Bawah Ayaga A, Phillips James F, Asuming Patrick O, Jackson Elizabeth F, Walega Paul, Kanmiki Edmund W, Sheff Mallory C, Oduro Abraham
Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana.
Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Ave, B-2, New York, NY 10032, USA.
SSM Popul Health. 2018 Dec 6;7:100335. doi: 10.1016/j.ssmph.2018.100335. eCollection 2019 Apr.
The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995-2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.
加纳政府制定了一项国家减贫计划，将一项名为社区卫生规划与服务（CHPS）的倡议作为其核心卫生发展战略。CHPS源自纳瓦龙戈卫生研究中心的一项合理性试验，该试验测试了四种截然不同的初级卫生保健策略：i）培训无薪志愿者在社区促进健康；ii）在社区安置配备治疗儿童疾病培训和物资的护士；iii）结合护士和志愿者方法；iv）维持一种对照情况，即不配备社区驻点工作人员提供诊所服务。本文对1995年1月1日至2010年12月期间94599名曾不满五岁儿童中社区卫生工作者接触的长期影响进行了年龄条件比例风险分析，针对1995 - 2000年期间纳瓦龙戈项目地区扩大CHPS规模时接触类型转变的年龄条件效应进行了调整。结果表明，父母未受过教育且相对贫困的儿童的死亡风险显著高于受过教育且较不贫困的儿童。条件风险回归模型通过估计公平指标与家庭接触CHPS服务运营的相互作用来评估CHPS对健康公平的影响，随着规模扩大，针对年龄条件下接触原始社区卫生和计划生育项目（CHFP）服务策略进行调整。母亲未受过教育且相对贫困的儿童的死亡风险关联因接触社区卫生护理服务而抵消。如果接触仅限于志愿者提供的服务，生存益处仅在相对优势家庭的儿童中出现。研究结果支持将促进CHPS护士参与社区服务的方法作为减贫计划核心卫生组成部分的政策。
