15-21 Webster Street, Liverpool, L3 2ET, UK.
Hum Resour Health. 2018 Jan 6;16(1):2. doi: 10.1186/s12960-017-0262-8.
Volunteer community health workers (CHWs) are an important link between the public health system and the community. The 'Community Participation Policy for Health' in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives.
Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres.
Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers.
The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.
志愿者社区卫生工作者（CHWs）是公共卫生系统与社区之间的重要纽带。柬埔寨的《社区参与卫生政策》将 CHWs 确定为地方健康促进的关键，并将其作为区卫生中心与社区之间的重要联系。然而，在柬埔寨背景下，对 CHWs 面临的挑战以及确定优化其绩效所需条件的研究有限。本研究探讨了柬埔寨农村 CHWs 对他们在实施卫生倡议时面临的挑战的看法。
采用定性方法来捕捉蒙多基里省和腊塔纳基里省 CHWs 的经验。在蒙多基里进行了两次 CHWs 参与式焦点小组讨论，在腊塔纳基里进行了十次半结构式访谈。两项研究的结果都被用来确定共同的主题。参与者是来自农村高棉族和穆斯林社区的 CHWs，与七个不同的区卫生中心有联系，他们有男性和女性。
研究结果表明，CHWs 经常向社区提供健康促进服务。然而，系统、个人和社区参与方面的挑战阻碍了他们有效运作的能力。这些挑战包括地方政府提供的领导力和支持有限，培训不规律且侧重于垂直化的卫生方案，资源不足，缺乏专业身份，以及难以实现社区成员的行为改变。此外，CHW 方案的实施方式是零散的，主要受外部援助目标的影响。然而，在咨询时，CHWs 表现出了他们有能力制定切实可行的解决方案来应对挑战和障碍。
柬埔寨 CHW 方案的零散实施意味着政府所有权很小。再加上缺乏明确的核心培训方案或足够的资源，阻碍了 CHWs 发挥潜力。CHWs 对如何改善他们的角色以及随后改善社区成员的健康有积极和现实的想法。为 CHWs 提供机会在支持性环境中分享学习和发展想法将有益于卫生倡议。
