Berman P A, Gwatkin D R, Burger S E
Department of International Health, Johns Hopkins University, Baltimore, MD 21205.
Soc Sci Med. 1987;25(5):443-59. doi: 10.1016/0277-9536(87)90168-7.
Health service delivery programs using minimally-trained community-based health workers (CHWs) have been established in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforce their successes and assure that they are adequately supported as an integral component of the basic health system.
近年来，许多发展中国家都建立了使用经过最少培训的社区卫生工作者（CHW）的卫生服务提供项目。这些项目旨在通过以低成本为大量此前未得到充分服务的人群提供具有高影响力的基本服务，来提高卫生保健系统的成本效益。关于这些项目的报告经验喜忧参半，这引发了人们对社区卫生工作者是否是扩展初级卫生保健的最佳途径的质疑。对六个大型社区工作者项目的这项综述表明，它们在某些目标上取得了成功，但在其他目标上却未成功。与其他服务组织模式相比，社区卫生工作者以低成本提高了服务提供的覆盖范围和公平性。然而，他们并未始终如一地提供可能对健康产生重大影响的服务，而且他们所提供服务的质量有时很差。大规模的社区卫生工作者系统需要大幅增加对培训、管理、监督和后勤的支持。证据表明，总体而言，在大型常规项目中，它们的潜力尚未得到发挥。需要进一步发展这些项目，以巩固其成功之处，并确保它们作为基本卫生系统的一个组成部分得到充分支持。
