Community Health and Humanities, Memorial University of Newfoundland, St. John's, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Hum Resour Health. 2019 Feb 6;17(1):12. doi: 10.1186/s12960-019-0347-7.
There is ample evidence to indicate that community health workers (CHW) are valuable human resources for health in many countries across the globe, helping to fill the gap created by a chronic health workforce shortage. This shortage is not only in number but also in workforce distribution and skill mix. There remains a lack of evidence, however, concerning the size and distribution of CHWs and their relationship to the professionally regulated and recognized health workforce, such as physicians and nurses, and the unregulated and unrecognized health workforce, such as traditional birth attendants and traditional healers. This is particularly the case in low-income, under-resourced countries, such as Afghanistan.
We conducted a descriptive qualitative analysis involving fieldwork in Afghanistan between 2013 and 2014. We undertook participant observation and in-depth interviews with community members, CHWs, health managers, and policymakers, in an attempt to add more depth to our knowledge of how CHWs function, or could function better, as a recognized health worker.
We found that the number of CHWs has increased dramatically in recent years and that CHWs play a variety of roles, including work generally associated with professional providers, such as referral, education, and counseling. Although not a replacement for professional health providers, CHWs, in places where the number of and access to such providers is low, become the only option to meet basic health needs of the population. In places where professional providers are available, CHWs have the potential to extend the services to marginalized populations, provide community health services, and become a recognized member of the health provider team. A limitation of their role in health system strengthening is their lack of integration and a clear career path including into more recognized professional roles.
CHWs provide a critical human resources for health role in Afghanistan, but there are opportunities for improved integration with other providers which can increase their potential to improve service delivery.
有充分的证据表明，社区卫生工作者（CHW）是全球许多国家宝贵的卫生人力资源，有助于填补长期卫生人力短缺造成的缺口。这种短缺不仅体现在数量上，还体现在劳动力分布和技能组合上。然而，关于 CHW 的规模和分布及其与受专业监管和认可的卫生工作者（如医生和护士）以及不受监管和认可的卫生工作者（如传统助产士和传统治疗师）的关系，仍缺乏证据。在阿富汗等低收入、资源匮乏的国家，情况尤其如此。
我们进行了一项描述性定性分析，涉及 2013 年至 2014 年在阿富汗的实地工作。我们对社区成员、CHW、卫生管理人员和政策制定者进行了参与式观察和深入访谈，试图更深入地了解 CHW 的运作方式，或者作为一种被认可的卫生工作者如何更好地运作。
我们发现，近年来 CHW 的数量急剧增加，CHW 扮演着多种角色，包括与专业提供者通常相关的工作，如转诊、教育和咨询。虽然不能替代专业卫生提供者，但在卫生提供者数量少且难以获得的地方，CHW 成为满足人口基本卫生需求的唯一选择。在有专业提供者的地方，CHW 有可能将服务扩展到边缘化人群，提供社区卫生服务，并成为卫生提供者团队中被认可的一员。他们在卫生系统加强方面的作用的局限性在于他们缺乏整合和明确的职业道路，包括更受认可的专业角色。
CHW 在阿富汗提供了至关重要的人力资源，但有机会与其他提供者更好地整合，从而提高他们改善服务提供的潜力。
